Clavicle fractures--is there a standard treatment?

Clavicle fractures, especially of the mid third, are an injury commonly seen in clinical practice, therefore, there is constant earnest discussion of the optimal approach to therapy. Until recently clavicle fractures were solely the domain of non surgical management. Even displaced fractures have been successfully managed without surgery. However, complications have been reported after non surgical treatment, the most frequent being post-traumatic shortening of the clavicle with varying functional consequences for the shoulder joint and range of arm motion as well as pseudarthrosis, especially after more severely displaced fractures. Recent studies have now shown that outcomes after non surgical management of displaced fractures or shortening of the clavicle are worse than had been previously assumed. Surgical techniques for the stable fixation of clavicle fractures have been improved and a wider selection of implants for osteosynthesis of these fractures has become available. Although there is widespread consensus that undisplaced or minimally displaced clavicle fractures respond well to non surgical management, optimal treatment of displaced fractures or severe shortening is under scrutiny with regard to both the basic choice between non surgical or surgical management and implant selection. According to current research findings, surgical management of displaced clavicle fractures has advantages and appears to be superior to non surgical management. Intramedullary nailing has proven suitable for simple straight fractures, and plate fixation for multifragmentary fractures.