And I thought we were done with the mid-shaft clavicle….


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.

What surprised me was that they advocated for surgery due to the faster recovery and similar complication rates. Coming from a registry research perspective this strikes me as astonishing:

  • severe complications are not adequately captioned by a mere 150 patients
  • they considered removal of the plate as not serious, if any of these is a cases of nerve-pain as in the health-board discussion – it is a cause for concern as more surgery often doesn’t help in these cases
  • 9 months is a rather short perspective since mean age was 36 and most patients have an additional 40 years of life expectancy

I’m sure we will see a flood of meta-analysis on the subject… not sure the area will get any clearer though… I believe there are more pressing orthopaedic issues that need our attention.

P. M. F. 1 Ahrens, N. I. F. Garlick, J. Barber, E. M. Tims, and T. C. T. C. Group, “The Clavicle Trial: A Multicenter Randomized Controlled Trial Comparing Operative with Nonoperative Treatment of Displaced Midshaft Clavicle Fractures,” Journal of Bone, vol. 99, no. 16, pp. 1345–1354, Aug. 2017.

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