Treatment of Clavicle Fractures Evidence-Based Clinical Practice Guideline is based on a systematic review of published studies examining the diagnosis and treatment of clavicle fractures. This guideline contains four recommendations and 10 options to assist orthopaedic surgeons and any other qualified healthcare professionals with determining the treatment of isolated clavicle fractures based on the best current available evidence. It is also intended to serve as an information resource for healthcare professionals and developers of practice guidelines and recommendations. In addition to providing pragmatic practice recommendations, this guideline also highlights gaps in the literature and informs areas for future research and quality measure development. This guideline has been endorsed by the Orthopaedic Trauma Association, the American Shoulder and Elbow Surgeons, and the American Society of Shoulder and Elbow Therapists.

BACKGROUND: Clavicle shaft fractures are among the most common fractures in childhood and adolescence. In the past they were almost exclusively treated conservatively but in recent years there has been an increase in surgical treatment. Nevertheless, exact recommendations for the choice of diagnostics and for the treatment regimen do not yet exist.
METHODS: Therefore, our aim was to develop a consensus within the 7th scientific working meeting of the section for pediatric traumatology in the German Society for Trauma Surgery based on expert opinion.
RESULTS: Single-plane radiographic imaging is considered the gold standard diagnostic tool. Children younger than 10 years are primarily treated conservatively, and the type of immobilization is secondary. In girls older than 12 years and boys older than 14 years, fractures dislocated by more than the shaft width and shortened by > 2 cm should be treated by open reduction and stabilized by osteosynthesis, followed by free-functional follow-up treatment.
CONCLUSIONS: In addition to X‑rays, diagnostics using ultrasound must be further established. Treatment continues to be primarily conservative, but surgical treatment is also important, especially in adolescents. If the indications are correct, a good outcome can be expected regardless of the choice of treatment.
UNASSIGNED: EINLEITUNG: Claviculaschaftfrakturen gehören zu den häufigsten Frakturen im Kindes- und Jugendalter. Früher wurden diese fast ausschließlich konservativ therapiert, in den letzten Jahren zeigte sich jedoch eine Zunahme der operativen Versorgungen. Klare Empfehlungen zur Diagnostik und zur Therapiewahl für diese Verletzung gibt es bisher nicht.
METHODS: Ziel war deshalb, im Rahmen des 7. wissenschaftlichen Arbeitstreffens der Sektion für Kindertraumatologie in der Deutschen Gesellschaft für Unfallchirurgie einen Konsens auf Basis der Expertenmeinung zu erarbeiten.
UNASSIGNED: Die Röntgendarstellung in einer Ebene gilt als Goldstandarddiagnostikum. Kinder unter 10 Jahren werden vornehmlich konservativ behandelt; die Art der Ruhigstellung ist zweitrangig. Bei Mädchen älter als 12 Jahre und Jungen älter als 14 Jahre sollten um mehr als Schaftbreite dislozierte und > 2 cm verkürzte Frakturen offen reponiert und osteosynthetisch stabilisiert werden, gefolgt von einer freifunktionellen Nachbehandlung.
UNASSIGNED: Neben dem Röntgen gilt es, die Ultraschalldiagnostik weiter zu etablieren. Die Therapie erfolgt weiterhin vornehmlich konservativ, die operative Therapie hat jedoch ebenfalls einen Stellenwert, insbesondere bei Jugendlichen. Bei korrekter Indikationsstellung ist unabhängig von der Therapiewahl von einem guten Outcome auszugehen.

The choice of treatment for midshaft clavicular fractures is not straightforward, but depends on fracture characteristics such as comminution, angulation and displacement. An online survey was conducted amongst trauma and orthopaedic surgeons to determine the preferred treatment for midshaft clavicular fractures, based on anteroposterior radiographs, for 17 randomly selected displaced or comminuted midshaft clavicular fractures. The background and experience of the respondents were documented. Data were analyzed using a Generalized Estimating Equations (GEE) model. The 102 respondents preferred non-operative treatment more frequently for displaced fractures than for comminuted fractures (OR 3.24, 95% CI 2.55-4.12). Locking plate fixation was more often preferred over other surgical modalities for comminuted than for displaced fractures (OR 1.50, 95% CI 1.17-1.91). In clinical practice, there is no consensus between surgeons on the choice of treatment for displaced or comminuted midshaft clavicular fractures. This lack of agreement calls for evidence-based treatment guidelines for these fractures.

The choice of treatment for midshaft clavicular fractures is not straightforward, but depends on fracture characteristics such as comminution, angulation and displacement. An online survey was conducted amongst trauma and orthopaedic surgeons to determine the preferred treatment for midshaft clavicular fractures, based on anteroposterior radiographs, for 17 randomly selected displaced or comminuted midshaft clavicular fractures. The background and experience of the respondents were documented. Data were analyzed using a Generalized Estimating Equations (GEE) model. The 102 respondents preferred non-operative treatment more frequently for displaced fractures than for comminuted fractures (OR 3.24, 95% CI 2.55-4.12). Locking plate fixation was more often preferred over other surgical modalities for comminuted than for displaced fractures (OR 1.50, 95% CI 1.17-1.91). In clinical practice, there is no consensus between surgeons on the choice of treatment for displaced or comminuted midshaft clavicular fractures. This lack of agreement calls for evidence-based treatment guidelines for these fractures.

Adolescent participation in sports is at an all-time high. Younger patients also are competing with a greater intensity level, frequently playing organized sports throughout the year. Players are putting greater demands on their shoulders, making them more prone to injuries. Because these players are in the process of skeletal development, certain considerations are needed for this patient population. There is controversy regarding the appropriate treatment of these adolescent athletes- including debate on injury prevention; nonsurgical treatment versus surgical treatment; overuse injuries; and return to play after shoulder fractures, dislocations, and instability. It is valuable to review evidence in the current literature regarding recommendations for the treatment of shoulder injuries in adolescent athletes.

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