Introduction: Fractures of the clavicle are common and make up 5% - 10%
of all fractures. Treatment options in part depend on the location of the
fracture along the bone and degree of displacement. These two parameters are
best determined by good quality, standardized radiographs of the clavicle. We
reviewed the literature to determine the optimal radiographs of clavicle fractures
and their influence on the treatment plan. Methods: A comprehensive search of
Medline? database was undertaken with the following search terms and MeSH
headings: clavicle, fractures, bone, radiography, and X-ray. We included
articles in English published from 1950 to present. We ruled out fractures in
children, fracture dislocations, open fractures, those with neurological and
vascular injuries and fractures involving the acromioclavicular or
sternoclavicular joints. Findings: Of the 821 citations obtained, only four studies
proved eligible. In the most pertinent, four orthopaedic surgeons were shown
standard views (antero-posterior and 20° cephalic tilt) of 50 clavicle
fractures and then additional two views (45° cephalic and caudal tilt), and
found that alternative views influenced their decision making, with more
surgeons opting for surgical fixation. In a different study, it was shown that
orthogonal views of the clavicle increased surgeons’ understanding and improved
their treatment of these fractures. The third paper was a case series on
clavicle fractures that were missed on the initial antero-posterior radiograph,
and the fourth paper postulated that postero-anterior views of the thorax were
most accurate in determining length of the clavicle. Conclusion: Studies
showing an optimal view for assessment of clavicle fractures with a decision to
then progressing to operative fixation are few, but the evidence points towards
surgical fixation when alternative views of mid-shaft clavicle fractures are
present.