A prospective comparative study of functional outcome in patients treated non-operatively and surgically (by plate osteosynthesis) for mid-shaft clavicle fractures in adults

Abstract

Clavicle fracture is a common traumatic injury around shoulder girdle due to their subcutaneous position. It is caused by either low-energy or high-energy impact. Fractures of the clavicle have been traditionally treated non-operatively. Although many methods of closed reduction have been described, it is recognized that reduction is practically impossible to maintain and a certain amount of deformity and disability is expected in adults. 30 patients with mid-shaft clavicle fracture were systematically randomized (alternate patient) into either operative treatment with plate fixation or non-operative treatment with clavicle brace and sling. All fractures were classified using Robinson’s classification for clavicle fractures and only Type 2A2 and 2B1 were considered for the study. Patients were followed up at 3wks, 6wks, 3rd month & 6th month. Functional outcomes were assessed according to the Constant and Murley Scoring and radiologically. Maximum number (90%) of patients had Robinson’s Type 2B1 fracture. The mean duration of hospital stay for patients in Group A(operative) and Group B(non operative) was 3.67 ± 0.90 days and 1.73 ± 0.46 days respectively. In Group A, the mean duration of trauma to surgery was 3.13 ± 2.64 days. While the mean operative time was 104.87 ± 13.52 minutes. The duration of union was significantly lesser in Group A as compared to Group B according to Chi-Square test (p0.05). Primary open reduction and internal fixation with pre-contoured clavicle plate for displaced, middle third clavicle fractures provide a more rigid fixation and allows early mobilization whereas conservative treatment require longer periods of immobilization till fracture union. Functional outcomes are better with surgical management of middle third clavicle fractures with pre-contoured locking compression plate. The successful use of locking compression plate for middle third fractures of clavicle requires careful assessment of fracture pattern, patient selection, meticulous operative technique, appropriate choice of fixation, judicious internal fixation, careful post-operative monitoring and aggressive early institution rehabilitation. So, there is need to individualize the treatment as per the need and functional demand of the patient to give the optimum outcome.