COPYRIGHT © SLACK INCORPORATED n Review Article T he clavicle is the most commonly broken bone in the human body, accounting for up to 5% to 10% of all fractures seen in hospital emergency admissions. These injuries are most com- mon in younger patients, often associated with direct trauma to the clavicle, as in contact sports and motor vehicle accidents. Males are affected more than females, and prevalence declines progressively with age, although traumatic falls in elderly pa- tients cause a bimodal peak in age distri- bution. 1 The clavicle is classically divided into thirds when describing the location of the fracture. Fractures of the middle third, or midshaft, are the most common, ac- counting for up to 80% of all clavicle frac- tures. 2,3 The location of the fracture, along with degree of displacement and associa- tion of surrounding structures, is important to consider for treatment. Traditionally, clavicle fractures have been treated with nonoperative management, but high-quali- ty randomized studies have recently begun to change the evidence-based management of these fractures. 4 The current review will present some relevant findings in the ongo- ing debate. ANATOMY The clavicle is a long, dual-curved bone that forms the only direct link be- tween the axial and appendicular skel- etons. 5-7 It is the first bone in the body to be ossified 7,8 (begins at 5 to 6 weeks’ gestation) 9 and the last bone to com- plete ossification 8 (the medial epiphysis completes ossification as late as age 27 years). 10 It is a highly variable structure in terms of length, although many stud- ies have shown the length to be approxi- mately 140 to 150 mm (range, 118-162 mm). 11-13 Midshaft Clavicle Fractures: A Critical Review JEREMY M. BURNHAM, MD; DANIEL C. KIM, MD; SRINATH KAMINENI, MD The clavicle is the most commonly broken bone in the human body, ac- counting for up to 5% to 10% of all fractures seen in hospital emergency admissions. Fractures of the middle third, or midshaft, are the most common, accounting for up to 80% of all clavicle fractures. Traditional treatment of midshaft clavicle fractures is usually nonoperative management, using a sling or figure-of-eight bandage. The majority of adults treated nonoperatively for midshaft clavicle fractures will heal completely. However, newer studies have shown that malunion, pain, and deformity rates may be higher than previously reported with traditional management. Recent evidence demon- strates that operative treatment of midshaft clavicle fractures can result in better functional results and patient satisfaction than nonoperative treatment in patients meeting certain criteria. This article provides a review of relevant anatomy, classification systems, and injury mechanisms for midshaft clavicle fractures, as well as a comparison of various treatment options. [Orthope- dics. 2016; 39(5):e814-e821.] abstract The authors are from the Department of Or- thopaedic Surgery and Sports Medicine (JMB, SK), University of Kentucky Medical Center, Lex- ington, Kentucky; and the Department of Ortho- paedic Surgery (DCK), University of South Ala- bama, Mobile, Alabama. Drs Burnham and Kim have no relevant finan- cial relationships to disclose. Dr Kamineni has received research support from Stryker. Correspondence should be addressed to: Srinath Kamineni, MD, Department of Orthopae- dic Surgery and Sports Medicine, University of Kentucky Medical Center, 740 S Limestone, K401, Lexington, KY 40536 (srinathkamineni@gmail. com). Received: August 1, 2014; Accepted: March 2, 2015 doi: 10.3928/01477447-20160517-06 e814