title: The operative outcomes of displaced medial-end clavicle fractures.
abstract: BACKGROUND
  Nonoperative treatment of displaced medial clavicle fractures often leads to poor functional outcomes and painful nonunions. This study investigates the functional outcomes of patients undergoing operative fixation of these fractures.
  
  
  METHODS
  We investigated 27 patients undergoing operative fixation of a medial clavicle fracture; 24 had an acute, displaced fracture and 3 had fixation for nonunions. Preoperative radiographs or computed tomography scans were obtained, and data collected included age, sex, mechanism of injury, and fixation method. Follow-up included physical examination and radiographs for assessment of union; Disabilities of the Arm, Shoulder, and Hand scores at 12 months; and the recording of complications.
  
  
  RESULTS
  The median age was 37 years (interquartile range, 17-47 years). There were 26 male patients and one female patient included, with 7 physeal injuries and 20 adult injuries. The most common mechanism of fracture was vehicular accident (n = 15). Three patients had operations for nonunions and 2 for a periprosthetic fracture medial to an existing plate. The fracture was fixed with plate and screws in 19 cases and with transosseous sutures in 8 cases. The median Disabilities of the Arm, Shoulder, and Hand score at 12 months was 0.4 (interquartile range, 0-5.0), with a union rate of 100% at 12 months. All patients had full shoulder range of motion at final follow-up and were able to return to preinjury occupational activities. There were no significant complications.
  
  
  CONCLUSIONS
  Operative fixation of displaced medial clavicle fractures results in anatomic reconstruction and excellent functional outcomes, even in the setting of fixation performed for symptomatic nonunion. Early intervention can minimize the risk of painful nonunion.
authors.affiliation: Hornsby Hospital, Hornsby, NSW, Australia; Sydney Adventist Hospital, Wahroonga, NSW, Australia. Electronic address: verinder.s.sidhu@gmail.com.
authors.forename: Verinder S
authors.initials: VS
authors.lastname: Sidhu
authors.affiliation: Hornsby Hospital, Hornsby, NSW, Australia; Sydney Adventist Hospital, Wahroonga, NSW, Australia.
authors.forename: Deborah
authors.initials: D
authors.lastname: Hermans
authors.affiliation: Hornsby Hospital, Hornsby, NSW, Australia; Sydney Adventist Hospital, Wahroonga, NSW, Australia.
authors.forename: David G
authors.initials: DG
authors.lastname: Duckworth
mesh_terms: D000293:Adolescent; D000328:Adult; D002968:Clavicle / Q000293:injuries* / Q000601:surgery*; D004185:Disability Evaluation; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation; D017102:Fracture Healing; D050723:Fractures, Bone / Q000601:surgery*; D005599:Fractures, Ununited / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D062707:Return to Work; D055815:Young Adult
keywords: Clavicle; fixation; fracture; medial; operative