Displaced mid-shaft clavicular fractures: is conservative treatment still preferred?

BACKGROUND A clavicular fracture accounts for 2.6%-5% of adult fractures. Fractures in the middle-third (OTA 15-B) represent 69%-82% of all clavicular fractures. There is no consensus among orthopedic surgeons regarding treatment for these fractures: many support conservative treatment even for displaced middle-third clavicular fractures, while others choose operative treatment. OBJECTIVES To assess the attitudes of orthopedic surgeons regarding treatment of displaced mid-shaft clavicular fractures. METHODS We conducted a survey in which we interviewed orthopedic surgeons from various countries during the 2012 EFORT meeting in Berlin. The questionnaire included an X-ray of a displaced middle-third clavicular fracture, as well as questions regarding the surgeon's proposed treatment plan. RESULTS A total of 177 orthopedic surgeons completed the questionnaire; 49% preferred operative treatment for a displaced middle-third clavicular fracture. Among the orthopedic trauma specialists, 58% suggested operative treatment, as did 82% of shoulder specialists. Most surgeons preferred a locking plate for fixation. CONCLUSIONS The treatment approach for a displaced middle-third clavicular fracture seems to be evenly split between conservative and operative approaches. The tendency toward operative treatment was.even more remarkable among orthopedic trauma specialists and shoulder specialists who completed the questionnaire. Most surgeons prefer a locking plate as a fixation system for this type of fracture.