Using 3-Dimensional Fluoroscopy to Assess Acute Clavicle Fracture Displacement: A Radiographic Study

Midshaft clavicle fractures are often treated successfully by nonoperative means. However, recent clinical studies have found benefit from surgical fixation in cases with particular fracture characteristics, such as complete fracture fragment displacement with no cortical contact, and fractures with axial shortening of more than 20 mm. Accurately determining the extent of displacement and shortening can therefore be important in guiding treatment recommendations. To our knowledge, the literature includes only 2 reports of studies that have compared different radiographic views and their accuracy in measuring fracture shortening, and no study has determined the best radiographic view for evaluating fracture displacement. We retrospectively studied the cases of 10 patients to determine which radiographic view best captured the most fracture fragment displacement. Acute midshaft clavicle fractures were assessed with simulated angled radiographs created from preoperative upright 3-dimensional fluoroscopy scans. Results showed that 15° angulated radiographs captured the most fracture fragment displacement. Given this finding, we recommend upright posteroanterior 15° caudal radiographs for midshaft clavicle fractures to best assess the extent of fracture displacement.