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Carvajal-Escobar, M. D. ., Gómez-Londoño, C. ., Borja-Gómez, W. ., & Sepúlveda-Gallego, L. E. . (2016). Diaphyseal clavicle fracture: review of published evidence. Biosalud, 15(1), 87–97. https://doi.org/10.17151/biosa.2016.15.1.10
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Abstract
Introduction: The clavicle is one of the bones more prone to injury because due to their subcutaneous and relative anterior position. Its management, either orthopedic or surgical, remains controversial. Therefore, the objective that guided this review was to identify current trends in the diagnosis and management of broken clavicle. Materials and Methods: a review of articles was conducted using PubMed / Medline, ScienceDirect, Embase, Ovid, and SpringerLink databases. Fifty-seven (57) references were selected based on the quality of the evidence they presented. Results and Discussion: Choosing the most appropriate treatment for broken clavicle continues to be a challenge for the orthopedist. The analysis should be based on the individual characteristics of each patient, a careful consideration of the benefits and the relative harms of each intervention, as well as patient preferences. To advance in the definition of therapeutic standards, are required the performance of studies that take into account a greater number of individuals particularly in the extremes of life, which allow generating a higher level of evidence.
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References
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2. Jeray KJ. Acute midshaft clavicular fracture. J Am Acad Orthop Surg 2007; 15(4):239-248.
3. O’Neill BJ, Hirpara KM, O’Briain D, McGarr C, Kaar TK. Clavicle fractures: a comparison of five classification systems and their relationship to treatment outcomes. Int Orthop 2011; 35(6):909-914.
4. Smekal V, Oberladstaetter J, Struve P, Krappinger D. Shaft fractures of the clavicle: current concepts. Arch Orthop Trauma Surg 2009; 129(6):807-815.
5. Alshameeri ZA, Katam K, Alsamaq M, Sonsale P. The outcome of surgical fixation of midshaft clavicle fractures; looking at patient satisfaction and comparing surgical approaches. Int J Shoulder Surg 2012; 6(3):76-81.
6. Vargas G. Fracturas diafisiarias de la clavícula: comparación entre tratamiento quirúrgico y ortopédico. Rev. Colomb. Ortop. Traumatol. 2009; 23(2):115-119.
7. Eskola A, Vainionpaa S, Myllynen P, Patiala H, Rokkanen P. Outcome of clavicular fracture in 89 patients. Arch Orthop Trauma Surg 1986; 105(6):337-338.
8. Robinson CM, Court-Brown CM, McQueen MM, Wakefield AE. Estimating the risk of nonunion following nonoperative treatment of a clavicular fracture. J Bone Joint Surg Am 2004; 86-A(7):1359-1365.
9. Postacchini R, Gumina S, Farsetti P, Postacchini F. Long-term results of conservative management of midshaft clavicle fracture. Int Orthop 2010; 34(5):731-736.
10. Wijdicks FJ, Houwert RM, Millett PJ, Verleisdonk EJ, Van der Meijden OA. Systematic review of complications after intramedullary fixation for displaced midshaft clavicle fractures. Can J Surg 2013; 56(1):58-64.
11. Edmonds EW. Use of an absorbable plate in the management of a clavicle fracture in an adolescent. Am J Orthop (Belle Mead NJ) 2012; 41(1):29-32.
12. Singh R, Rambani R, Kanakaris N, Giannoudis PV. A 2-year experience, management and outcome of 200 clavicle fractures. Injury 2012; 43(2):159-163.
13. Schiffer G, Faymonville C, Skouras E, Andermahr J, Jubel A. Midclavicular fracture: not just a trivial injury: current treatment options. Dtsch Arztebl Int 2010; 107(41):711-717.
14. Lee YS, Huang HL, Lo TY, Hsieh YF, Huang CR. Surgical treatment of midclavicular fractures: a prospective comparison of Knowles pinning and plate fixation. Int Orthop 2008; 32(4):541-545.
15. Mirzatolooei F. Comparison between operative and nonoperative treatment methods in the management of comminuted fractures of the clavicle. Acta Orthop Traumatol Turc 2011; 45(1):34-40.
16. Namdari S, Ganley TJ, Baldwin K, Rendon Sampson N, Hosalkar H, Nikci V, et al. Fixation of displaced midshaft clavicle fractures in skeletally immature patients. J Pediatr Orthop 2011; 31(5):507-511.
