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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
ORTHOPEDIC TRAUMA UPDATE PART I
Minerva Ortopedica e Traumatologica 2009 October;60(5):437-46
Midshaft clavicular fractures. A sling, a plate or a nail?
Smekal V., Struve P., Krappinger D.
Department of Trauma Surgery and Sports Medicine, Innsbruck Medical University, Innsbruck, Austria
Clavicular fractures have been a domain of nonoperative treatment for a long time. However, the incidence of comminuted and displaced fractures is growing due to various factors, including increasing participation in high velocity sports. While nondisplaced fractures as well as fractures in adolescents yield good functional and cosmetic results after nonoperative treatment, more complicated fractures in adults profit from surgical treatment. In the presence of comminution or displacement of more than one shaft width a sling may not suffice, especially when other risk factors such as female sex or advanced age are present. Current literature recommends primary surgical treatment of these fractures. Plate osteosynthesis and intramedullary stabilisation are valid treatment options. Patients’ compliance is a critical factor for the outcome after surgical treatment. Additional randomized studies are needed to ascertain risk-benefit calculations regarding treatment options and to provide better data about the usefulness of different surgical techniques in relation to fracture types.