Treatment of clavicle fractures: systematic review

Introduction Clavicle fracture is one of the most common fractures in adults. The incidence in Western countries has increased during last decades along with mobile and energetic way of life. At present the incidence of clavicle fractures is 50-64/100 000 and it is decreasing with age, especially within men (1,2). Clavicle fractures are more common among men (68%) than women (32%) and within men the most significant age group is young adults. Great majority of clavicle fractures are situated in the middle part (81%); whereas lateral (17%) and medial fractures (2%) are much more infrequent (3). Conventionally clavicle fractures have been treated non-operatively arm immobilized in a sling for few weeks. There have been some recommendations for operative treatment, such as skin compromising in fracture area, open fracture, floating shoulder, neurovascular symptoms in upper extremity, or multiple injuries. Nowak et al. (2004) found out 7% non-union rate in non-operatively treated clavicle fractures after 6 months follow-up and great risk to prolonged sequels at 9-to 10-year follow-up (4). Hill et al. (1997) reported 15% non-union rate in non-operatively treated clavicle fractures, and also evident connection between shortening and non-union (5). It is also defined predictable risk factors, which may cause complications in fracture healing and overall recovery. Fractures with displacement without bony contact, transversely placed fragments, and ageing are risk factors, which may cause sequels and therefore indicate for operative treatment (4). Systematic review of 17 retrospective and 5 prospective reports with 2144 clavicle fractures shows some evidence for better results in operative treatment compared to non-operative treatment, and also a great risk for long-term sequels, if the fracture is displaced, comminuted, or fragmented (6). In this study we aimed to assess systemically the effectiveness and safety of non-operative and operative treatment of clavicle fractures. The aim was also to find out, if the results could be generalized to daily practise and assess the reliability of evidence.