Comparison between operative and nonoperative treatment methods in the management of comminuted fractures of the clavicle

Abstract

Objectives: To evaluate the outcome and satisfaction of closed treatment versus open reduction and internal fixation in comminuted clavicular fractures.

Methods: Sixty patients with displaced clavicular fractures were randomized into operative (29 patients) and nonoperative (31 patients) groups. Three patients in the operative group did not accept the surgery, and seven patients in the nonoperative group did not complete the one-year follow-up. Outcomes were assessed using the Disability of the Arm, Shoulder and Hand (DASH) score, Constant shoulder score, specific questions regarding patients' final satisfaction, physical examination, measurement of the shortening of the clavicular length, and plain radiographs.

Results: There was one nonunion in the operative group and one in the nonoperative group. The nonunion in operative group was the result of the only infection in this group. Four malunions were developed in the operative group and nineteen malunions in the nonoperative treatment, (p<0.001). Three patients in the operative group were completely dissatisfied with their treatment. Eighteen patients in the nonoperative group were partially satisfied. Pain was the main reason for dissatisfaction in this group. The mean shortening of the clavicle was 26.5 mm in the nonoperative group and 4.0 mm in the operative group. The mean DASH score for the operative and nonoperative groups were 8.6 and 21.3, respectively (p<0.001); and the Constant shoulder scores were 89.8 and 78.8 (p<0.001).

Conclusion: Open reduction and internal fixation of comminuted fractures of the clavicle using a reconstruction plate is an effective treatment modality. Despite the variety of complications, this method has a higher satisfaction rate than conservative treatment.