Broad Arm Sling vs Figure of 8 Bandage: The Better Choice in Conservative Management of Middle Third Clavicle Fractures in Indian Population

Abstract

Background: A prospective randomised trial was conducted to compare the results of conservative management of middle-third clavicular fracture using the figure of 8 bandage and broad-arm sling.

Methods: 296 patients with middle-third clavicle fracture were included in the study conducted between March 2017 and January 2020. 152 patients were managed with figure of 8 bandage and 144 patients were managed with a broad arm sling. Results were evaluated based on clinical, radiological and functional outcomes. Visual analogue scale (VAS) for pain was used to evaluate the clinical outcomes, whereas radiological outcomes were assessed with non-union, malunion, clavicle shortening and time to union. Disability of Arm, Shoulder and Hand score (DASH), Constant score and Nottingham Clavicle Score were used to assess functional outcomes.

Results: The broad arm sling group showed a significantly better VAS score in the first 4 weeks. DASH score was significantly superior in the broad arm sling group in the initial 4 weeks, but with similar outcome thereafter. Constant scores showed a good outcome for both groups at the final follow-up, whereas the Nottingham Clavicle Score was significantly superior in the broad arm sling group at the 2 year follow-up. A satisfactory outcome was achieved with respect to the radiological parameters, without any significant difference between the 2 groups. Incidence of malunion was significantly higher in figure of 8 bandage group.

Conclusions: Broad-arm sling proves to be a better modality of management for middle-third clavicular fractures in terms of ease of application, pain relief, incidence of malunion, and functional outcomes.

Keywords: Broad arm sling; Clavicle; Conservative management; Constant score; DASH score; Figure of 8 bandage; Fracture; Middle-third; Nottingham Clavicle Score; VAS score.

Fig. 1

Clinical picture showing a figure of 8 bandage (left) and broad arm sling (right)

Fig. 2

VAS (Visual Analogue Scale) scores. *p < 0.05 between group 1 and 2 at week 1 and week 4

Fig. 3

Radiograph of a patient showing a middle third clavicular fracture before treatment (left) and a middle third clavicular fracture managed with figure of 8 brace resulting in malunion (right)

Fig. 4

Radiograph of a patient showing a middle third clavicular fracture before treatment (left) and a middle third clavicular fracture managed with figure of 8 brace resulting in nonunion (right)