Are fractures of the clavicle (collarbone) surgically reduced in adults?

From the Guidelines

Surgical reduction is recommended for displaced clavicle fractures in adults, as it results in higher union rates and better early patient-reported outcomes, according to the most recent and highest quality study 1. The treatment of clavicle fractures in adults can vary depending on the severity and characteristics of the fracture.

• Displaced clavicle fractures are defined as those with significant displacement or shortening, and these are the ones that benefit from surgical treatment.
• The American Academy of Orthopaedic Surgeons clinical practice guideline summary on the treatment of clavicle fractures 1 provides a strong recommendation on surgical versus nonsurgical treatment of displaced clavicle fractures in adults.
• High-quality evidence shows that surgical treatment of displaced clavicle fractures in adults results in higher union rates and better early patient-reported outcomes, as well as a faster time to union, which may be relevant for patients seeking to return to work or sport quickly 1.
• However, it's worth noting that long-term patient-reported outcomes are similar after surgical versus nonsurgical treatment, so both remain valid treatment options.
• The decision to operate should be individualized based on fracture characteristics, patient factors, and functional demands, and should be made by an appropriately trained healthcare professional.
• Surgical treatment typically involves open reduction and internal fixation with plates and screws or intramedullary devices, and carries risks including infection, hardware problems, and anesthetic complications.
• Non-surgical management may occasionally result in malunion or nonunion, though these rarely cause functional limitations.
• Ultimately, the choice between surgical and non-surgical management should be based on the best available evidence and the individual patient's needs and circumstances, with the goal of optimizing outcomes and minimizing risks.

From the Research

Fracture of the Collarbone in Adults

• Fractures of the collarbone are common, accounting for around 4% of all fractures and up to 44% of fractures of the shoulder girdle 2.
• The majority of clavicle fractures (approximately 80%) occur in the middle third or mid-shaft of the bone 2, 3.

Surgical Reduction of Collarbone Fractures

• Surgical treatment, specifically open reduction and internal fixation (ORIF), is often used to manage displaced mid-shaft clavicle fractures in adults 2, 4, 3.
• ORIF surgery can help restore the anatomy of the clavicle, allowing patients to rehabilitate sooner and potentially improving functional outcomes 4.
• Studies have shown that ORIF can result in a high rate of bone union, improved functional outcomes, and earlier pain relief compared to conservative management 4, 3.

Considerations and Complications

• While ORIF is generally effective, it is associated with a risk of complications, including adhesive capsulitis or stiffness, paresthesia, and superficial infection 4, 5.
• The choice of surgical approach, including the use of vertical or horizontal incisions, can impact outcomes, such as scar length and the risk of haematoma 5.
• Meticulous closure of the subcutaneous tissue is recommended to minimize the risk of complications 5.