Emerging Orthopaedics: Do Clavicle Fractures Require Surgery?

Orthopaedic Surgeon and Triangle Division Medical Director Dr. William Silver specializes in Sports Medicine and treatment of the knee and shoulder.  He shares with us the outcome of a recent study comparing a surgical and non-surgical approach to displaced midshaft clavicle fracture.  Courses of treatment for many procedures depend on conversations between you and your medical provider as you discuss your goals.  What is the best way to help you Emerge Stronger, Healthier, Better?

A study published in the July 19 issue of The Journal of Bone & Joint Surgery compares surgical and nonsurgical treatment approaches for displaced midshaft clavicle fracture. The authors conducted a prospective, randomized, controlled trial of 117 patients who received either nonsurgical treatment with a figure-of-eight harness or surgical treatment with anteroinferior plate osteosynthesis. At 6-week, 6-month, and 1-year follow-ups, they found no difference across cohorts in Disabilities of the Arm, Shoulder and Hand score, visual analog scale pain level, time to return to previous activities, or cosmetic dissatisfaction. However, the authors note that seven nonsurgical patients (14.9 percent) developed nonunion, compared to none in the surgical group. Further, nonsurgically treated patients displayed radiographic evidence of greater clavicle shortening compared with those in the surgical cohort, and more patients in that group answered “yes” when asked if their clavicle felt short and if they felt bone prominence. In the surgical group, more patients answered “yes” when asked if they felt paresthesia.

In summary, 117 patients received either a nonsurgical or surgical treatment for a displaced midshaft clavicle fracture. The patients returned for a 6-week, 6-month and 1 year follow up to try and find the difference between the two treatment options. It was found that there was very little difference between the surgical and non surgical option other then 15% of nonsurgical patients bones did not complete connect, and also showed evidence of greater clavicle shortening.

Dr. Silver is a board certified Orthopaedic Surgeon with a Certificate of Added Qualification in Sports Medicine.  To schedule an appointment with Dr. Silver, contact (919) 220-5255.