Midshaft clavicle fractures treatment: proposal of informed consent for a shared-treatment decision

Midshaft clavicle fractures treatment: proposal of informed consent for a shared-treatment decision
Remo Goderecci, Stefano Di Filippantonio, Norman Ciprietti, Alessio Ciuffoletti
Lo Scalpello, August 2023
Abstract
Fractures of clavicle frequently occur in young active patients and the middle-third of the shaft is the most involved segment. Traditionally mid-shaft clavicle fractures have been treated mainly non-operatively. The literature of the first decade of the 2000s strongly supported a routine indication of surgical treatment for the fracture of this segment, resulting in a clear change of attitude compared to previous years. However, most recent systematic reviews demonstrated an uncertain superiority of surgery over conservative treatment in the acute management of these fractures. In fact, both types of treatment can result in complications that need to be balanced for the individual patient in order to determine the best indication; in addition, increasing attention is being given to the patient’s involvement in the decision-making process for the therapeutic choice, which also influences final treatment satisfaction. Herein, we propose an informed consent that is clearly understandable to the patient in which all the points relating to the two types of treatment (conservative vs surgical) are discussed: from a review of the literature, we report the factors and relative percentages that can influence the final result. We believe that this document can be a useful tool in the clinic for an informed and shared choice of treatment with the patient suffering from a fracture of the middle third of the clavicle, potentially influencing surgical practice from a legal point of view.

Editor’s note: Lo Scalpello is published by the Italian Journal of Orthopaedics and Traumatology.