The study of the functional outcome between surgical and conservatively treated clavicular fractures

Abstract

Background: One of the most frequently fractured bones in the body is the clavicle. Traditionally, midshaft clavicle fractures have been treated conservatively. There is a higher prevalence of patients with displaced midshaft clavicle fractures going in for non-union or mal-union after conservative treatment than in those treated with Open Reduction & Internal Fixation (ORIF). The primary treatment for displaced midshaft clavicular fractures is surgery. Improved functionality, a reduction in the time taken for a union, and early return to activity were observed in patients treated operatively as compared to those treated with a conservative approach. Materials and methods: The Department of Orthopaedics, A.J. Institute of Medical Sciences and Research Centre, Mangalore, conducted a hospital-based retrospective and prospective study for two years. On meeting the inclusion and exclusion criteria after ethical clearance and consent, a total of 100 cases of midshaft clavicle fractures were treated by operative and non-operative methods. Physiotherapy was started for the patients after 3 weeks. Follow-ups were done at 6, 12, and 24 weeks and the patients were evaluated clinically based on the Constant-Murley Score.Results: There was a significantly higher number of male subjects compared to females (83% against 17%). 54 patients (54%) had a history of RTA while the remaining 46 patients (46%) gave an account of a fall. The youngest patient's age was 19yrs, while the oldest was 72yrs old. The mean age was 36.93 years. Amongst the complications witnessed, 1 patient had plate breakage, 13 patients experienced non-union, and 18 patients had a limitation in range of motion. 63% of patients had a left-sided fracture, whereas 37% of patients had a right-sided fracture. As per the Constant and Murley scoring system, the Conservative study 46% fell under the Good category, 36% had Fair functional outcome while 18% had a poor result. In the Operative study, 82% fell under the Good category, 16%) had a Fair functional while 2% had a poor outcome. Conclusion: Midshaft clavicular fractures treated operatively have clinically better union rates in comparison to those taking a conservative approach based treatment.