How to treat diaphyseal clavicular fractures?

Clavicular fractures have a very high rate of incidence, making up 2.6-5% of all fractures and 35-44% of injuries to the shoulder girdle. Although it is usually acceptable to treat diaphyseal clavicular fractures conservatively with either an arm sling or with an eight-shaped bandage with satisfactory results, more recent studies have shown that better outcome can be achieved by both functionally and radiologically thorough operative tratment. Plate osteosynthesis has shown good reliability  and is usually the first choice for treatment of nonunions. Intramedullary osteosynthesis has been controversial until now that the introduction of the titanium elastic nail has shown good results and has been proved to be a biomechanically very suitable method. The results with the use of the titanium elastic nail in Tartu University Hospital have been very good: during 8 months 20 TENs were used while there were 2 nonunions; at the same time, with the Rush pin there were 3 nonunions out of 22 pins.