Overtreatment of displaced midshaft clavicle fractures

Background and purpose — The best treatment for displaced clavicle fractures has been debated for decades. Operative treat- ment has become more common. However, several randomized trials comparing non-operative and operative treatment have not shown any compelling evidence in favor of surgery. We identifi ed the preferred treatment of displaced midshaft clavicle fractures at public hospitals in 3 countries in Scandinavia. Patients and methods — A purpose-made multiple-choice ques- tionnaire in English was sent to all public hospitals in Denmark, Sweden, and Finland. This was addressed to the orthopedic sur- geon responsible for treatment of clavicle fractures, and com- pleted questionnaires were obtained from 85 of 118 hospitals. Results — In the 3 countries, 69 of the 85 hospitals that responded would treat displaced clavicle fractures operatively. Clear criteria for treatment allocation were used at 58 of the hospitals, with the remaining 27 using individual assessment in collaboration with the patient. Precontoured locking plates were mostly used, placed either superiorly (64/85) or anteriorly (10/85). Interpretation — Displaced midshaft clavicle fractures are mainly treated operatively in Sweden, Denmark, and Finland. This treatment is not supported by compelling evidence.