Skip to main content

Advertisement

SpringerLink
Log in

Shaft fractures of the clavicle: current concepts

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Fractures of the clavicle are common and have been typically addressed to nonoperative treatment. Favorable results, which predominantly were achieved in the young and adolescents, were supposed to be usual in midshaft clavicular fractures. However, in the presence of comminution or complete displacement, especially when occurring in females or elderly patients, there is a marked risk of nonunion, malunion, and poor outcome. Thus, many authors prefer primary surgical stabilization, when risk factors add up. Plate fixation and intramedullary stabilization seem to be equally favored. Though, indications for operative management remain controversial. Further prospective randomized comparative clinical trials are necessary for a well-founded risk-benefit analysis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Allman Fl Jr (1967) Fractures and ligamentous injuries of the clavicle and its articulation. J Bone Joint Surg Am 49:774–784

    PubMed  Google Scholar 

  2. Andermahr J, Jubel A, Elsner A et al (2006) Malunion of the clavicle causes significant glenoid malposition: a quantitative anatomic investigation. Surg Radiol Anat 28:447–456

    Article  PubMed  Google Scholar 

  3. Andersen K, Jensen PO, Lauritzen J (1987) Treatment of clavicular fractures. Figure-of-eight bandage versus a simple sling. Acta Orthop Scand 58:71–74

    Article  PubMed  CAS  Google Scholar 

  4. Anonymous (1996) Fracture and dislocation compendium. Orthopaedic trauma association committee for coding and classification. J Orthop Trauma 10(Suppl 1):v–ix, 1–154

    Google Scholar 

  5. Bostman O, Manninen M, Pihlajamaki H (1997) Complications of plate fixation in fresh displaced midclavicular fractures. J Trauma 43:778–783

    Article  PubMed  CAS  Google Scholar 

  6. Brinker MR, Edwards TB, O’connor DP (2005) Estimating the risk of nonunion following nonoperative treatment of a clavicular fracture. J Bone Joint Surg Am 87:676–677 author reply 677

    PubMed  Google Scholar 

  7. Calder JD, Solan M, Gidwani S et al (2002) Management of paediatric clavicle fractures—is follow-up necessary? An audit of 346 cases. Ann R Coll Surg Engl 84:331–333

    Article  PubMed  CAS  Google Scholar 

  8. Society CanadianOrthopaedicTrauma (2007) Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial. J Bone Joint Surg Am 89:1–10

    Google Scholar 

  9. Coupe BD, Wimhurst JA, Indar R et al (2005) A new approach for plate fixation of midshaft clavicular fractures. Injury 36:1166–1171

    Article  PubMed  CAS  Google Scholar 

  10. Denard PJ, Koval KJ, Cantu RV et al (2005) Management of midshaft clavicle fractures in adults. Am J Orthop 34:527–536

    PubMed  Google Scholar 

  11. Eskola A, Vainionpaa S, Myllynen P et al (1986) Outcome of clavicular fracture in 89 patients. Arch Orthop Trauma Surg 105:337–338

    Article  PubMed  CAS  Google Scholar 

  12. Geel CW (2000) Scapula and clavicle. In: Ruedi TP, Murphy WM (eds) AO principles of fracture management. Thieme Verlag, Stuttgart

    Google Scholar 

  13. Hill JM, Mcguire MH, Crosby LA (1997) Closed treatment of displaced middle-third fractures of the clavicle gives poor results. J Bone Joint Surg Br 79:537–539

    Article  PubMed  CAS  Google Scholar 

  14. Jeray KJ (2007) Acute midshaft clavicular fracture. J Am Acad Orthop Surg 15:239–248

    PubMed  Google Scholar 

  15. Jubel A, Andermahr J, Faymonville C et al (2002) Reconstruction of shoulder-girdle symmetry after midclavicular fractures. Stable, elastic intramedullary pinning versus rucksack bandage. Chirurg 73:978–981

    Article  PubMed  CAS  Google Scholar 

  16. Jubel A, Andermahr J, Prokop A et al (2002) Minimal invasive biological osteosynthesis of the clavicle with a titanium nail. Kongressbd Dtsch Ges Chir Kongr 119:485–490

    PubMed  CAS  Google Scholar 

  17. Jubel A, Andemahr J, Bergmann H et al (2003) Elastic stable intramedullary nailing of midclavicular fractures in athletes. Br J Sports Med 37:480–483 discussion 484

    Article  PubMed  CAS  Google Scholar 

  18. Jubel A, Andermahr J, Prokop A et al (2005) Treatment of mid-clavicular fractures in adults. Early results after rucksack bandage or elastic stable intramedullary nailing. Unfallchirurg 108:707–714

    Article  PubMed  CAS  Google Scholar 

  19. Kettler M, Schieker M, Braunstein V et al (2007) Flexible intramedullary nailing for stabilization of displaced midshaft clavicle fractures: technique and results in 87 patients. Acta Orthop 78:424–429

    Article  PubMed  Google Scholar 

  20. Klonz A, Hockertz T, Reilmann H (2002) Clavicular fractures. Chirurg 73:90–100 quiz 100–101

    Article  PubMed  CAS  Google Scholar 

  21. Lazarides S, Zafiropoulos G (2006) Conservative treatment of fractures at the middle third of the clavicle: the relevance of shortening and clinical outcome. J Shoulder Elbow Surg 15:191–194

    Article  PubMed  Google Scholar 

  22. Ledger M, Leeks N, Ackland T et al (2005) Short malunions of the clavicle: an anatomic and functional study. J Shoulder Elbow Surg 14:349–354

    Article  PubMed  Google Scholar 

  23. Lee YS, Lin CC, Huang CR et al (2007) Operative treatment of midclavicular fractures in 62 elderly patients: knowles pin versus plate. Orthopedics 30:959–964