17. Vander Have KL, Perdue AM, Caird MS, Farley FA. Operative versus nonoperative treatment of midshaft clavicle fractures in adolescents. J Pediatr Orthop 2010; 30(4):307-312.
18. Houwert RM, Wijdicks FJ, Steins Bisschop C, Verleisdonk EJ, Kruyt M. Plate fixation versus intramedullary fixation for displaced mid-shaft clavicle fractures: a systematic review. Int Orthop 2012; 36(3):579-585.
19. Wijdicks FJ, Houwert M, Dijkgraaf M, De Lange D, Oosterhuis K, Clevers G, et al. Complications after plate fixation and elastic stable intramedullary nailing of dislocated midshaft clavicle fractures: a retrospective comparison. Int Orthop 2012; 36(10):2139-2145.
20. Hillen RJ, Burger BJ, Poll RG, De Gast A, Robinson CM. Malunion after midshaft clavicle fractures in adults. Acta Orthop 2010; 81(3):273-279.
21. Malik S, Chiampas G, Leonard H. Emergent evaluation of injuries to the shoulder, clavicle, and humerus. Emerg Med Clin North Am 2010; 28(4):739-763.
22. Concha J, Gerstner J, Gallón L, Bárcenas C. Patrón de fracturas en el Hospital Universitario Cali. Rev. Colomb. Ortop. Traumatol.1990; 4(3):247-250.
23. Stegeman SA, Roeloffs CW, Van den Bremer J, Krijnen P, Schipper IB. The relationship between trauma mechanism, fracture type, and treatment of midshaft clavicular fractures. Eur J Emerg Med 2013; 20(4):268-272.
24. Van der Meijden OA, Gaskill TR, Millett PJ. Treatment of clavicle fractures: current concepts review. J Shoulder Elbow Surg 2012; 21(3):423-429.
25. Bachoura A, Deane AS, Kamineni S. Clavicle anatomy and the applicability of intramedullary midshaft fracture fixation. J Shoulder Elbow Surg 2012; 21(10):1384-1390.
26. Jubel A, Andermahr J. Intramedullary nailing of the clavicle. San Francisco, CA. AAOS march 2008 annual meeting (Abstracts, 75th annual meeting proceedings, 9:302-303).
27. Jubel A, Andermahr J, Schiffer G, Tsironis K, Rehm KE. Elastic stable intramedullary nailing of midclavicular fractures with a titanium nail. Clin Orthop Relat Res 2003; 408:279-285.
28. Arismendi A, Sarassa C. Fractura del tercio lateral de la clavícula en pacientes adolescentes: reporte de caso. Rev. Colomb. Ortop. Traumatol 2009; 23(4):229-233.
29. Zlowodzki M, Zelle BA, Cole PA, Jeray K, McKee MD. Treatment of acute midshaft clavicle fractures: systematic review of 2144 fractures: on behalf of the Evidence-Based Orthopaedic Trauma Working Group. J Orthop Trauma 2005; 19(7):504-507.
30. Caird MS. Clavicle shaft fractures: are children little adults? J Pediatr Orthop 2012; 32(Suppl 1):S1- 4.
31. Bajuri MY, Maidin S, Rauf A, Baharuddin M, Harjeet S. Functional outcomes of conservatively treated clavicle fractures. Clinics (Sao Paulo) 2011; 66(4):635-639.
32. Shin SJ, Do NH, Jang KY. Risk factors for postoperative complications of displaced clavicular midshaft fractures. J Trauma Acute Care Surg 2012; 72(4):1046-1050.
33. Simon P. Mid-clavicle fractures in adults: surgery or not? Eur J Orthop Surg Traumatol 2010; 20(7):521- 525.
34. Liu GD, Tong SL, Ou S, Zhou LS, Fei J, Nan GX, Gu JW. Operative versus non-operative treatment for clavicle fracture: a meta-analysis. Int Orthop 2013; 37(8):1495-1500.
35. Wijdicks FJ, Van der Meijden OA, Millett PJ, Verleisdonk EJ, Houwert RM. Systematic review of the complications of plate fixation of clavicle fractures. Arch Orthop Trauma Surg 2012; 132(5):617-625.
