Management of midclavicular fractures: comparison between nonoperative treatment and open intramedullary fixation in 80 patients

Abstract

Background: The aim of this study was to compare the results achieved in two groups of 40 patients, treated for uncomplicated midclavicular fractures.

Methods: Group 1 (mean age, 37.2 years) underwent nonoperative treatment with a figure-of-8 bandage, whereas group 2 (mean age, 30.2 years) underwent open reduction and intramedullary fixation with a 2.5-mm threaded pin. The groups were similar with respect to fracture type.

Results: A high rate of complications occurred in group 2, including eight superficial infections, three refractures, two delayed unions with pin breakage, and two nonunions. Return to daily activities was undertaken after an average of 16.7 days from trauma in group 1, and after 40.7 days in group 2 (p = 0.00). Also, return to heavy and sport activities was more rapid for patients treated conservatively: 2.6 months versus 3.2 months (p = 0.014). At follow-up, which averaged 63.7 months, clinical evaluation according to the Constant rating scale did not show significant differences between the two groups. The absolute score averaged 84.8 in group 1 and 82.9 in group 2, whereas the mean relative scores were 94.9% and 95%, respectively. Thirty patients of each group were completely satisfied with the treatment received. The most common cause of dissatisfaction was represented by the unaesthetic appearance of the clavicle, because of subcutaneous bone prominence or dystrophic surgical scars.

Conclusion: According to our experience, we conclude that nonoperative treatment appears more advantageous than open intramedullary fixation for the management of most midclavicular fractures.