Midclavicular fracture: not just a trivial injury: current treatment options.
BACKGROUND
Conservative treatment was long recommended for midclavicular fractures because of the excellent results that were reported in the 1960's and 70's. Recently, however, the rucksack bandage has received competition from surgical treatment. The spectrum of operations ranges from classic plate osteosynthesis to intramedullary techniques and angle-stable implants.


METHODS
We present and evaluate the current treatment options on the basis of a selective review of the literature.


RESULTS
Recent studies have confirmed some long-held concepts and refuted others. The risk of non-union after conservative treatment was previously reported as 1% to 2% but has turned out to be much higher in selected subgroups such as in patients with severe displacement, female patients, and patients of advanced age. Furthermore, new implants and techniques have made surgery safer and more likely to result in bony union.


CONCLUSIONS
In any case of midclavicular fracture, the type of fracture should be precisely analyzed and an individual treatment strategy should be developed in view of the patient's particular situation. Current studies show with a high level of evidence (level 1) that patients with dislocated fractures benefit from surgery.
Klinik für Orthopädie und Unfallchirurgie, Schwerpunkt Unfallchirurgie, Universitätsklinikum Köln, Kerpener Str. 62, 50937 Köln, Germany. gereon.schiffer@uk-koeln.de
Gereon
G
Schiffer
Christoph
C
Faymonville
Emmanouil
E
Skouras
Jonas
J
Andermahr
Axel
A
Jubel
D001860:Bone Plates / Q000706:statistics & numerical data; D001863:Bone Screws / Q000706:statistics & numerical data; D002968:Clavicle / Q000293:injuries* / Q000601:surgery*; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000706:statistics & numerical data*; D050723:Fractures, Bone / Q000453:epidemiology* / Q000601:surgery*; D005599:Fractures, Ununited / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D006801:Humans; D007103:Immobilization / Q000706:statistics & numerical data*; D008297:Male; D015995:Prevalence; D012737:Sex Factors; D016896:Treatment Outcome