Comparison between conservative and surgical management of displaced mid-shaft clavicle fractures in adults

Abstract

Clavicle fracture is a one of the most frequently fractured bones in the body with an incidence of 2.6-10% of all fractures due to its subcutaneous placement and relatively anterior position. Fractures affecting the middle third account for majority (approximately 80%) of all clavicular fractures and 50% of these are displaced. Both non-operative and surgical methods have been described for the management of clavicular fractures. However, it is not uniformly dictated on which treatment modality to opt for. Hence, this study was done in order to compare conservative approach with open reduction and internal fixation with plate in mid-shaft clavicular fractures in terms of subjective outcome, functional outcome, rates of non-union and mal-union and other local complications. Patients of age between 20-50yrs were allocated into two groups, each including 15 patients on alternate basis. Group 1 patients were managed conservatively, consisting of a figure-of-eight bandage and a sling, whereas patients of group 2 were treated surgically by open reduction & internal fixation with plate & screws. Follow-up examination was done at every 2 weeks for 6 weeks and then 3, 6 and 9 months using patient’s subjective evaluation, functional outcome, radiographic assessment and other complications. The study showed that time to union was significantly shorter in patients treated surgically and this group also showed a favourable Constant shoulder score at all follow-ups. Though there was no statistically significant difference between the groups with regard to complication rate, subjective outcome or functional outcome, the surgical intervention group fared better especially when considering overall outcome results. The present study showed that the time to union was lesser, rate of mal-union and non-union was lower, and Constant shoulder scores were higher in the surgical group. This affirms that while conservative treatment remains the treatment of choice for simple un-displaced mid-shaft clavicle fractures, for displaced and comminuted fractures the surgical intervention gives better outcomes and early functional recovery in young active adults.