• Sylvia A Stegeman, Charlotte W J Roeloffs, Jephta van den Bremer, Pieta Krijnen, and Inger B Schipper.
• Department of Trauma Surgery, Leiden University Medical Centre, Leiden, The Netherlands. s.a.stegeman@lumc.nl
• Eur J Emerg Med. 2013 Aug 1;20(4):268-72.

ObjectiveThe debate on whether midshaft clavicular fractures should preferably be treated operatively or nonoperatively still continues. Several patient-related factors may influence this treatment decision. A retrospective study was carried out to determine the relation between fracture type and trauma mechanism, age and sex, and the influence of these factors on the choice of primary treatment.MethodsData on the trauma mechanism and treatment of 232 adult patients, who presented with a midshaft clavicular fracture in two hospitals in the Netherlands during the years 2006-2009, were collected. The extent of clavicular shortening, displacement, and fracture type on the primary radiograph were scored.ResultsTraffic accidents are the main cause of midshaft clavicular fractures. After correction for age, no relation was found between the trauma mechanism and the fracture type. Older age correlated with more comminuted and displaced fractures. Extensive shortening (>20 mm) was identified as the main clinical indication for primary surgery, whereas displacement and fracture classification seemed less relevant. Operative treatment was increasingly favored from 5% in 2006 to 44% in 2009, which could not be explained by an increase in more complex fractures or by age-related or trauma mechanism-related factors.ConclusionAge has a major influence on the fracture type, whereas the trauma mechanism does not. The choice for the surgical treatment of midshaft clavicular fractures is primarily determined by the amount of axial shortening of the clavicle, rather than by the overall displacement or fracture type. Over the years, the choice of treatment seems to have been increasingly influenced by the patient's and surgeon's preferences.

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