Abstract
Michael Robinson has been a Consultant Orthopaedic Surgeon and Senior Lecturer in the Department of Orthopaedics and Traumatology in Edinburgh, Scotland, United Kingdom for 10 years. His special interests include the treatment of proximal humeral and clavicle fractures, and shoulder instability.
The traditional view that the vast majority clavicle fractures heal with non- operative treatment with consistently good functional outcomes is no longer valid. Recent studies have identified a higher rate of nonunion and specific defects of shoulder function in sub-groups of patients with these injuries. These fractures should therefore be viewed as a spectrum of injuries with diverse functional outcomes, each requiring careful assessment and individualised treatment. This talk provides an overview of the current knowledge regarding their epidemiology, classification, clinical assessment and treatment in adults. The following key points will be highlighted:
Undisplaced fractures of both the diaphysis and the lateral end of the clavicle have a high rate of union and good functional outcomes after non-operative treatment.
Non-operative treatment of displaced shaft fractures may be associated with a higher rate of non-union and functional deficit than previously reported. However, it remains difficult to predict which patients will develop these complications.
Since satisfactory functional outcome may be regained from operative treatment for clavicular nonunion or malunion, there is currently considerable debate about the benefits of primary operative treatment for these injuries.
Displaced lateral-end fractures have a higher risk of nonunion after non-operative treatment than shaft fractures. However, nonunion is difficult to predict and may be asymptomatic in the elderly. The results of operative treatment are more unpredictable than for shaft fractures.
None of the authors have received any payment or consideration from any source for the conduct of this study.