36. Fu TH, Tan BL, Liu HC, Wang JW. Anatomical reduction for treatment of displaced midshaft clavicular fractures: Knowles pinning vs. reconstruction plating. Orthopedics 2012; 35(1):e23-30.
37. Paul SP, Heaton PA, Patel K. Breaking it to them gently: fractured clavicle in the newborn. Pract Midwife 2013; 16(9):31-34.
38. Kleweno CP, Jawa A, Wells JH, O’Brien TG, Higgins LD, Harris MB, et al. Midshaft clavicular fractures: comparison of intramedullary pin and plate fixation. J Shoulder Elbow Surg 2011; 20(7):1114-1117.
39. Peroni L. Medullary osteosynthesis in the treatment of clavicle fractures. Arch Ortop 1950; 63(4):398- 405.
40. Assobhi JE. Reconstruction plate versus minimal invasive retrograde titanium elastic nail fixation for displaced midclavicular fractures. J Orthop Traumatol 2011; 12(4):185-192.
41. Walz M, Kolbow B, Auerbach F. Elastic, stable intramedullary nailing in midclavicular fractures - a change in treatment strategies? Unfallchirurg 2006; 109(3):200-211.
42. Lee HJ, Oh CW, Oh JK, Yoon JP, Kim JW, Na SB, Kyung HS. Percutaneous plating for comminuted midshaft fractures of the clavicle: a surgical technique to aid the reduction with nail assistance. Injury 2013; 44(4):465-470.
43. Millett PJ, Hurst JM, Horan MP, Hawkins RJ. Complications of clavicle fractures treated with intramedullary fixation. J Shoulder Elbow Surg 2011; 20(1):86-91.
44. Lenza M, Belloti JC, Andriolo RB, Gomes Dos Santos JB, Faloppa F. Conservative interventions for treating middle third clavicle fractures in adolescents and adults. Cochrane Database Syst Rev 2009; 15(2):CD007121.
45. McKee RC, Whelan DB, Schemitsch EH, McKee MD. Operative versus nonoperative care of displaced midshaft clavicular fractures: a meta-analysis of randomized clinical trials. J Bone Joint Surg Am 2012; 94(8):675-684.
46. Stegeman SA, et al. Displaced midshaft fractures of the clavicle: non-operative treatment versus plate fixation (Sleutel-TRIAL). A multicentre randomised controlled trial. BMC Musculoskelet Disord 2011; 12:196.
47. Mudd CD, Quigley KJ, Gross LB. Excessive complications of open intramedullary nailing of midshaft clavicle fractures with the Rockwood Clavicle Pin. Clin Orthop Relat Res 2011; 469(12):3364-3370.
48. Liu PC, Chien SH, Chen JC, Hsieh CH, Chou PH, Lu CC. Minimally invasive fixation of displaced midclavicular fractures with titanium elastic nails. J Orthop Trauma 2010; 24(4):217-223.
49. Kulshrestha V, Roy T, Audige L. Operative versus nonoperative management of displaced midshaft clavicle fractures: a prospective cohort study. J Orthop Trauma 2011; 25(1):31-38.
50. Martetschläger F, Gaskill TR, Millett PJ. Management of clavicle nonunion and malunion. J Shoulder Elbow Surg 2013; 22(6):862-868.
51. Rehn CH, Kirkegaard M, Viberg B, Larsen MS. Operative versus nonoperative treatment of displaced midshaft clavicle fractures in adults: a systematic review. Eur J Ortopedic Surg Traumatol 2013. Available from: 10.1007/s00590-013-1370-3
52. Lenza M, Buchbinder R, Johnston RV, Belloti JC, Faloppa F. Surgical versus conservative interventions for treating fractures of the middle third of the clavicle. Cochrane Database Syst Rev 2013; 6:CD009363.
53. Duan X, Zhong G, Cen S, Huang F, Xiang Z. Plating versus intramedullary pin or conservative treatment for midshaft fracture of clavicle: a meta-analysis of randomized controlled trials. J Shoulder Elbow Surg 2011; 20(6):1008-1115.
54. Xu CP, Li X, Cui Z, Diao XC, Yu B. Should displaced midshaft clavicular fractures be treated surgically? A meta-analysis based on current evidence. Eur J Orthop Surg Traumatol 2013; 23(6):621-629.
55. McKee MD. Clavicle fractures in 2010: sling/swathe or open reduction and internal fixation? Orthop Clin North Am 2010; 41(2):225-231.
