The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

The Comparison of Results of Treatment of Midshaft Clavicle Fracture between Operative Treatment with Plate and Non-Operative Treatment

Document Type : RESEARCH PAPER

Authors
Mohsen Khorami 1
Hamid Reza Arti 2
Mohammad Fakour 3
Hossein Mokarrami 3
Abdolhossein Mahdi Nasab 3
Farid Shahrivar 3
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
10.22038/abjs.2014.3351
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
Clavicle
Constant Shoulder Score
DASH score
Internal Fixation
Non-operative management

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

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

  3. 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.

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

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

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. 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.

  11. 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. 

  12. 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.

  13. 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.

  14. 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.

  15. 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.

The Archives of Bone and Joint Surgery
Volume 2, Issue 3 - Serial Number 3
September 2014
Pages 210-214

  • Receive Date 26 April 2014
  • Revise Date 28 May 2014
  • Accept Date 27 August 2014