CURRENT TRENDS IN THE MANAGEMENT OF MIDSHAFT CLAVICLE FRACTURES: A SYSTEMATIC REVIEW

Marcin Stępiński; Kornel Pawlak; Julia Dobrowolska; Marta Krężołek; Mateusz Balicki; Paula Kaczmarczyk; Alicja Palus; Oliwia Zynek; Tomasz Arkuszyński; Filip Kamyszek

doi:10.31435/ijitss.2(50).2026.5574

Authors

Marcin Stępiński Medical University of Warsaw, Warsaw, Poland https://orcid.org/0009-0004-5878-6293
Kornel Pawlak Medical University of Warsaw, Warsaw, Poland https://orcid.org/0009-0009-6435-6587
Julia Dobrowolska Medical University of Warsaw, Warsaw, Poland https://orcid.org/0009-0008-9498-9521
Marta Krężołek Medical University of Warsaw, Warsaw, Poland https://orcid.org/0009-0004-3646-5640
Mateusz Balicki Corten Dental Medical Center, Warsaw, Poland https://orcid.org/0009-0002-5066-9645
Paula Kaczmarczyk CITODENT Dental Center, Oława, Poland https://orcid.org/0009-0005-6099-5657
Alicja Palus PRODENTAL Private Dental Clinic – Joanna Bronowska, Legionowo, Poland https://orcid.org/0009-0002-7462-6893
Oliwia Zynek Medical University of Warsaw, Warsaw, Poland https://orcid.org/0009-0000-5537-565X
Tomasz Arkuszyński Wroclaw Medical University, Wroclaw, Poland https://orcid.org/0009-0001-4894-361X
Filip Kamyszek Corten Dental Medical Center, Warsaw, Poland https://orcid.org/0009-0000-2767-8215

DOI:

https://doi.org/10.31435/ijitss.2(50).2026.5574

Keywords:

Clavicle Fracture, Meta-Analysis, Surgical Fixation, Non-Operative Management, Trauma, Orthopedic Surgery

Abstract

Introduction: Clavicle shaft fractures account for up to 80% of all injuries to this bone. For decades, conservative treatment remained the gold standard, based on historical reports of a minimal (0.6%) non-union rate. However, modern diagnostics and increasing patient expectations regarding biomechanical performance have necessitated a revision of these views.

Aim of the study: To analyze the effectiveness of surgical versus conservative treatment based on literature from 2021–2026, with a particular focus on union rates, functional outcomes, and complication profiles.

Material and methods: A review of the PubMed, Cochrane Library, Scopus, and Google Scholar databases was conducted. The analysis included meta-analyses, systematic reviews, and randomized controlled trials (RCTs) involving adult patients with clavicle shaft fractures.

Results: Contemporary data indicate that the non-union rate for conservative treatment is approximately 11%, whereas surgical stabilization (ORIF) reduces this risk by 77%. Surgically treated patients achieve significantly better short-term functional outcomes (at 6 weeks: DASH improved by 9.4 points; CMS: SMD = 0.49), which is of key economic and performance importance for athletes and manual workers. Although long-term results for both groups eventually align, surgical intervention allows for a faster return to full function (3.1 vs. 3.9 months). Conservative treatment eliminates iatrogenic risks but is associated with the risk of scapular dyskinesis when bone shortening exceeds 2 cm, as well as more frequent patient dissatisfaction with aesthetic outcomes.

Conclusions: Current scientific evidence indicates the superiority of surgical treatment in terms of union reliability and rehabilitation speed. However, the choice of method requires personalization - balancing the risk of postoperative complications against potential biomechanical dysfunction resulting from clavicular shortening.

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