Plate Osteosynthesis versus conservative treatment in middle third shaft fractures of clavicle: A comparative study

Abstract

Objectives: Mid shaft clavicle fractures have traditionally been treated by conservative means with good outcome. ORIF with plating is an upcoming option to improve outcome further. Aim of this study is to compare the outcome of open reduction and internal fixation with conservative treatment. Methods: The study was done at the tertiary care trauma centre of Krishna institute of medical sciences, karad, Maharashtra between January 2018 to January 2019. The study was conducted over a period of one year, with 40 closed mid shaft clavicle fractures included. Half of the patients were operated using AO pre-contoured plate. The functional outcome was evaluated by the Constant and Murley score at the end of 3 months from injury. The fracture union time and associated problems were also compared. Results: In the operative group, 20 patients (76%) had excellent functional outcome. In the operated group, 2 patients (8%) had hypertrophic skin scar and in 2 patients (8%) plate prominence occurred. 1 patient (4%), plate loosening occurred. In 2 patients (8%), delayed union occurred which went for malunion and in 1 patient (4%), plate breakage occurred. In the non-operative group, 3 patients (15%) had good functional outcome, 7 patients (35%) had fair functional outcome and 10 patients (50%) had poor functional outcome. Conclusion: In this study, early primary plate fixation of mid shaft clavicular fractures results in improved patient-oriented outcomes, improved surgeon-oriented outcomes, earlier return to function and decreased rates of non-union and malunion.