Comparative study of surgical management with plating versus non-operative management of displaced fracture of middle one-third of the clavicle

Abstract

Clavicle is subcutaneously located and is relatively anterior in location, these peculiarities makes clavicle fracture as one of the commonest injury. Among clavicle fracture mid shaft fracures are the most common type. Both non operative and surgical management are the standard method of choice for midshaft clavicle fractures, however there are lots of debate in literature regarding which gives better results, hence the present study is undertaken to compare surgical management with plating and conservative management interms of functional outcome, the rates of malunion, delayed union and nonunion and related complications.Aims and Objectives:1.To analyse the functional and radiological outcome of fracture of middle third of the clavicle treated surgically with plating versus non operative management.2.To evaluate the complications associated with the operative and the non-operative management of the fracture of middle-third of clavicle.Method: 40 cases of mid shaft clavicular fracture were recruited for the study. They were divided into 2 groups each having 20 patients. Patients in group 1 were managed conservatively and patients in group 2 were managed surgically. Follow up was done at 6 weeks, 3 month and 6 months to assess functional and radiological outcomes.Result: Radiographic and clinical union was faster in the operative group, Constant and murley scores showed more improvement in the operative group when compared to non operative group. The average Constant murley score at the end of 6 months in group 1 was 73.8 and group 2 was 80 with significant mean difference of 6.20. Out of 20 cases operated 3 had surgical site infection (15%) and out of 20 conservatively managed cases three had non union (15%) and two had delayed union (10%).Conclusion: The current study showa that union rate was faster, incidence of malunion and non union were lesser and fuctional outcome assessed using Constant murley scores were significantly higher in the surgical group, this asserts that for displaced and communited mid shaft clavicle fractures operative intervention provides better results and early recovery of function.