Comparison of treatment of fracture midshaft clavicle in adults by external fixator with conservative treatment.

Abstract

High rate of malunion and non union in displaced fracture clavicle treated conservatively lead to use of different types of internal fixation methods which also were found to be associated with various complications. Moreover their superiority over conservative treatment has not been established. This study was designed to compare clinical outcome of conservative treatment with external fixator in cases with displaced midshaft clavicle fractures. Fifty adult consenting cases of acute midshaft fracture clavicle, displaced >15mm were included. Twenty five cases were allotted to conservative (group A) and external fixator (group B) each. In group A treatment was given in form of clavicle brace. In group B schanz pins were inserted obliquely between supero-inferior and anterior-posterior direction and connected with rod. The outcome was measured by Constant score, union time and complications. Mean radiographic union time in group A was 23.45±1.40 weeks (with 8% non union and 80% malunion) and in group B it was 9.36±1.49 weeks. Mean Constant score at 6 months in group A was 78.28±6.45 and in group B 92.72±1.48. Mean shortening at 6 months in group A was 19.36mm. In group B shortening at 6 months was noticed in three cases (6, 5, 6mm). Close reduction of acute fracture mid clavicle and application of external fixator is a simple procedure providing the benefits of rigid fixation and undisturbed fracture environment. Pain relief is faster, union time is shorter and there are no hardware related problems.