Midshaft clavicle fractures: Current concepts

[摘要] Clavicle fractures are common fractures, comprising 5% to 10% of all fractures.1 They occur due to falls on the lateral aspect of the shoulder, the outstretched hand or due to high-energy direct impact over the bone. The incidence of clavicle fractures has increased in recent years and the operative treatment of these fractures has increased disproportionately.2,3 Clavicle fractures are most commonly classified according to the Allman classification and/or the Robinson classification. The location and type of fracture is important in the decision-making as it influences management strategies. This paper focuses on the most common clavicle fractures, which are those in the mid-diaphyseal third (Allman 1 and Robinson 2).1,4-6 Described conservative treatment options for the clavicle fracture consist of pain reduction by temporary immobilization using a sling or collar and cuff in combination with analgesics and/or kinesio tape. Operative treatment comprises open reduction and internal fixation (ORIF) using plates and screws or intramedullary fixation (IMF), of which the titanium elastic nail (TEN) is the most commonly used and described option.7-16 Classical operative treatment indications are open fractures, compromised skin, neurovascular complications or an additional fracture of the scapular neck (floating shoulder).17,18 Others have described relative indications for operative management, which are displaced midshaft clavicle fractures, a shortening of ⩾ 2 cm, age, activity level and dominant side.

[学科分类] 神经科学

[关键词] clavicle;fracture;midshaft;treatment;operative;conservative;cost effectiveness;shared decision-making