A 22-year-old man sustains a completely displaced comminuted midshaft clavicle fracture with 2 cm of shortening after a motorcycle accident. Compared with sling treatment, primary open reduction and internal fixation with a plate has been shown to reduce the incidence of which outcome?
- A Avascular necrosis of the medial fragment
- B Brachial plexus injury
- C Nonunion and symptomatic malunion ✓
- D Post-traumatic osteomyelitis
Correct answer: C. Nonunion and symptomatic malunion
Explanation
Displaced midshaft clavicle fractures carry a substantial nonunion rate when treated closed, and malunion with shortening causes persistent weakness and cosmetic deformity. The Canadian Orthopaedic Trauma Society randomised trial showed plate fixation significantly reduced nonunion and symptomatic malunion compared with sling treatment. Brachial plexus injury occurs at the moment of trauma, not as an outcome of the treatment choice, so it kills distractor B.
Reference: Miller's Review of Orthopaedics, 8th ed.
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