CLOSED TREATMENT OF DISPLACED MIDDLE-THIRD FRACTURES OF THE CLAVICLE GIVES POOR RESULTSJ. M. Hill, MD, Orthopaedic SurgeonOrthopaedic Associates, 1300 East Central Road, Arlington Heights, Illinois 60005, USA. M. H. McGuire, MD, Professor and Chairman Department of Surgery L. A. Crosby, MD, Associate Professor Division of Orthopaedic Surgery, Creighton University, 601 North 30th Street, Omaha, Nebraska 68131, USA. Correspondence should be sent to Dr L. A. Crosby. We evaluated 242 consecutive fractures of the clavicle in adults which had been treated conservatively. Of these, 66 (27%) were originally in the middle third of the clavicle and had been completely displaced. We reviewed 52 of these patients at a mean of 38 months after injury. Eight of the 52 fractures (15%) had developed nonunion, and 16 patients (31%) reported unsatisfactory results. Thirteen patients had mild to moderate residual pain and 15 had some evidence of brachial plexus irritation. Of the 28 who had cosmetic complaints, only 11 considered accepting corrective surgery. No patient had significant impairment of range of movement or shoulder strength as a result of the injury.
We found that initial shortening at the fracture of We now recommend open reduction and internal fixation of severely displaced fractures of the middle third of the clavicle in adult patients. This article has been cited by other articles:
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20 mm had a highly significant association with nonunion (p < 0.0001) and the chance of an unsatisfactory result. Final shortening of 20 mm or more was associated with an unsatisfactory result, but not with nonunion. No other patient variable, treatment factor, or fracture characteristic had a significant effect on outcome. 
