Vertical fragment in adult midshaft clavicle fractures: an indicator for surgical intervention
This article describes a retrospective cohort study that investigated whether adult midshaft clavicle fractures possessing the radiological sign of a butterfly vertical fragment demonstrate a higher rate of early and delayed surgical intervention when compared to adult midshaft clavicle fractures with no vertical fragment sign. The radiographs of 134 adult midshaft clavicle fractures were divided into 2 cohorts: those with a vertical fragment radiological sign and those without. Within each cohort, the number of cases that underwent early surgical intervention and that underwent delayed surgical intervention was noted. The vertical fragment group displayed a rate for early surgical intervention, all for skin tenting, of 8.5%, whereas the no vertical fragment group's rate was 1.1%; this proved to be significantly different (P=.0464). Furthermore, the vertical fragment group displayed a rate for delayed surgical intervention for symptomatic nonunion of 12.8%, whereas the no vertical fragment group's rate was 5.7%. Despite being twice as likely for the vertical fragment group to have undergone delayed surgical intervention, this did not prove to be statistically significant (P=.0965). This study revealed that midshaft fractures with the radiological sign of an interfragmentary vertical fragment are significantly more likely to require early surgical intervention due to skin tenting. Furthermore, these fractures are twice as likely to go into symptomatic nonunion, and in this area we may be able to improve current management by considering early surgical intervention.
- Orthopaedics 
Kirmani, Sayyied J