Management of mid-shaft clavicular fractures: comparison between non-operative treatment and plate fixation in 60 patients

Abstract

Clavicle fracture is a common injury due to its subcutaneous and relatively anterior position. Fractures affecting the middle third account for majority of all clavicular fractures. Both non-operative and surgical methods have been described for the management of this injury. However, there is no uniform consensus on the definite choice of treatment. Hence, this study was undertaken to compare conservative approach with primary internal plate fixation in mid-shaft clavicular fractures in terms of subjective outcome, functional outcome, the rates of nonunion and malunion and other local complications. Patients were allocated into two groups, each including 30 patients on alternate basis. Group 1 patients were managed conservatively, consisting of a figure-of-eight bandage and a sling, whereas patients of group 2 were treated surgically by plate fixation. Follow-up examination was done at 06 weeks, 03 and 06 months using patient's subjective evaluation, functional outcome, radiographic assessment and other complications. The study showed that time to union was significantly shorter in patients treated surgically and this group also showed a favorable Constant shoulder score at all follow-ups. Though there was no statistically significant difference between the groups with regard to complication rate, subjective outcome or functional outcome, the surgical intervention group fared better especially when considering overall outcome results. The present study showed that the time to union was lesser, rate of malunion and nonunion was lower, and Constant shoulder scores were higher in the surgical group. This affirms that while conservative treatment remains the treatment of choice for simple undisplaced mid-shaft clavicle fractures, for displaced and comminuted fractures the surgical intervention gives better outcomes and early functional recovery in young active adults.

Keywords: Clavicle; Fracture; Mid-shaft; Plating.

Fig. 1

a Figure-of-eight bandage with shoulder arm pouch-anterior view. b Figure-of-eight bandage with shoulder arm pouch-posterior view. c Initial radiograph of the fracture at presentation. d Fracture union after 6 months of conservative treatment

Fig. 2

a Intra-operative fracture reduction. b Fracture fixation with 3.5 mm DCP. c Radiograph before fracture fixation. d Fracture union after 6 months of surgical treatment

Fig. 3

Time to union with respect to treatment group

Fig. 4

Subjective evaluation at six months follow-up