Closed midshaft clavicle fractures : an evidence-based triage management algorithm.

Area of Science:

• Orthopedic Surgery
• Traumatology
• Evidence-Based Medicine

Background:

• Mid-shaft clavicle fractures (MSCFs) management has evolved, with ongoing debate regarding optimal treatment strategies.
• Specific fracture patterns and patient populations (adolescents vs. adults) necessitate tailored approaches.

Purpose of the Study:

• To synthesize current literature on operative versus nonoperative management of MSCFs.
• To develop a management algorithm for MSCFs in adolescents and adults.

Main Methods:

• Systematic review of clinical studies published in the last 15 years.
• Literature search conducted across PubMed, Google Scholar, OVID Medline, and Embase.
• Inclusion of 27 full-text articles after screening 247 initial studies.

Main Results:

• Operative management of MSCFs demonstrated reduced rates of nonunion and malunion compared to nonoperative methods.
• Functional outcomes at six months post-treatment were comparable between operative and nonoperative groups for fractures that united.

Conclusions:

• Current evidence is insufficient to advocate for routine operative management of MSCFs in adolescents.
• Identifying risk factors for nonunion is crucial for selecting adult patients who benefit from operative intervention.
• A proposed algorithm facilitates shared decision-making between patients and surgeons to optimize outcomes.