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Sling Compared with Plate Osteosynthesis for Treatment of Displaced Midshaft Clavicular FracturesA Randomized Clinical Trial
Kaisa J. Virtanen, MD1; Ville Remes, MD, PhD1; Jarkko Pajarinen, MD, PhD1; Vesa Savolainen, MD, PhD1; Jan-Magnus Björkenheim, MD, PhD1; Mika Paavola, MD, PhD1
1 Department of Orthopaedics and Traumatology, Helsinki University Central Hospital and University of Helsinki, Topeliuksenkatu 5, 00260 Helsinki, Finland. E-mail address for K. Virtanen: kaisa.virtanen@hus.fi
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Investigation performed at Helsinki University Central Hospital, Helsinki, Finland

This article was chosen to appear electronically on July 25, 2012, in advance of publication in a regularly scheduled issue.

A commentary by David Ring, MD, PhD, is linked to the online version of this article at jbjs.org.

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2012 Sep 05;94(17):1546-1553. doi: 10.2106/JBJS.J.01999
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Few randomized controlled trials have compared operative with nonoperative treatment of clavicular fractures.


Patients with displaced midshaft clavicular fractures were randomized either to nonoperative treatment with a sling or to operative treatment with a stainless steel 3.5-mm reconstruction plate. Outcome measures were the Constant shoulder score, DASH (Disabilities of the Arm, Shoulder and Hand) score, pain, fracture-healing, and complications. The null hypothesis was that the Constant and DASH scores would not differ between the groups at the one-year follow-up evaluation.


In accordance with the power analysis, we included sixty patients in the study; thirty-two were randomized to the nonoperative group and twenty-eight to the operative group. We found no difference in the Constant score (p = 0.75), the DASH score (p = 0.89), or pain (p = 0.98) between the groups at the one-year follow-up evaluation. All fractures in the operative group healed, but six nonunions (24%) occurred in the nonoperative group.


One year after a displaced midshaft clavicular fracture, nonoperative treatment resulted in a higher nonunion rate but similar function and disability compared with operative treatment.

Level of Evidence: 

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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