Treatment of clavicle fracture: Interpretation of the 2023 American Academy of Orthopaedic Surgeons (AAOS) Clinical Practice Guidelines_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 ZHENG Xianyou

Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 200233, P. R. China;

Corresponding author：

ZHENG Xianyou, Email: zhengxianyou@126.com

Keywords：

Clavicle fracture; treatment; guidelines interpretation

DOI：

10.7507/1002-1892.202404101

Video：

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Clavicle fracture is a common orthopedic injury, accounting for approximately 2.6%-4% of all adult skeletal fractures. In 2023, the American Academy of Orthopaedic Surgeons (AAOS) developed evidence-based treatment guidelines for clavicle fractures, which include 4 recommendations and 10 options. This article, based on a thorough review of the guidelines, discusses the clinical treatment of clavicle fractures, aiming to share advancements and the latest diagnostic and therapeutic considerations with orthopedic colleagues to enhance treatment outcomes.

Citation： ZHENG Xianyou. Treatment of clavicle fracture: Interpretation of the 2023 American Academy of Orthopaedic Surgeons (AAOS) Clinical Practice Guidelines. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(8): 942-946. doi: 10.7507/1002-1892.202404101 Copy

1.	Walton B, Meijer K, Melancon K, et al. A cost analysis of internal fixation versus nonoperative treatment in adult midshaft clavicle fractures using multiple randomized controlled trials. J Orthop Trauma, 2015, 29(4): 173-180.
2.	American Academy of Orthopaedic Surgeons. Treatment of clavicle fractures evidence-based clinical practice guideline [S/OL]. [2024-06-30]. https://www.aaos.org/claviclecpg.
3.	Putnam M, Vanderkarr M, Nandwani P, et al. Surgical treatment, complications, and reimbursement among patients with clavicle fracture and acromioclavicular dislocations: a US retrospective claims database analysis. J Med Econ, 2019, 22(9): 901-908.
4.	Tamaoki MJS, Matsunaga FT, Costa ARFD, et al. Treatment of displaced midshaft clavicle fractures: figure-of-eight harness versus anterior plate osteosynthesis: a randomized controlled trial. J Bone Joint Surg (Am), 2017, 99(14): 1159-1165.
5.	Ban I, Kristensen MT, Barfod KW, et al. Neither operative nor nonoperative approach is superior for treating displaced midshaft clavicle fractures: a partially blinded randomized controlled clinical trial. Bone Joint J, 2021, 103-B(4): 762-768.
6.	Chen QY, Kou DQ, Cheng XJ, et al. Intramedullary nailing of clavicular midshaft fractures in adults using titanium elastic nail. Chin J Traumatol, 2011, 14(5): 269-276.
7.	Wang HK, Liang LS, He RG, et al. Comparative analysis of locking plates versus hook plates in the treatment of Neer type Ⅱ distal clavicle fractures. J Int Med Res, 2020, 48(4): 300060520918060. doi: 10.1177/0300060520918060.
8.	Fuglesang HFS, Flugsrud GB, Randsborg PH, et al. Five-year follow-up results of a randomized controlled study comparing intramedullary nailing with plate fixation of completely displaced midshaft fractures of the clavicle in adults. JBJS Open Access, 2018, 3(4): e0009. doi: 0.2106/JBJS.OA.18.00009. doi: 10.2106/JBJS.OA.18.00009.
9.	van der Meijden OA, Houwert RM, Hulsmans M, et al. Operative treatment of dislocated midshaft clavicular fractures: plate or intramedullary nail fixation? A randomized controlled trial. J Bone Joint Surg (Am), 2015, 97(8): 613-619.
10.	Lubbert PH, van der Rijt RH, Hoorntje LE, et al. Low-intensity pulsed ultrasound (LIPUS) in fresh clavicle fractures: a multi-centre double blind randomised controlled trial. Injury, 2008, 39(12): 1444-1452.
11.	Napora JK, Grimberg DC, Childs BR, et al. Results and outcomes after midshaft clavicle fracture: matched pair analysis of operative versus nonoperative management. Orthopedics, 2018, 41(5): e689-e694.
12.	Napora JK, Grimberg D, Childs BR, et al. Factors affecting functional outcomes after clavicle fracture. J Am Acad Orthop Surg, 2016, 24(10): 721-727.
13.	Murray IR, Foster CJ, Eros A, et al. Risk factors for nonunion after nonoperative treatment of displaced midshaft fractures of the clavicle. J Bone Joint Surg (Am), 2013, 95(13): 1153-1158.
14.	Chen X, Shannon SF, Torchia M, et al. Radiographic outcomes of single versus dual plate fixation of acute mid-shaft clavicle fractures. Arch Orthop Trauma Surg, 2017, 137(6): 749-754.
15.	Serrano R, Borade A, Mir H, et al. Anterior-inferior plating results in fewer secondary interventions compared to superior plating for acute displaced midshaft clavicle fractures. J Orthop Trauma, 2017, 31(9): 468-471.
16.	Fang CX, Liu R, Yee DKH, et al. Comparison of radiological and clinical outcomes, complications, and implant removals in anatomically pre-contoured clavicle plates versus reconstruction plates—A propensity score matched retrospective cohort study of 106 patients. BMC Musculoskelet Disord, 2020, 21(1): 413. doi: 10.1186/s12891-020-03445-5.
17.	Malik A, Jazini E, Song X, et al. Positional change in displacement of midshaft clavicle fractures: an aid to initial evaluation. J Orthop Trauma, 2017, 31(1): e9-e12.
18.	Rugpolmuang L, Harnroongroj T, Sudjai N, et al. Comminution plays no role in worsening fracture healing of conservatively treated middle third clavicular fractures. Acta Orthop Traumatol Turc, 2016, 50(1): 32-36.
19.	Riiser MO, Molund M. Long-term functional outcomes and complications in operative versus nonoperative treatment for displaced midshaft clavicle fractures in adolescents: A retrospective comparative study. J Pediatr Orthop, 2021, 41(5): 279-283.

