Comparison of the efficacy of non-operative and surgical treatment of distal clavicle fractures in older children

Abstract

Objective To compare the clinical efficacy of non-operative and surgical treatment of distal clavicle fractures in older children. Methods From January 2011 to March 2018, 41 older children with distal clavicle fractures were treated. Among them, 24 cases underwent non-operative treatment, shoulder abduction brace fixation for 4 to 6 weeks (non-operation group); while 17 cases underwent surgical treatment, open reduction and Kirschner wire internal fixation of the fractures on the affected side, and shoulder abduction brace fixation for 4 to 6 weeks (operation group). The fracture healing time, Constant-Murley shoulder function score and complication rate of the two groups were compared and analyzed. Results All the 41 cases were follow-up for 3 to 17 months, with an average of 8.4 months. There was no significant difference in gender, age and fracture side between the two groups, so two groups were comparable. All the incisions in the operation group achieved primary healing. X-ray examination showed that there was continuous callus formation at the fracture end and Kirschner wire was removed. The fracture healing time was (44.3±6.7) days. No early complications such as infection occurred. In the non-operation group, X-ray examination showed bone healing at the fracture end. The healing time was (41.7±7.6) days. At the last follow-up, there were no complications such as malunion of fracture, premature epiphyseal closure and obvious shoulder dysfunction in both groups. Constant-Murley shoulder joint function score: non-operative group was (97.7±4.7) points, while operation group was (96.5±3.7) points. There was no significant difference between the two groups (P=0.32). Conclusion Non-operative treatment of the distal clavicle fractures in older children has the same effect as surgical treatment. However, non-operative treatment has the advantages of less trauma, low cost and no need of secondary surgical removal of internal fixation. Key words: Clavicle; Fractures,bone; Child