• Gereon Schiffer, Christoph Faymonville, Emmanouil Skouras, Jonas Andermahr, and Axel Jubel.
• Klinik für Orthopädie und Unfallchirurgie, Schwerpunkt Unfallchirurgie, Universitätsklinikum Köln, Kerpener Str. 62, 50937 Köln, Germany. gereon.schiffer@uk-koeln.de
• Dtsch Arztebl Int. 2010 Oct 1;107(41):711-7.

BackgroundConservative treatment was long recommended for midclavicular fractures because of the excellent results that were reported in the 1960's and 70's. Recently, however, the rucksack bandage has received competition from surgical treatment. The spectrum of operations ranges from classic plate osteosynthesis to intramedullary techniques and angle-stable implants.MethodsWe present and evaluate the current treatment options on the basis of a selective review of the literature.ResultsRecent studies have confirmed some long-held concepts and refuted others. The risk of non-union after conservative treatment was previously reported as 1% to 2% but has turned out to be much higher in selected subgroups such as in patients with severe displacement, female patients, and patients of advanced age. Furthermore, new implants and techniques have made surgery safer and more likely to result in bony union.ConclusionIn any case of midclavicular fracture, the type of fracture should be precisely analyzed and an individual treatment strategy should be developed in view of the patient's particular situation. Current studies show with a high level of evidence (level 1) that patients with dislocated fractures benefit from surgery.

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