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Acta Orthop. 2016 Dec;87(6):541-545. Epub 2016 May 26.

Overtreatment of displaced midshaft clavicle fractures.

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a Department of Orthopaedic Surgery , Copenhagen University Hospital Hvidovre , Copenhagen , Denmark.
d Clinical Orthopedic Research Hvidovre , Copenhagen University Hospital Hvidovre , Copenhagen , Denmark.
b Department of Orthopaedic Surgery , University Hospital , Uppsala , Sweden.
c Department of Surgery , Helsinki University Central Hospital and University of Helsinki , Helsinki , Finland.


Background and purpose - The best treatment for displaced clavicle fractures has been debated for decades. Operative treatment has become more common. However, several randomized trials comparing non-operative and operative treatment have not shown any compelling evidence in favor of surgery. We identified the preferred treatment of displaced midshaft clavicle fractures at public hospitals in 3 countries in Scandinavia. Patients and methods - A purpose-made multiple-choice questionnaire in English was sent to all public hospitals in Denmark, Sweden, and Finland. This was addressed to the orthopedic surgeon responsible for treatment of clavicle fractures, and completed questionnaires were obtained from 85 of 118 hospitals. Results - In the 3 countries, 69 of the 85 hospitals that responded would treat displaced clavicle fractures operatively. Clear criteria for treatment allocation were used at 58 of the hospitals, with the remaining 27 using individual assessment in collaboration with the patient. Precontoured locking plates were mostly used, placed either superiorly (64/85) or anteriorly (10/85). Interpretation - Displaced midshaft clavicle fractures are mainly treated operatively in Sweden, Denmark, and Finland. This treatment is not supported by compelling evidence.

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