11 responses to “Midshaft Clavicle Fractures”

  1. This was the way my cycling related clavicular # was handled. I am very satisfied with the result.

  2. I guess I will be referring a lot more clavicular fractures to my Ortho colleagues to make this judgement call. Great article!

  3. My original fracture (bike accident) was treated “conservatively”, with ORIF only done 8 months later after the inadequately healed fracture went POP while swimming backstroke 6 months post accident. Rehab after surgery was much easier and strength and ROM notably better after ORIF than after original conservative treatment. Even considering an unpleasant reaction to general general anaesthesia, I would much prefer to have had the ORIF right away.

  4. very useful. Thank you

  5. It would have been helpful if the article had been more clear on what indications might lead to a referral for operative treatment of a clavicular fracture.

  6. I will definitely discuss all of the mid-shaft clavicular fractures I see in the ED with ortho. I also appreciate the responses by colleagues who have sustained this injury and found operative intervention worthwhile.

  7. My general indications are 1 cm of shortening or displacement superiorly of the medial fragment greater than one width of the diameter of the clavicle. The other relative indication is unacceptable cosmetic shortening. I will often tell a patient to look in the mirror with their shirt off and if they do not like the appearance of their shoulder with the medial displacement due the shortening of the clavicle then that can be corrected with surgery (although they are trading a bump for a scar). Done well, the recovery is much quicker and I often have people back to medium work within two weeks and heavy work within four.

  8. I disagree with the immobilization portion of this
    I immobilize for comfort but not with any dreams that immobilization will improve repair. I tell patients if it hurts they shouldn’t do that yet. I give them some very basic shoulder movement exercises to do to keep the shoulder from becoming stiff. I do refer those with the indications listed as above I just try to be a minimalist with immobilization, except to treat discomfort.

  9. As a community orthopedic surgeon I think this article is potentially misleading and doesn’t reflect the practice of most community orthopods who the readers will interact with.
    The author is a sub specialist shoulder surgeon who, while he may do general call, likely sees a selective subset of patients who have failed non operative treatment. His use of the term benign neglect is misleading since it is not neglect but non operative treatment.
    The evidence for operative intervention is not robust and essentially applies to significantly shortened (> 2 cm not 1 cm)) fractures. The complications related to operative treatment including hardware failure and infection are difficult to deal with and the rate of nonunion in nonoperative treatment is extremely low. Further, any patient who tells me he wants surgery to return to work or vigorous activity within 2-4 weeks is a red flag for treatment complications such as hardware failure and I would not treat him operatively.

  10. Interesting article on a procedure that has usually not been readily available in most urban orthopaedic centres. The author mentions that one out of six studies noted significant pain relief in the operative group. Does this mean that the other 5 studies did not find this? Most clavicular fractures seem to do well with conservative (benign neglect?) treatment, but it can be difficult getting a consult on the cases that may need consideration of surgery

  11. I appreciated the whole article. A patient of mine has had a bad outcome because of a missed, for a long time, dislocation of a sternal-clavicular joint in an over the handlebars bicycle accident. His shoulder hit the open car door which opened suddenly in front of him. He was assessed at the ER, xrays taken of the shoulder, but not the medial clavicle, and seen by myself and many visits to a physiotherapist before the dislocation was finally diagnosed. Language barriers may have played a small role in missing this. I had not ever heard of such a thing happening. Now the vascular and orthopedic surgeons are leery to operate, but it is a tragedy for this young athlete.

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