Document Type: RESEARCH PAPER

Authors

1 Department of Orthopedic Surgery, Golestan Hospital, Jonishapur University of MedicalSciences, Ahvaz, Iran.

2 Golestan Hospital, Joundishapour University of Medical Sciences, Ahvaz, Iran

3 Imam Khomeini Hospital, Joundishapour University of Medical Sciences, Ahvaz, Iran

Abstract

Background:
 Clavicle fractures are common and usually heal without complications. In this study, we evaluated the outcomes of non-operative versus operative management of displaced fractures.  
Methods:
 In a prospective clinical trial study, sixty-five patients with displaced clavicle mid-shaft fractures were nonrandomly divided in two treatment groups. The first group underwent non-operative treatment with figure of 8 bandage (30 patients), and the other underwent operative treatment with plate fixation (35 patients). Figure of 8 bandage and 3.5 millimeter DCP plate with at least six cortical screws were used in non-operative and operative groups respectively. We followed up all patients at weeks 2, 6 and 12, and at month sixth. In addition to clinical examination and x-ray evaluation, we assessed satisfaction, DASH and Constant Shoulder Score for each individual.
Results:
 The average durations of union were 19.3 and 24.4 weeks in operative and non-operative groups respectively (P=0.006). Satisfaction with operative treatment was 74.3% and with non-operative treatment was 66.7%, showing no significant difference (P=0.500). The non-union rate was 5.7% in the operative group and 13.3% in the non-operative group (P=0.518). A significant difference between the two groups in terms of DASH and Constant Shoulder Scores after the six-month follow-up was not found (P=0.352).
Conclusions:
 According to our results, we recommend operative treatment in mid-shaft clavicle fractures only when there is a definitive indication. 

Keywords

Neer CS II. Fractures of the distal third of the clavicle. Clin Orthop Relat Res. 1968;58:43-50.

  • Van der Meijden OA, Gaskill TR, Millett PJ. Treatment of clavicle fractures: current concepts review. J Shoulder Elbow Surg. 2012;21(3):423-9.

  • Stanley D, Trowbridge EA, Norris SH. The mechanism of clavicular fracture. A clinical and biomechanical analysis. J Bone Joint Surg Br. 1988;70(3):461-4.

  • Browner BD, Jupiter JB. Skeletal Trauma. 3rd ed. Philadelphia, PA: WB Saunders; 2003.

  • Graves ML, Geissler WB, Freeland AE. Midshaft clavicular fractures: the role of operative treatment. Orthopedics. 2005;28(8):761-4.

  • Hill JM, McGuire MH, Crosby LA. Closed treatment of displaced middle-third fractures of the clavicle gives poor results. J Bone Joint Surg Br. 1997;79(4):537-9.

  • Tabatabaei S, Shalamzari S. Treatment of displaced midshaft clavicular fractures: A comparison between smooth pin and LCDCP and reconstruction plate fixation. Pak J Med Sci. 2011; 27(5):1129-34.

  • Altamimi SA, McKee MD, Canadian Orthopaedic Trauma Society. Nonoperative    Treatment   Compared  With  Plate  Fixation   of   Displaced    Midshaft Clavicular    Fractures. J Bone Joint Surg Am. 2008; 90:1-8.

  • Zlowodzki M, Zelle BA, Cole PA, Jeray K, McKee MD, Evidence-Based Orthopaedic Trauma Working Group. Treatment of acute midshaft clavicle fractures: systematic review of 214 fractures: on behalf of the Evidence-Based Orthopaedic Trauma Working Group. J Orthop Trauma. 2005;19:504-7.

  • Virtanen KJ, Remes V, Pajarinen J, Savolainen V, Björkenheim JM, Paavola M.  Sling   Compared    With   Plate   Osteosynthesis    For    Treatment    of    Displaced   Midshaft Clavicular Fractures.   J Bone Joint Surg Am. 2012;94(17):1546-53.

  • Ban I, Branner U, Holck K, Krasheninnikoff M, Troelsen A. Clavicle fractures may be conservatively treated with acceptable results-asystematic review.Danish Med J. 2012; 59:1-7. 

  • Robinson CM, Court-Brown CM, McQueen MM, Wakefield AE. Estimating the risk of nonunion following nonoperative treatment of a clavicular fracture. J Bone Joint Surg Am. 2004;86:1359-65.

  • Brinker MR, Edwards TB, O’Connor DP. Estimating the risk of nonunion following nonoperative treatment of a clavicular fracture.  J Bone Joint Surg Am. 2005;87(3):676-7.

  • Dhoju D, Shrestha D, Parajuli NP, Shrestha R, Sharma V. Operative fixation of displaced middle third clavicle (Edinburg Type 2) fracture with superior reconstruction plate osteosynthesis. Kathmandu Univ Med J (KUMJ). 2011;9(36):286-90.

  • Bajuri MY, Maidin S, Rauf A, Baharuddin M, Harjeet S. Functional    Outcomes   of   Conservatively    treated    Clavicle    fractures. Clinics (Sao Paulo). 2011; 66(4): 635-9.