This 2007 JAAOS review by Jeray covers the anatomy, classification, and treatment decision-making for acute midshaft clavicular fractures. It asks specifically: when is conservative management sufficient, and when should surgical fixation be offered? The article synthesizes existing literature including a systematic review of 2,144 fractures to define operative thresholds.
The traditional teaching that clavicular fractures 'generally do well with non-operative management' was based on surgeon-rated and radiographic outcomes, not patient-reported function. This review synthesizes the data that changed that thinking.
When you see a completely displaced midshaft clavicular fracture in a young woman with comminution, the nonsurgical nonunion risk is 33–47%. That fracture deserves a surgical conversation.
When shortening reaches 1.5–2 cm on any radiographic view, start the operative discussion. Below that threshold, give the patient a sling (not a figure-of-8) and set expectations that mild discomfort can persist for 3 months.
For plating, place the construct anterosuperiorly (tension side), use a 3.5-mm dynamic compression plate with at least 6 cortices per side, and warn the patient upfront that hardware removal is needed in a substantial proportion of cases. Clavicular nonunion is defined at 16 weeks — if you reach that point, plate fixation with bone graft achieves union in >92%.
This 2007 JAAOS review by Jeray covers the anatomy, classification, and treatment decision-making for acute midshaft clavicular fractures. It asks specifically: when is conservative management sufficient, and when should surgical fixation be offered? The article synthesizes existing literature including a systematic review of 2,144 fractures to define operative thresholds.
The traditional teaching that clavicular fractures 'generally do well with non-operative management' was based on surgeon-rated and radiographic outcomes, not patient-reported function. This review synthesizes the data that changed that thinking.
When you see a completely displaced midshaft clavicular fracture in a young woman with comminution, the nonsurgical nonunion risk is 33–47%. That fracture deserves a surgical conversation.
When shortening reaches 1.5–2 cm on any radiographic view, start the operative discussion. Below that threshold, give the patient a sling (not a figure-of-8) and set expectations that mild discomfort can persist for 3 months.
For plating, place the construct anterosuperiorly (tension side), use a 3.5-mm dynamic compression plate with at least 6 cortices per side, and warn the patient upfront that hardware removal is needed in a substantial proportion of cases. Clavicular nonunion is defined at 16 weeks — if you reach that point, plate fixation with bone graft achieves union in >92%.