56. Lenza M, Belloti JC, Gomes Dos Santos JB, Matsumoto MH, Faloppa F. Surgical interventions for treating acute fractures or non-union of the middle third of the clavicle. Cochrane Database Syst Rev 2009; 4:CD007428.
57. Kadakia AP, Rambani R, Qamar F, McCoy S, Koch L, Venkateswaran B. Titanium elastic stable intramedullary nailing of displaced midshaft clavicle fractures: A review of 38 cases. Int J Shoulder Surg 2012; 6(3):82-85.
2. Jeray KJ. Acute midshaft clavicular fracture. J Am Acad Orthop Surg 2007; 15(4):239-248.
3. O’Neill BJ, Hirpara KM, O’Briain D, McGarr C, Kaar TK. Clavicle fractures: a comparison of five classification systems and their relationship to treatment outcomes. Int Orthop 2011; 35(6):909-914.
4. Smekal V, Oberladstaetter J, Struve P, Krappinger D. Shaft fractures of the clavicle: current concepts. Arch Orthop Trauma Surg 2009; 129(6):807-815.
5. Alshameeri ZA, Katam K, Alsamaq M, Sonsale P. The outcome of surgical fixation of midshaft clavicle fractures; looking at patient satisfaction and comparing surgical approaches. Int J Shoulder Surg 2012; 6(3):76-81.
6. Vargas G. Fracturas diafisiarias de la clavícula: comparación entre tratamiento quirúrgico y ortopédico. Rev. Colomb. Ortop. Traumatol. 2009; 23(2):115-119.
7. Eskola A, Vainionpaa S, Myllynen P, Patiala H, Rokkanen P. Outcome of clavicular fracture in 89 patients. Arch Orthop Trauma Surg 1986; 105(6):337-338.
8. Robinson CM, Court-Brown CM, McQueen MM, Wakefield AE. Estimating the risk of nonunion following nonoperative treatment of a clavicular fracture. J Bone Joint Surg Am 2004; 86-A(7):1359-1365.
9. Postacchini R, Gumina S, Farsetti P, Postacchini F. Long-term results of conservative management of midshaft clavicle fracture. Int Orthop 2010; 34(5):731-736.
10. Wijdicks FJ, Houwert RM, Millett PJ, Verleisdonk EJ, Van der Meijden OA. Systematic review of complications after intramedullary fixation for displaced midshaft clavicle fractures. Can J Surg 2013; 56(1):58-64.
11. Edmonds EW. Use of an absorbable plate in the management of a clavicle fracture in an adolescent. Am J Orthop (Belle Mead NJ) 2012; 41(1):29-32.
12. Singh R, Rambani R, Kanakaris N, Giannoudis PV. A 2-year experience, management and outcome of 200 clavicle fractures. Injury 2012; 43(2):159-163.
13. Schiffer G, Faymonville C, Skouras E, Andermahr J, Jubel A. Midclavicular fracture: not just a trivial injury: current treatment options. Dtsch Arztebl Int 2010; 107(41):711-717.
14. Lee YS, Huang HL, Lo TY, Hsieh YF, Huang CR. Surgical treatment of midclavicular fractures: a prospective comparison of Knowles pinning and plate fixation. Int Orthop 2008; 32(4):541-545.
15. Mirzatolooei F. Comparison between operative and nonoperative treatment methods in the management of comminuted fractures of the clavicle. Acta Orthop Traumatol Turc 2011; 45(1):34-40.
16. Namdari S, Ganley TJ, Baldwin K, Rendon Sampson N, Hosalkar H, Nikci V, et al. Fixation of displaced midshaft clavicle fractures in skeletally immature patients. J Pediatr Orthop 2011; 31(5):507-511.
17. Vander Have KL, Perdue AM, Caird MS, Farley FA. Operative versus nonoperative treatment of midshaft clavicle fractures in adolescents. J Pediatr Orthop 2010; 30(4):307-312.
18. Houwert RM, Wijdicks FJ, Steins Bisschop C, Verleisdonk EJ, Kruyt M. Plate fixation versus intramedullary fixation for displaced mid-shaft clavicle fractures: a systematic review. Int Orthop 2012; 36(3):579-585.
