Michael D McKee et al. JBJS (Am) 2007; 89-A:1-10.
Clavicular fractures are common injuries and mostly occur in younger active individuals. 80% of all clavicular fractures are of the midshaft and have been traditionally treated non-operatively. Recent studies show high prevalence of symptomatic malunions and non-unions after conservative management of displaced midshaft clavicular fractures. The authors compared the outcomes and complication rates of operative versus non-operative management of displaced midshaft clavicular fractures.
A total of 132 patients aged between 16 and 60 years, with a displaced mid shaft fracture were randomized to either receiving a plate fixation [67 patients] or conservative management [65 patients] with a sling.111 patients completed a one year follow-up.
Assessment of the outcome was done using the Constant shoulder score, the Disability of the Arm, Shoulder and Hand [DASH] score and plain radiographs. There was significant improvement in the operative fixation group at all times. There was no difference in the range of motion between the two groups. The mean union time was 16.4 weeks in the operative group and 28.4 weeks in the non-operative group. Non union occurred in 2 patients in the operative group compared to 7 in the non-operative group. 9 patients in the non-operative group developed symptomatic malunion compared to none in the operative group. Patients in the operative group were more likely to be satisfied with the appearance of shoulder at one year compared to non-operative group.
There are improved patient and surgeon oriented outcomes, earlier functional recovery, decreased non unions and no malunions within the operative group. This paper supports the primary plate fixation of completely displaced midshaft clavicular fractures in active patients.