Collarbone or middle third of the clavicle fractures are a very common injury and account for up to 4% of all fractures. Although the majority of acute fractures can be treated conservatively, such as using a sling, there are some types of fracture that need to be surgically treated. Non-union of the collarbone, which results from failed fracture healing, is usually treated surgically when associated with pain and functional impairment.
This review set out to evaluate the effects, primarily on pain and long-term function, of different methods for surgically treating collarbone fractures and non-union.
Three small studies, two of which had methodological limitations that may affect the reliability of their findings, were included in this review. One poor quality trial that involved 36 participants compared two types of plates for treating non-union of fractures of the middle third of the clavicle. The trial found that participants treated with a low-contact dynamic compression plate reported a better quality of life in the year after surgery and returned to work earlier than those patients treated with a standard dynamic compression plate. The second trial, which was also of poor quality, concluded that there were advantages in using intramedullary nail fixation compared with plate fixation in 69 people with either acute fractures or non-union. The third trial, involving 133 participants, was well conducted but did not include enough participants to be conclusive. It compared two different techniques for placement of plates to fix displaced clavicle fractures. This trial found that a technique in which the plate is contoured in three dimensions before fixation to the clavicle gave better results than placing the plate along the upper surface of the clavicle.
Evidence regarding the effectiveness of different methods of surgical interventions for treating fracture and non-union of the collarbone is limited and further studies are justified.