Can J Emerg Med
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Current recommended treatment for middle-third clavicle fractures is limited to the use of ice, analgesics, a sling, and rest. Radiography for these fractures would be superfluous if physicians could accurately identify them by clinical examination alone. The primary purpose of this study was to determine whether emergency physicians can accurately diagnose clavicle fractures, and whether they can differentiate middle-third fractures from medial- or lateral-third fractures by clinical assessment alone. ⋯ This study provides evidence that experienced emergency physicians are highly accurate when they are clinically certain of clavicle fracture. Further, when emergency physicians do clinically diagnose clavicle fracture, they can accurately identify the patient subgroup that will be responsive to conservative treatment. Routine radiography of obvious middle-third clavicle fractures does not appear to improve diagnostic accuracy or treatment decisions.
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Reviews of the medical literature have always been an important resource for physicians. Increasingly, qualitative and quantitative "systematic reviews" have replaced the traditional "narrative review" as a means of capturing and summarizing current evidence on a topic or, when possible, answering a specific clinical question. ⋯ To facilitate readability, examples from the emergency medicine literature have been included for illustrative purposes and technical details have been kept to a minimum. The references, however, are comprehensive and provide a resource for readers seeking further information.