Midshaft Clavicle Fractures When Is Surgical Management Indicated and Which Fixation Method Should Be Used?

The recent literature has continued to evaluate management options for midshaft clavicle fractures and various outcome data. For fractures that are significantly displaced, operative treatment either with open reduction and plate fixation or with IM fixation has been shown to provide improved functional outcomes, earlier return to work, greater patient-reported satisfaction with appearance, and significantly decreased incidence of nonunion and malunion when compared with conservative treatment without surgery. Return to sport has also been shown to be faster in operatively treated fractures. When considering return to contact sports, even minimally or mildly displaced frac-tures should be considered for surgical stabilization, as this can have significant ben-efits for athletes and their training and can protect the original injury site from reinjury. However, as with all surgical management, operative intervention is not without risk that otherwise is avoided with conservative treatment. Although initially more expen-sive, the opportunity for more time with improved quality-of-life and return to produc-tivity makes operative fixation an attractive option when evaluating cost-effectiveness data. Ultimately, shared decision-making with the patient and their support system combined with understanding patient goals allows the provider to recommend a management option to achieve a satisfactory outcome.