MIDSHAFT CLAVICLE FRACTURE

Abstract

Introduction: Fracture of clavicle is common, occurring most commonly inmales accounting for approximately 2.5%of all fracture presenting to orthopedic surgeon.1 Thisstudy has been conducted to compare the broad arm sling and figure of eight bandage in thefirst 21 days of treatment with primary outcome measure of pain and disability. Study Design:Comparative study. Setting: Department of orthopedic surgery, Dow International MedicalCollege, Dow University hospital. Period: February 2015-2016. Material and Methods: 60eligible patients with a mean age of (15-60 years) were randomized to conservative treatmentwith either a broad arm sling or figure of eight bandage. After detailed counseling taking informedconsent we did non stratified randomization in blocks of two using the sealed envelope method.Patients were kept in strict follow up to complete the outcome measures the next day and onday seven, fourteen and twenty one. On each visit a Performa was filled known as SPADI havingtwo components of pain and disability and VAS on day one, seven, fourteen and twenty one.Results: Seventy patients were enrolled initially, out of them ten patients were dropped outdue to different reasons. Of the remaining 60 patients 30 were treated with broad arm sling and30 were treated with figure of eight bandage. The two groups were randomized fulfilling theinclusion criteria. The Mean VAS on the first day of treatment in the broad arm sling group was5.433 SD 1.04 (p= 0.034, 95% CI 0.10 -2.46) where as in figure of eight group was 8.9 (SD 10.8).On subsequent visits (Day 7,14,21) VAS of broad arm sling was 3.83, 1.40,1 whereas figure ofeight was 5.76, 4.3, 3.469. This result clearly shows good pain control in broad arm sling groupas compared to the figure of eight group. The mean SPADI on the first day of treatment was94.52(SD 2.273) in broad arm sling group, on the other hand it was 93.87(SD 2.239) in figure ofeight group. In follow up visits of day 7, 14 and 21 score was as follows in broad arm group 3.83(SD 0.79), 1.4(SD 0.49), 1(SD 0.0), it was 5.76(SD 1.04), 4.3(SD 0.740), 3.4(SD0.68) in figure ofeight group. It also shows better result in terms of pain and functional outcome. Conclusion:Fracture clavicle is still managed conservatively in majority of the cases, either with the figure ofeight bandage or polyarm sling. Patient’s outcome in terms of pain management and functionalrange of motion in poly arm sling is better than figure of eight bandage.