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Displaced distal clavicle fractures, particularly Neer type II patterns, have a recognised risk of nonunion because the fracture is unstable and the coracoclavicular ligaments may no longer maintain alignment. This multicentre randomized trial compared operative fixation with nonoperative treatment in adults with completely displaced type II fractures. The study found that surgery produced a lower rate of nonunion and better radiographic union, but the benefit came with implant-related complications and a meaningful need for later hardware removal in some patients. Functional outcomes at one year were not dramatically different across every measure. For clinicians, the important lesson is that the decision to operate should consider fracture instability, displacement, patient activity and tolerance for a possible second procedure. Plate or hook-plate fixation may be particularly attractive when maintaining shoulder function and union is a priority, but the presence of a radiographically displaced fracture alone should not be treated as an automatic indication for surgery. Shared decision-making should include the expected healing course, the risk of nonunion with nonoperative care and the possibility of implant-related reoperation after fixation.
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Displaced distal clavicle fractures, particularly Neer type II patterns, have a recognised risk of nonunion because the fracture is unstable and the coracoclavicular ligaments may no longer maintain alignment. This multicentre randomized trial compared operative fixation with nonoperative treatment in adults with completely displaced type II fractures. The study found that surgery produced a lower rate of nonunion and better radiographic union, but the benefit came with implant-related complications and a meaningful need for later hardware removal in some patients. Functional outcomes at one year were not dramatically different across every measure. For clinicians, the important lesson is that the decision to operate should consider fracture instability, displacement, patient activity and tolerance for a possible second procedure. Plate or hook-plate fixation may be particularly attractive when maintaining shoulder function and union is a priority, but the presence of a radiographically displaced fracture alone should not be treated as an automatic indication for surgery. Shared decision-making should include the expected healing course, the risk of nonunion with nonoperative care and the possibility of implant-related reoperation after fixation.
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