This 8-center Canadian RCT randomized 132 adults (age 16–60) with completely displaced midshaft clavicular fractures to plate fixation or sling immobilization. The primary question: does operative fixation produce better functional outcomes and fewer complications at one year? 111 patients completed follow-up (62 operative, 49 nonoperative).
For decades, completely displaced midshaft clavicular fractures were managed in a sling — based on Neer and Rowe's 1960s data reporting nonunion in fewer than 1% of patients. Those series included children and relied on radiographic endpoints, missing the functional deficits that patient-reported outcomes reveal.
This trial reframes the decision: when you see a completely displaced midshaft clavicular fracture in an active adult (ages 16–60, no cortical contact between fragments), offer primary plate fixation. Expect faster union, an 18% absolute reduction in symptomatic malunion, and better shoulder function at one year. With hardware removal as the most likely reoperation, not a catastrophic complication.
In the nonoperative group, greater fracture displacement predicted worse DASH scores at one year, so fracture shortening and displacement are not cosmetic details. They are functional risk factors worth quantifying at the initial visit. The one technique caveat: this trial studied only plate fixation. Intramedullary fixation remains a valid alternative but was not directly compared here.
This 8-center Canadian RCT randomized 132 adults (age 16–60) with completely displaced midshaft clavicular fractures to plate fixation or sling immobilization. The primary question: does operative fixation produce better functional outcomes and fewer complications at one year? 111 patients completed follow-up (62 operative, 49 nonoperative).
For decades, completely displaced midshaft clavicular fractures were managed in a sling — based on Neer and Rowe's 1960s data reporting nonunion in fewer than 1% of patients. Those series included children and relied on radiographic endpoints, missing the functional deficits that patient-reported outcomes reveal.
This trial reframes the decision: when you see a completely displaced midshaft clavicular fracture in an active adult (ages 16–60, no cortical contact between fragments), offer primary plate fixation. Expect faster union, an 18% absolute reduction in symptomatic malunion, and better shoulder function at one year. With hardware removal as the most likely reoperation, not a catastrophic complication.
In the nonoperative group, greater fracture displacement predicted worse DASH scores at one year, so fracture shortening and displacement are not cosmetic details. They are functional risk factors worth quantifying at the initial visit. The one technique caveat: this trial studied only plate fixation. Intramedullary fixation remains a valid alternative but was not directly compared here.