Online radiographic survey of midshaft clavicular fractures : no consensus on treatment for displaced fractures

The choice of treatment for midshaft clavicular fractures is not straightforward, but depends on fracture characteristics such as comminution, angulation and displacement. An online survey was conducted amongst trauma and orthopaedic surgeons to determine the preferred treatment for midshaft clavicular fractures, based on anteroposterior radiographs, for 17 randomly selected displaced or comminuted midshaft clavicular fractures. The background and experience of the respondents were documented. Data were analyzed using a Generalized Estimating Equations (GEE) model. The 102 respondents preferred non-operative treatment more frequently for displaced fractures than for comminuted fractures (OR 3.24, 95% CI 2.55-4.12). Locking plate fixation was more often preferred over other surgical modalities for comminuted than for displaced fractures (OR 1.50, 95% CI 1.17-1.91). In clinical practice, there is no consensus between surgeons on the choice of treatment for displaced or comminuted midshaft clavicular fractures. This lack of agreement calls for evidence-based treatment guidelines for these fractures.