Surgical treatment of displaced middle-third clavicular fractures: a prospective, randomized trial in a working compensation population

Abstract

Background: Surgical treatment with open reduction and internal fixation (ORIF) of displaced middle-third clavicular fractures resulted in shorter complete return to work periods with earlier consolidation documented on computed tomography (CT) scans in this prospective, randomized controlled trial.

Methods: The study randomized 76 consecutive patients with displaced fractures (2B1-2B2 according to Robinson) to conservative (C, n = 42) and surgical (S, n = 34) treatment with plates and screws. Bone union was documented with CT scans at 6 and 12 weeks.

Results: Risk factors known to increase the risk of nonunion were similar between groups. Time until discharge for complete return to work was 3.7 ± 1.1 months for C and 2.9 ± 0.8 months for S (P = .003). On the CT scan at 6 weeks, 24.1% of the patients presented advanced bone union in S vs 5.3% in C (P = .05). At 12 weeks, 81% of the patients presented advanced bone union in S vs 16.7% in C (P = .005). At final follow-up, 4 nonunions were present in the C group that required surgery; in the S group, 4 patients underwent revision surgery for plate removal. At 6 and 12 months of follow-up, Constant scores were higher for the S group.

Conclusions: Surgical treatment with ORIF of displaced middle-third clavicular fractures achieved good and excellent functional results, shorter time to complete return to work, earlier bone union, and fewer cases of nonunions in a working population under injury compensation.

Keywords: Clavicular fracture; middle third; nonoperative treatment; nonunion; off-work period; operative treatment.