[Middle third clavicle fractures--diagnosis, complications and treatment]

Clavicle fractures compose 2.5% to 5% of all fractures, and usually occur due to a direct blow to the shoulder. The incidence of these fractures persistently increases. Most of the fractures are in the middle third--a result of the unique structure of the clavicle and its ligamentous and muscular attachments. The fracture diagnosis includes focused physical examination, radiographic evaluation, and comprehensive evaluation of the patient, considering the fact that the fracture can be the result of significant energy absorption and can hide other injuries. Usually treatment is non-operative, and results in fracture union of 95%. Healing is achieved with a certain amount of deformity. The most common treatment is a sling or figure-of-8 dressing worn for several weeks. When absolute surgical indications (open fracture or neurovascular injury) or relative surgical indications (multiple injuries or floating shoulder) exist, several surgical procedures can be chosen. The fracture displacement as a predictive factor for union or function after healing is controversial. Complications associated with clavicle fractures are the result of either conservative or surgical treatment. The most common complication is an esthetic defect. Other complications are non-union, mal-union, limited range of motion and neurovascular injury.