[Midshaft clavicle fractures--classification and therapy. Results of a survey at German trauma departments].

INTRODUCTION: The therapy of the midshaft clavicle fracture, in particular dislocated midshaft fractures, remains controversial. Therefore the objective of this study was to obtain data about the current treatment for midshaft clavicle fractures.
METHODS: In a countrywide anonymous survey 240 German orthopaedic trauma departments were asked about their diagnostic and therapeutic procedures for midshaft clavicle fractures. A total of 142 questionnaires (59%) were returned and evaluated.
RESULTS: More than 80% of the hospitals dispense with a standardised fracture classification for midshaft fractures. Simple fractures are generally conservatively treated, in the majority using a figure-of-eight bandage (88%). On average 26% of all clavicle fractures are operatively stabilized, independent of whether the treatment was performed at a trauma centre or any other hospital (p=0.45). Indications for operative treatment of midshaft fractures include severe additional injuries in the shoulder region (81-95%), young and active adults (52-64%) and dislocated midshaft fractures (56-75%). All departments use plate fixation for midshaft fractures; in particular the reconstruction plate (56%) is most frequently applied. Alternatively, if the fracture pattern is considered suitable for intramedullary fixation, this procedure is performed by 43% of the clinics, although this operative technique is used significantly more often in trauma centres (55%) than in other hospitals (31%) (p=0.01).
CONCLUSION: This survey demonstrates a high rate (26%) of German trauma hospitals operating clavicular midshaft fractures. This result is consistent with recently published studies showing better results for operative treatment of dislocated midshaft clavicular fractures compared to conservative therapy.