19. Wijdicks FJ, Houwert M, Dijkgraaf M, De Lange D, Oosterhuis K, Clevers G, et al. Complications after plate fixation and elastic stable intramedullary nailing of dislocated midshaft clavicle fractures: a retrospective comparison. Int Orthop 2012; 36(10):2139-2145.
20. Hillen RJ, Burger BJ, Poll RG, De Gast A, Robinson CM. Malunion after midshaft clavicle fractures in adults. Acta Orthop 2010; 81(3):273-279.
21. Malik S, Chiampas G, Leonard H. Emergent evaluation of injuries to the shoulder, clavicle, and humerus. Emerg Med Clin North Am 2010; 28(4):739-763.
22. Concha J, Gerstner J, Gallón L, Bárcenas C. Patrón de fracturas en el Hospital Universitario Cali. Rev. Colomb. Ortop. Traumatol.1990; 4(3):247-250.
23. Stegeman SA, Roeloffs CW, Van den Bremer J, Krijnen P, Schipper IB. The relationship between trauma mechanism, fracture type, and treatment of midshaft clavicular fractures. Eur J Emerg Med 2013; 20(4):268-272.
24. Van der Meijden OA, Gaskill TR, Millett PJ. Treatment of clavicle fractures: current concepts review. J Shoulder Elbow Surg 2012; 21(3):423-429.
25. Bachoura A, Deane AS, Kamineni S. Clavicle anatomy and the applicability of intramedullary midshaft fracture fixation. J Shoulder Elbow Surg 2012; 21(10):1384-1390.
26. Jubel A, Andermahr J. Intramedullary nailing of the clavicle. San Francisco, CA. AAOS march 2008 annual meeting (Abstracts, 75th annual meeting proceedings, 9:302-303).
27. Jubel A, Andermahr J, Schiffer G, Tsironis K, Rehm KE. Elastic stable intramedullary nailing of midclavicular fractures with a titanium nail. Clin Orthop Relat Res 2003; 408:279-285.
28. Arismendi A, Sarassa C. Fractura del tercio lateral de la clavícula en pacientes adolescentes: reporte de caso. Rev. Colomb. Ortop. Traumatol 2009; 23(4):229-233.
29. Zlowodzki M, Zelle BA, Cole PA, Jeray K, McKee MD. Treatment of acute midshaft clavicle fractures: systematic review of 2144 fractures: on behalf of the Evidence-Based Orthopaedic Trauma Working Group. J Orthop Trauma 2005; 19(7):504-507.
30. Caird MS. Clavicle shaft fractures: are children little adults? J Pediatr Orthop 2012; 32(Suppl 1):S1- 4.
31. Bajuri MY, Maidin S, Rauf A, Baharuddin M, Harjeet S. Functional outcomes of conservatively treated clavicle fractures. Clinics (Sao Paulo) 2011; 66(4):635-639.
32. Shin SJ, Do NH, Jang KY. Risk factors for postoperative complications of displaced clavicular midshaft fractures. J Trauma Acute Care Surg 2012; 72(4):1046-1050.
33. Simon P. Mid-clavicle fractures in adults: surgery or not? Eur J Orthop Surg Traumatol 2010; 20(7):521- 525.
34. Liu GD, Tong SL, Ou S, Zhou LS, Fei J, Nan GX, Gu JW. Operative versus non-operative treatment for clavicle fracture: a meta-analysis. Int Orthop 2013; 37(8):1495-1500.
35. Wijdicks FJ, Van der Meijden OA, Millett PJ, Verleisdonk EJ, Houwert RM. Systematic review of the complications of plate fixation of clavicle fractures. Arch Orthop Trauma Surg 2012; 132(5):617-625.
36. Fu TH, Tan BL, Liu HC, Wang JW. Anatomical reduction for treatment of displaced midshaft clavicular fractures: Knowles pinning vs. reconstruction plating. Orthopedics 2012; 35(1):e23-30.
37. Paul SP, Heaton PA, Patel K. Breaking it to them gently: fractured clavicle in the newborn. Pract Midwife 2013; 16(9):31-34.
38. Kleweno CP, Jawa A, Wells JH, O’Brien TG, Higgins LD, Harris MB, et al. Midshaft clavicular fractures: comparison of intramedullary pin and plate fixation. J Shoulder Elbow Surg 2011; 20(7):1114-1117.