1. Walton B, Meijer K, Melancon K, et al. A cost analysis of internal fixation versus nonoperative treatment in adult midshaft clavicle fractures using multiple randomized controlled trials. J Orthop Trauma, 2015, 29(4): 173-180.
2. American Academy of Orthopaedic Surgeons. Treatment of clavicle fractures evidence-based clinical practice guideline [S/OL]. [2024-06-30]. https://www.aaos.org/claviclecpg.
3. Putnam M, Vanderkarr M, Nandwani P, et al. Surgical treatment, complications, and reimbursement among patients with clavicle fracture and acromioclavicular dislocations: a US retrospective claims database analysis. J Med Econ, 2019, 22(9): 901-908.
4. Tamaoki MJS, Matsunaga FT, Costa ARFD, et al. Treatment of displaced midshaft clavicle fractures: figure-of-eight harness versus anterior plate osteosynthesis: a randomized controlled trial. J Bone Joint Surg (Am), 2017, 99(14): 1159-1165.
5. Ban I, Kristensen MT, Barfod KW, et al. Neither operative nor nonoperative approach is superior for treating displaced midshaft clavicle fractures: a partially blinded randomized controlled clinical trial. Bone Joint J, 2021, 103-B(4): 762-768.
6. Chen QY, Kou DQ, Cheng XJ, et al. Intramedullary nailing of clavicular midshaft fractures in adults using titanium elastic nail. Chin J Traumatol, 2011, 14(5): 269-276.
7. Wang HK, Liang LS, He RG, et al. Comparative analysis of locking plates versus hook plates in the treatment of Neer type Ⅱ distal clavicle fractures. J Int Med Res, 2020, 48(4): 300060520918060. doi: 10.1177/0300060520918060.
8. Fuglesang HFS, Flugsrud GB, Randsborg PH, et al. Five-year follow-up results of a randomized controlled study comparing intramedullary nailing with plate fixation of completely displaced midshaft fractures of the clavicle in adults. JBJS Open Access, 2018, 3(4): e0009. doi: 0.2106/JBJS.OA.18.00009. doi: 10.2106/JBJS.OA.18.00009.
9. van der Meijden OA, Houwert RM, Hulsmans M, et al. Operative treatment of dislocated midshaft clavicular fractures: plate or intramedullary nail fixation? A randomized controlled trial. J Bone Joint Surg (Am), 2015, 97(8): 613-619.
10. Lubbert PH, van der Rijt RH, Hoorntje LE, et al. Low-intensity pulsed ultrasound (LIPUS) in fresh clavicle fractures: a multi-centre double blind randomised controlled trial. Injury, 2008, 39(12): 1444-1452.
11. Napora JK, Grimberg DC, Childs BR, et al. Results and outcomes after midshaft clavicle fracture: matched pair analysis of operative versus nonoperative management. Orthopedics, 2018, 41(5): e689-e694.
12. Napora JK, Grimberg D, Childs BR, et al. Factors affecting functional outcomes after clavicle fracture. J Am Acad Orthop Surg, 2016, 24(10): 721-727.
13. Murray IR, Foster CJ, Eros A, et al. Risk factors for nonunion after nonoperative treatment of displaced midshaft fractures of the clavicle. J Bone Joint Surg (Am), 2013, 95(13): 1153-1158.
14. Chen X, Shannon SF, Torchia M, et al. Radiographic outcomes of single versus dual plate fixation of acute mid-shaft clavicle fractures. Arch Orthop Trauma Surg, 2017, 137(6): 749-754.
15. Serrano R, Borade A, Mir H, et al. Anterior-inferior plating results in fewer secondary interventions compared to superior plating for acute displaced midshaft clavicle fractures. J Orthop Trauma, 2017, 31(9): 468-471.
16. Fang CX, Liu R, Yee DKH, et al. Comparison of radiological and clinical outcomes, complications, and implant removals in anatomically pre-contoured clavicle plates versus reconstruction plates—A propensity score matched retrospective cohort study of 106 patients. BMC Musculoskelet Disord, 2020, 21(1): 413. doi: 10.1186/s12891-020-03445-5.
17. Malik A, Jazini E, Song X, et al. Positional change in displacement of midshaft clavicle fractures: an aid to initial evaluation. J Orthop Trauma, 2017, 31(1): e9-e12.
18. Rugpolmuang L, Harnroongroj T, Sudjai N, et al. Comminution plays no role in worsening fracture healing of conservatively treated middle third clavicular fractures. Acta Orthop Traumatol Turc, 2016, 50(1): 32-36.
19. Riiser MO, Molund M. Long-term functional outcomes and complications in operative versus nonoperative treatment for displaced midshaft clavicle fractures in adolescents: A retrospective comparative study. J Pediatr Orthop, 2021, 41(5): 279-283.

Chinese Journal of Reparative and Reconstructive Surgery

Treatment of clavicle fracture: Interpretation of the 2023 American Academy of Orthopaedic Surgeons (AAOS) Clinical Practice Guidelines

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