Explanation:
Correct Option: D. Historically, nearly all midshaft clavicle fractures were treated non-operatively with simple sling immobilization. However, recent prospective randomized multicenter trials (such as the landmark Canadian Orthopaedic Trauma Society - COTS trial) have definitively shifted the paradigm for completely displaced midshaft fractures with significant shortening (>2 cm). Operative fixation with plate osteosynthesis has been proven to significantly decrease the rate of symptomatic nonunion (dropping from approximately 15% in the non-operative cohort down to less than 2% in the surgical cohort) and decrease the incidence of symptomatic malunion. Furthermore, patients treated surgically demonstrate faster return to functional baseline and significantly improved patient-reported outcome scores in the first year post-injury. Surgery does carry distinct inherent risks, including deep infection, hardware prominence requiring secondary removal, and incisional neuromas, meaning it does not eliminate neurovascular risks or mathematically guarantee union (rendering Options A, B, and C false). (Ref: Canadian Orthopaedic Trauma Society, J Bone Joint Surg Am, 2007)