Midshaft clavicle fractures can be classified into simple or complex/comminuted. The hardest fracture to treat is the severely comminuted and displaced fracture. We retrospectively compared 286 consecutive operatively treated simple (2 and 3 part) fractures with the more complex comminuted (>=4 part) midshaft clavicle fractures, looking at outcome, complication rate and union rate. Between 2008 and 2010 the senior author operated on 286 displaced midshaft clavicle fractures using a plate and screws. In this cohort there were 173 simple (2 and 3 part) fractures and 99 complex (>=4 part) fractures. The operation was performed through a limited incision technique and was standardized. All fractures were fixed with at least 3 screws on either side of the comminution. All patients were up until radiological and clinical union. A standardized questionnaire was used to assess patient satisfaction, return to work, sport and outcome at each postoperative visit. All complications were documented. All fractures eventually went onto union. There were 242 males and 44 females with the average age being 33. The complex fractures had a larger scar, took longer to return to normal motion, work and sport, and took on average 10 weeks to unite compared to 6 weeks in the simple fractures. The infection rate in the simple fractures was 1% and in the complex fractures was 2%. The big difference was the incidence of non union in the complex fractures of 10% compared to 1%; the other main difference was postoperative shoulder stiffness of 3% at 3 months in the complex fractures compared to 1 % in the simple fractures. Plate elevation/irritation was also more prevalent in the complex fractures of 10% compared to 3%. This study clearly shows there is a higher complication rate in complex fractures. Particular attention must be placed on surgical technique and anatomical reduction of these difficult fractures followed closely by postoperative rehabilitation. Future studies of clavicle fractures should specify the type of fracture being treated to give a better understanding of the potential outcome.
