Functional outcomes of conservative versus operative management of displaced midshaft clavicular fracture: a comparative study

Abstract

Purpose Management of displaced midthird clavicle fractures is still controversial. Recent studies have shown a high incidence of symptomatic malunion and nonunion following nonoperative treatment of displaced midshaft clavicular fractures, with other studies showing no much improvement in shoulder function following operative treatment. The aim of this study is to compare patient-oriented and surgeon-based outcomes after nonoperative treatment with results following operative treatment of acute completely displaced midshaft clavicular fractures. Patients and methods This retrospective study was carried out on 91 patients with a displaced midshaft fracture of the clavicle distributed into two groups, with the first group managed conservatively and the second group with open reduction and internal fixation. Outcome analysis included standard clinical follow-up and the Constant shoulder score, the disability of the arm, shoulder and hand score, as well as radiological evaluation. Deformity evaluation included measurement of displacement, shortening, and angulation in both immediate posttrauma radiograph and final radiographs. Results Mean follow-up duration was 28.7±13.3 months in the nonoperative group and 20.4±5 months in the operative group. The mean time to radiographic union was 16.4±3.3 weeks in the nonoperative group compared with 15.6±3 weeks in the operative group (P=0.00). All fractures in the operative group united compared with six nonunions (12.5%) in the nonoperative group, and 12 symptomatic malunions (25%) occurred in the nonoperative group. Constant shoulder scores were significantly better for the operative group at all follow-ups (P=0.00). The disability of the arm, shoulder and hand score showed also significant improvement within the operative group (P=0.00). Conclusion In this study, primary open reduction and internal plate fixation of acute displaced midshaft clavicular fractures resulted in improved outcomes − including both patient-oriented outcome and surgeon-based outcome − and a decreased rate of nonunion and symptomatic malunion compared with nonoperative treatment. Shorting and displacement were found significantly related to decreased shoulder function.