Treatment of acute midshaft clavicle fractures: Systematic review of 2144 fractures. On behalf of the Evidence-Based Orthopaedic Trauma Working Group

Background: Fractures of the clavicle were reported to represent 2.6% of all fractures with an overall incidence of 64 per 100,000 per year (1987, Malmö, Sweden). Midshaft fractures account for approximately 69% to 81% of all clavicle fractures. Treatment options for acute midshaft clavicle fractures include nonoperative treatment (mostly sling or figure-of-eight bandage), open reduction and internal fixation with plates, and closed or open reduction and internal fixation with intramedullary pins, wires, or a nail. Most surgeons prefer nonoperative treatment of nondisplaced midshaft clavicle fractures. However, the optimal treatment option for isolated acute displaced midshaft clavicle fractures remains controversial. Objectives: This study was designed to systematically summarize and compare results of different treatment options (nonoperative, operative extramedullary fixation, and operative intramedullary fixation) in the management of midshaft clavicle fractures, specifically for displaced fractures.