Comparative study of plating versus conservative treatment in mid shaft fractures of clavicle

Background: Clavicle fractures represent up to 4% and 1% of all fractures, respectively. Historically, both fracture types have been treated conservatively with acceptable outcomes. The surgical correction of these fractures is currently being investigated as a viable alternative to conservative management.Methods: A systematic search of PubMed was performed to identify articles comparing open reduction and internal fixation (ORIF) with conservative treatment for clavicular fractures. Specific outcomes of interest were shoulder function, pain, strength, range of motion, and risk of non-union. Results: ORIF of midshaft clavicular fractures results in increased shoulder function within 6 weeks following treatment and a decreased risk of non-union. After 1 year, there was no longer a difference in shoulder function between groups. There was no difference in pain between treatment groups. Both ORIF and conservative treatment of extraarticular scapular fractures yield comparable results in shoulder function, range of motion, and strength following treatment.Conclusions: This study, early primary plate fixation of comminuted mid shaft clavicular fractures results in improved patient-oriented outcomes, improved surgeon-oriented outcomes, earlier return to function and decreased rates of non-union and malunion.