Reliability of preoperative conventional X-ray diagnostics for multifragmentary midclavicular fractures - a...

The aim of this study was to evaluate the reliability of assessing preoperative conventional X-ray diagnostics in determining whether a comminuted clavicle fracture is present.

A total of 326 patients with complete clinical and radiological documentation treated for a central clavicle fracture at the author's department between January 1, 2012, and June 30, 2023, were included. Among these, 73 were female, and 253 were male in a mean age of 37.5 ± 17 years.

On preoperative X-ray images or operation reports, 109 (33%) or 78 (24%) simple and 217 (67%) or 248 (76%) comminuted fractures were identified. Thity-one out of 248 comminuted fractures were only discovered intraoperatively, accounting for 13%. According to the AO classification on preoperative X-ray or operation reports, 109 or 78 fractures were classified as type A (33% or 24%), 51 or 45 as type B (16% or 14%), and 166 or 203 as type C (51% or 62%). For 40 patients, the discrepancy between the preoperative X-ray and the intraoperative fracture type led to a change in the surgical procedure. This represents 12% of the total cohort or 91% of the fractures that were classified differently preoperatively compared to intraoperatively. In these cases, fractures were treated with open reduction and angular stable plate osteosynthesis instead of the preoperatively planned elastic stable intramedullary nailing (ESIN).

The results of this study suggest that conventional X-ray diagnostics may not always detect comminuted clavicle shaft fractures. The treating physician should be aware of this issue.