Plate Osteosynthesis or Figure-of-Eight Brace: Which One Is Better in Midshaft Clavicle Fractures?

Abstract

Introduction Fracture of the clavicle bone is a very common injury owing to its subcutaneous location. Controversy exists about the optimal treatment of midshaft clavicle fractures in the presence of significant displacement and comminution of the fracture. Traditionally, non-surgical management was considered the first treatment option for most clavicle fractures. However, recent evidence shows that the non-surgical option causes more complications than previously reported. The purpose of this study was to compare the clinical and radiological outcomes of conservative treatment and surgical treatment for midshaft clavicle fractures. Materials and methods A total of 45 patients meeting the inclusion criteria were included in this randomized study. The patients were allocated to two groups: conservative and operative on an alternate basis. Patients in the conservative group were managed with figure-of-eight bandage, whereas patients in the operative group were treated surgically by plate fixation. Primary outcome was recorded at six weeks, three months, six months, and 12 months follow-up using the Disabilities of the Arm, Shoulder, and Hand (DASH) and American Shoulder and Elbow Surgeons (ASES) scores. We also assessed patient's satisfaction after the treatment, fracture union, and complication rates among the study cohort. Results The ASES scores were significantly better in the operative group at three months and six months follow-up; however, at 12 months follow-up, there was no significant difference in the score between the groups. Although not statistically significant, the DASH score was better in the operative group than in the conservative group at all the follow-ups. This study showed that the time to union was lesser, rate of non-union was lower, and return to work was faster on the operative group. The mean satisfaction score in the operative and conservative groups was 4.16±0.76 and 4.05±1.24, respectively (p = 0.76). Conclusion This study suggests that open reduction and internal fixation with plate reduced the incidence of mal-union and non-union; however, surgical treatment showed no significant difference in the functional outcome as compared to conservative treatment.

Keywords: ases score; clavicle; dash score; figure-of-eight brace; functional score; non union.

Figure 1. Post-operative radiograph showing the anatomical locking plate with screws in a clavicle fracture

Figure 2. Radiograph of the left clavicle showing united fracture with locking plate in situ

Figure 3. Radiograph of the conservatively treated right clavicle fracture showing non-union

Figure 4. Radiograph showing left clavicle non-union in a patient managed conservatively

Figure 5. Radiograph showing a right clavicle mal-union with shortening at 12 months follow-up