39. Peroni L. Medullary osteosynthesis in the treatment of clavicle fractures. Arch Ortop 1950; 63(4):398- 405.
40. Assobhi JE. Reconstruction plate versus minimal invasive retrograde titanium elastic nail fixation for displaced midclavicular fractures. J Orthop Traumatol 2011; 12(4):185-192.
41. Walz M, Kolbow B, Auerbach F. Elastic, stable intramedullary nailing in midclavicular fractures - a change in treatment strategies? Unfallchirurg 2006; 109(3):200-211.
42. Lee HJ, Oh CW, Oh JK, Yoon JP, Kim JW, Na SB, Kyung HS. Percutaneous plating for comminuted midshaft fractures of the clavicle: a surgical technique to aid the reduction with nail assistance. Injury 2013; 44(4):465-470.
43. Millett PJ, Hurst JM, Horan MP, Hawkins RJ. Complications of clavicle fractures treated with intramedullary fixation. J Shoulder Elbow Surg 2011; 20(1):86-91.
44. Lenza M, Belloti JC, Andriolo RB, Gomes Dos Santos JB, Faloppa F. Conservative interventions for treating middle third clavicle fractures in adolescents and adults. Cochrane Database Syst Rev 2009; 15(2):CD007121.
45. McKee RC, Whelan DB, Schemitsch EH, McKee MD. Operative versus nonoperative care of displaced midshaft clavicular fractures: a meta-analysis of randomized clinical trials. J Bone Joint Surg Am 2012; 94(8):675-684.
46. Stegeman SA, et al. Displaced midshaft fractures of the clavicle: non-operative treatment versus plate fixation (Sleutel-TRIAL). A multicentre randomised controlled trial. BMC Musculoskelet Disord 2011; 12:196.
47. Mudd CD, Quigley KJ, Gross LB. Excessive complications of open intramedullary nailing of midshaft clavicle fractures with the Rockwood Clavicle Pin. Clin Orthop Relat Res 2011; 469(12):3364-3370.
48. Liu PC, Chien SH, Chen JC, Hsieh CH, Chou PH, Lu CC. Minimally invasive fixation of displaced midclavicular fractures with titanium elastic nails. J Orthop Trauma 2010; 24(4):217-223.
49. Kulshrestha V, Roy T, Audige L. Operative versus nonoperative management of displaced midshaft clavicle fractures: a prospective cohort study. J Orthop Trauma 2011; 25(1):31-38.
50. Martetschläger F, Gaskill TR, Millett PJ. Management of clavicle nonunion and malunion. J Shoulder Elbow Surg 2013; 22(6):862-868.
51. Rehn CH, Kirkegaard M, Viberg B, Larsen MS. Operative versus nonoperative treatment of displaced midshaft clavicle fractures in adults: a systematic review. Eur J Ortopedic Surg Traumatol 2013. Available from: 10.1007/s00590-013-1370-3
52. Lenza M, Buchbinder R, Johnston RV, Belloti JC, Faloppa F. Surgical versus conservative interventions for treating fractures of the middle third of the clavicle. Cochrane Database Syst Rev 2013; 6:CD009363.
53. Duan X, Zhong G, Cen S, Huang F, Xiang Z. Plating versus intramedullary pin or conservative treatment for midshaft fracture of clavicle: a meta-analysis of randomized controlled trials. J Shoulder Elbow Surg 2011; 20(6):1008-1115.
54. Xu CP, Li X, Cui Z, Diao XC, Yu B. Should displaced midshaft clavicular fractures be treated surgically? A meta-analysis based on current evidence. Eur J Orthop Surg Traumatol 2013; 23(6):621-629.
55. McKee MD. Clavicle fractures in 2010: sling/swathe or open reduction and internal fixation? Orthop Clin North Am 2010; 41(2):225-231.
56. Lenza M, Belloti JC, Gomes Dos Santos JB, Matsumoto MH, Faloppa F. Surgical interventions for treating acute fractures or non-union of the middle third of the clavicle. Cochrane Database Syst Rev 2009; 4:CD007428.
57. Kadakia AP, Rambani R, Qamar F, McCoy S, Koch L, Venkateswaran B. Titanium elastic stable intramedullary nailing of displaced midshaft clavicle fractures: A review of 38 cases. Int J Shoulder Surg 2012; 6(3):82-85.
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