Operative versus Nonoperative Management of Displaced Midshaft Clavicle Fractures: A Prospective Cohort Study

Abstract

To compare results of primary internal fixation of acute displaced midshaft clavicle fractures with those managed nonoperatively in terms of fracture union and functional outcome. Prospective cohort study. Level II military trauma center. Seventy-three patients (civilian and military) between 20 and 50 years of age with displaced midshaft clavicle fractures were allocated either to the operative (n = 45) or nonoperative (n = 28) group. Patients in the nonoperative group were managed by simple sling immobilization, whereas in the operative group, fractures were reduced and fixed with a contoured reconstruction plate. The patients were actively followed up during an 18-month period. Primary outcome measures were the rates of nonunion and symptomatic malunion; secondary outcomes included the assessment of the Constant score and the overall local complication rate. The 18-month follow-up rate was 90%. All fractures in the operative group united compared with eight nonunions (29%) in the nonoperative group (P = 0.002). Ten symptomatic malunions (36%) occurred in the nonoperative group, whereas only two (4%) were reported for the operative group (P = 0.0008). Constant shoulder scores were significantly better for the operative group at all follow-ups (P < 0.0001). All six operative complications were implant-related. In this prospective cohort study, primary open reduction and internal plate fixation of acute displaced midshaft clavicular fractures resulted in improved outcomes and a decreased rate of nonunion and symptomatic malunion compared with nonoperative treatment.