Conservative Vs operative management of displaced midshaft clavicle fracture: A comparative study

Abstract

Background: Clavicle fracture is one of the common fractures accounting for 2.6-12% of all fractures and 44-66% of shoulder fractures. Mid-clavicle fractures account for almost 80% of clavicle fractures. Most of the these fractures were treated conservatively in past but recently there has been an increasing tendency for operative management. Though many studies have been conducted to assess the benefit of primary surgical management against conservative management, no consistent results have been obtained to show which one is better. So, this study was carried out to compare the radiological and functional outcome following conservative management to that of operative management with open reduction and internal fixation (ORIF) with plating for displaced midshaft clavicle fractures. Methods: In a single centre, prospective clinical trial, 60 patients with displaced midshaft fracture of the clavicle were systematically randomized (alternate patient) into either operative treatment with plate fixation or non-operative treatment with clavicle brace and arm sling. Outcome was analysed in terms of functional outcome and radiological union by standard follow-up, Constant and Murley shoulder score and plain radiographs. All sixty patients completed six month follow up and there was no difference between two groups with respect to patient demographics, mechanism of injury and fracture pattern. Result: There was no significant difference in Constant shoulder score between the two groups. The mean time of union was 14.57 weeks in operative group compared to 16.04 weeks in nonoperative group (p value=0.191). There were two non-union in nonoperative group compared to none in operative group. The complications in operative group were mainly hardware related (four had loosening of screw, two had implant failure and one had infection). At six months after surgery patient were more likely to be satisfied with the results in operative group compared to nonoperative group (p=0.02). Conclusion: Six months after a displaced midshaft clavicular fracture, nonoperative treatment resulted in higher malunion and non-union rate but similar functional outcome and union time compared to operative management. However, patients were more likely to be satisfied in operative group compared to nonoperative group.