Study Comparing Plate Stabilization to Conservative Treatment in Midshaft Clavicle Fractures

Nonoperative Versus Operative Treatment of Midshaft Clavicle Fractures - A Randomized Controlled Trial

The purpose of this study is to find whether to operate or treat conservatively dislocated midshaft clavicle fractures.

Midshaft clavicle fractures are common comprising 2% of all fractures and 35% to 45% of all shoulder girdle injuries in adults. Old-established treatment practices, based on no randomised controlled trials, are used for clavicle fractures. By tradition, midshaft clavicle fractures have been treated conservatively with arm immobilized to a sling for few weeks. The goal of treatment is to restore painless function of the upper extremity.

There have been some recommendations for operative treatment, such as skin compromising in fracture area, open fracture, floating shoulder, neurovascular symptoms in upper extremity, or multiple injuries. Recently, increasing interest has emerged in the surgical treatment.

Inclusion Criteria:

• a completely displaced middle third clavicle fracture, no cortical contact between main fragments
• fresh fracture, treatment within seven days after injury
• age between 18 and 70 years
• provided informed consent

Exclusion Criteria:

• fracture was not dislocated
• multiple injured patient
• associated neurovascular injury, or suspicion of it
• reduced cooperation
• cancer or any severe illness impairing health
• pathological fracture
• treatment seven days after injury
• open fracture
• corticosteroid or immunosuppressive medication
• upper extremity fracture at same time
• an earlier clavicle or shoulder region fracture
• pregnancy
• lack of consent