Bicycle injuries are by far the most common mechanism of injury for clavicle injuries. The image is CC by Hiroyuki Takeda.

So… just a few days after my previous clavicle post, Ahrens et al released their multi-center study on 300 patients randomized to surgery. They found that operated clavicles have less pain early on, but that after 9 months they perform the same. The study was excellently performed with 20 centers, adequate patient selection, random block permutation for treatment allocation, and reasonable treatment options. Continue reading →

Finding the right path can be harder than we want to think . The image is CC by Gwenole Camus.

In the early 2000s Nowak et al. [1] shattered the belief that mid-shaft clavicle fractures always healed fine; even after 10 years almost half of the patients had remaining symptoms*. This common injury had also by in others [2] (with shorter follow-ups) been hinted as problematic, and within short we were showered with fancy new implants. After ≥ 7 RCTs [3], [4] on the subjects it seems that these new implants failed do deliver. Can we finally start questioning if surgery is the solution? Continue reading →