This 2005 systematic review by Zlowodzki et al. synthesizes 22 studies totaling 2,144 midshaft clavicle fractures to compare outcomes — specifically nonunion rates — across nonoperative treatment, plate fixation, and intramedullary fixation, with particular focus on the displaced fracture subset where optimal management was most contested.
When you see a displaced midshaft clavicle fracture — especially in a female patient with comminution — recognize that nonoperative management carries a 15% nonunion rate, making operative fixation a serious consideration; if you treat nonoperatively, use a sling rather than a figure-of-eight bandage.
This 2005 systematic review by Zlowodzki et al. synthesizes 22 studies totaling 2,144 midshaft clavicle fractures to compare outcomes — specifically nonunion rates — across nonoperative treatment, plate fixation, and intramedullary fixation, with particular focus on the displaced fracture subset where optimal management was most contested.
When you see a displaced midshaft clavicle fracture — especially in a female patient with comminution — recognize that nonoperative management carries a 15% nonunion rate, making operative fixation a serious consideration; if you treat nonoperatively, use a sling rather than a figure-of-eight bandage.