A 2018 narrative review synthesizing over a decade of RCTs, meta-analyses, and cohort studies on midshaft clavicle fracture management in adults. Addresses which fractures benefit from surgery versus nonsurgical treatment, what radiographic thresholds guide operative decision-making, and how available fixation techniques compare.
When a midshaft clavicle fracture shows >2 cm shortening, >100% displacement, comminution, or a Z-type pattern, counsel the patient toward surgery — these are the parameters tied to 15–20% nonunion and measurable functional deficits with nonsurgical care.
For female patients or those with low BMI undergoing ORIF, favor precontoured or dual plating to minimize the leading cause of reoperation: implant irritation.
A 2018 narrative review synthesizing over a decade of RCTs, meta-analyses, and cohort studies on midshaft clavicle fracture management in adults. Addresses which fractures benefit from surgery versus nonsurgical treatment, what radiographic thresholds guide operative decision-making, and how available fixation techniques compare.
When a midshaft clavicle fracture shows >2 cm shortening, >100% displacement, comminution, or a Z-type pattern, counsel the patient toward surgery — these are the parameters tied to 15–20% nonunion and measurable functional deficits with nonsurgical care.
For female patients or those with low BMI undergoing ORIF, favor precontoured or dual plating to minimize the leading cause of reoperation: implant irritation.