    PubMed  Google Scholar 

  24. McKee MD, Wild LM, Schemitsch EH (2003) Midshaft malunions of the clavicle. J Bone Joint Surg Am 85-A:790–797

    PubMed  Google Scholar 

  25. McKee MD, Wild LM, Schemitsch EH (2004) Midshaft malunions of the clavicle. Surgical technique. J Bone Joint Surg Am 86-A(Suppl 1):37–43

    PubMed  Google Scholar 

  26. McKee MD, Pedersen EM, Jones C et al (2006) Deficits following nonoperative treatment of displaced midshaft clavicular fractures. J Bone Joint Surg Am 88:35–40

    Article  PubMed  Google Scholar 

  27. Meier C, Grueninger P, Platz A (2006) Elastic stable intramedullary nailing for midclavicular fractures in athletes: indications, technical pitfalls and early results. Acta Orthop Belg 72:269–275

    PubMed  Google Scholar 

  28. Muller MC, Burger C, Florczyk A et al (2007) Elastic titanium nails in minimally invasive osteosynthesis for mid-clavicular fractures. Chirurg 78:349–355

    Article  PubMed  CAS  Google Scholar 

  29. Neer CSII (1960) Nonunion of the clavicle. JAMA 172:1006–1011

    Google Scholar 

  30. Nordqvist A, Petersson C (1994) The incidence of fractures of the clavicle. Clin Orthop Relat Res 300:127–132

    PubMed  Google Scholar 

  31. Nordqvist A, Petersson CJ, Redlund-Johnell I (1998) Mid-clavicle fractures in adults: end result study after conservative treatment. J Orthop Trauma 12:572–576

    Article  PubMed  CAS  Google Scholar 

  32. Nowak J, Mallmin H, Larsson S (2000) The aetiology and epidemiology of clavicular fractures. A prospective study during a two-year period in Uppsala, Sweden. Injury 31:353–358

    Article  PubMed  CAS  Google Scholar 

  33. Nowak J, Holgersson M, Larsson S (2004) Can we predict long-term sequelae after fractures of the clavicle based on initial findings? A prospective study with nine to ten years of follow-up. J Shoulder Elbow Surg 13:479–486

    Article  PubMed  Google Scholar 

  34. Nowak J, Holgersson M, Larsson S (2005) Sequelae from clavicular fractures are common: a prospective study of 222 patients. Acta Orthop 76:496–502

    Article  PubMed  Google Scholar 

  35. Petracic B (1983) Efficiency of a rucksack bandage in the treatment of clavicle fractures. Unfallchirurgie 9:41–43

    PubMed  CAS  Google Scholar 

  36. Poigenfurst J, Rappold G, Fischer W (1992) Plating of fresh clavicular fractures: results of 122 operations. Injury 23:237–241

    Article  PubMed  CAS  Google Scholar 

  37. Postacchini F, Gumina S, De Santis P et al (2002) Epidemiology of clavicle fractures. J Shoulder Elbow Surg 11:452–456

    Article  PubMed  Google Scholar 

  38. Robinson CM (1998) Fractures of the clavicle in the adult. Epidemiology and classification. J Bone Joint Surg Br 80:476–484

    Article  PubMed  CAS  Google Scholar 

  39. Robinson CM, Court-Brown CM, Mcqueen MM et al (2004) Estimating the risk of nonunion following nonoperative treatment of a clavicular fracture. J Bone Joint Surg Am 86-A:1359–1365

    PubMed  Google Scholar 

  40. Rowe CR (1968) An atlas of anatomy and treatment of midclavicular fractures. Clin Orthop Relat Res 58:29–42

    Article  PubMed  CAS  Google Scholar 

  41. Stanley D, Norris SH (1988) Recovery following fractures of the clavicle treated conservatively. Injury 19:162–164

    Article  PubMed  CAS  Google Scholar 

  42. Strauss EJ, Egol KA, France MA et al (2007) Complications of intramedullary Hagie pin fixation for acute midshaft clavicle fractures. J Shoulder Elbow Surg 16:280–284

    Article  PubMed  Google Scholar 

  43. Walz M, Kolbow B, Auerbach F (2006) Elastic, stable intramedullary nailing in midclavicular fractures—a change in treatment strategies? Unfallchirurg 109:200–211

    Article  PubMed  CAS  Google Scholar 

  44. Wick M, Muller EJ, Kollig E et al (2001) Midshaft fractures of the clavicle with a shortening of more than 2 cm predispose to nonunion. Arch Orthop Trauma Surg 121:207–211

    Article  PubMed  CAS  Google Scholar 

  45. Zlowodzki M, Zelle BA, Cole PA et al (2005) Treatment of acute midshaft clavicle fractures: systematic review of 2144 fractures: on behalf of the Evidence-Based Orthopaedic Trauma Working Group. J Orthop Trauma 19:504–507

    Article  PubMed  Google Scholar 

Download references

Conflict of interest statement

No author has a conflict of interest that relates to the content discussed in this manuscript. No financial support of this project has occurred.

Author information

Authors and Affiliations

  1. Department of Trauma Surgery and Sports Medicine, Innsbruck Medical University, Anichstraße 35, 6020, Innsbruck, Austria

    Vinzenz Smekal, Juergen Oberladstaetter, Peter Struve & Dietmar Krappinger

Authors
  1. Vinzenz Smekal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Juergen Oberladstaetter
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Peter Struve
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dietmar Krappinger
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dietmar Krappinger.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Smekal, V., Oberladstaetter, J., Struve, P. et al. Shaft fractures of the clavicle: current concepts. Arch Orthop Trauma Surg 129, 807–815 (2009). https://doi.org/10.1007/s00402-008-0775-7

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-008-0775-7

Keywords

Search

Navigation