Prospective study of middle 1/3rd clavicle fracture managed with clavicle contoured plates

Abstract

Aim Clavicle being most common bone to get fractured, accounting for about 5-10% of all injuries, with middle 3rd being the commonly fractured site. As it is common in young active adults and the incidence being increased due to RTA’s and sports injuries, clavicular plate fixation gained importance in recent trends. Earlier clavicle fracture is managed conservatively with figure of ‘8’ bandage, arm sling or clavicular brace with a relatively good outcome. Though uncommon, nonunion rate of 0.8-1% is seen in conservatively managed patients according to Rowe 1. In 2006 Michael Mckee et al. 2 concluded residual deficits in shoulder strength and endurance in conservatively managed patients. Purpose of this paper is to study clavicle middle 1/3rd fractures treated with plating technique. Materials and Methods Prospective analysis of 30 patients who were operated at MIMS hospital, Nellimarla, Vizianagaram, between Nov 2015 to Jan 2017 for clavicle fractures treated with clavicle contoured plate fixation. Patient position is beach –chair semi sitting position on regular operating table. An oblique skin incision centered over fracture site. Sub cutaneous tissue & platysma muscle are kept together as one layer and extensively mobilized. Supra clavicular nerve is protected. Myofascial layer over clavicle is incised & elevated in one layer. The main fragments cleaned and debris removed. Do not violate the subclavicular space. Then precontoured plate positioned and fixed over superior surface of clavicle and neutral mode for comminuted and unstable fractures. The wound is closed in layers with interrupted, non-absorbable sutures. Review done post- operatively at 2 weeks, 6 weeks, 12 weeks and 6 months. ResultsThe average hospital stay is 7days. 27 out of 30 had functional & radiological union by 12 weeks (range of 6-18 weeks), 2 had deep infection and nonunion, 1 got superficial infection which was treated with antibiotics. No significant difference in functional & ROM scores at 3, 6 months. We followed standard score like Constant Murley score, oxford shoulder score, DASH scoring system for evaluating the functional outcome. We had Average oxford shoulder score of 42 (range 34-48). Lane Sandhu score showed no difference between control group and experiment group, Average Quick DASH score of 46 (range 38-54).ConclusionOpen reduction and internal fixation with clavicle contoured plate is gold standard treatment for displaced middle 1/3rd clavicle fracture. It helps in getting back to daily activities and early mobilization with significantly less nonunion rates.