Reliability of preoperative conventional X-Ray diagnostics for multifragmentary clavicular fractures: A retrospective cohort study

This study aimed to assess the reliability of preoperative conventional X-ray diagnostics for identifying multifragmentary clavicular fractures using intraoperative findings as the reference standard and explores potential implications for surgical approach modification.

Data from 326 patients with isolated central clavicular fractures who underwent surgical treatment between July 1, 2012, and June 30, 2023, were retrospectively analyzed. Among these, 73 were female, and 253 were male in a mean age of 37.5 ± 17 years. The fractures were classified pre- and intraoperatively using the AO classification system.

31 out of 248 comminuted fractures were only discovered intraoperatively, accounting for 10% of all fractures. According to the AO Classification 43 out of 326 fractures (13%) exhibited a disparity between preoperative and intraoperative assessments, resulting in a change in the surgical approach for 40 patients, 12% of the total cohort or 91% of the fractures that were classified differently preoperatively compared to intraoperatively. In these cases, fractures were treated with open reduction and angular stable plate fixation instead of the preoperatively planned elastic stable intramedullary nailing (ESIN).

The results of this study suggest that conventional X-ray diagnostics may not always detect comminuted clavicle shaft fractures.

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