Unsolved issues in diagnostics and treatment decisions for clavicular fractures

Abstract

Clavicular fractures are among the most common fractures of the shoulder. Displacement or comminution of the fracture fragments may lead to shortening of the clavicle, but could also cause mal-union or non-union of the clavicle and might lead to poor functional outcome. These fracture characteristics are therefore important in clinical decision making. The diagnostic aspects of clavicular fractures are evaluated in the first part of this thesis, whereas the second part describes studies on treatment and clinical outcomes. The third part of these thesis focuses on the complex biomechanics of the shoulder after a displaced midshaft clavicular fracture. The findings on diagnostic aspects underline the importance of fracture characteristics for classification and of two-view radiography for treatment decisions for clavicular fractures. Clavicular shortening after a midshaft clavicular fracture is deemed the most important factor in deciding whether or not to operate, but no clinically relevant changes after clavicular shortening in the scapular kinematics and functional outcome were demonstrated. Clavicular shortening should therefore not be used as the only reason to justify operative treatment.