Antero superior plate osteosynthesis versus conservative treatment for diaphyseal clavicle fractures: A prospective comparative study

Abstract

Background: Clavicle fractures were traditionally treated conservatively but there is growing awareness of non-unioun, mal-unioun leading to shoulder girdle malfunction resulting in unsatisfactory outcomes. Operative intervention is increasingly being advocated to prevent these complications and achieve better outcomes. Aim: To compare functional outcome, fracture union rates and complication rates of clavicle fractures treated conservatively vs those treated operatively with anatomical locking plate. Methods: This prospective comparative clinical study conducted at a tertiary trauma center from May 2014 to June 2017.100 patients were enrolled. Fractures were classified according to Allman and AO/OTA scheme. Patients underwent conservative treatment or operative fixation with 3.5mm locking compression plate. Regular follow up at 6 weeks and 3,6,12 months was done clinically and radiologically. Functional outcome was measured using constant murley and DASH score, and complications if any were noted. Results: Mean time for fracture union was shorter in operative group (14weeks) compared to non-operative group (23weeks). Mean time for functional recovery in operative group was 5.2 weeks compared to 7.3 weeks in conservative group. At 12months, Mean DASH score was 3.8 in operative group and 7.4 in conservative group, and mean Constant Murley Score at 12 months was 93.74 in operative group vs 88.21 in conservative group. Mean DASH and constant murley score was better in operative group throughout the course of study. Conservative group had 26% non-union and 40% malunion rates.10% pts in operative group had prominent hardware, 6 % had superficial surgical site infection, 2% had deep infection. In conservative group, 6% had excellent, 32% had well, 26% had fair and 36% had poor outcome. In operative group 80% had excellent, 16% had well and 4% had fair outcome. Conclusion: Antero superior plate osteosynthesis helps to achieve anatomical reduction in acute clavicle fractures especially in displaced and comminuted fractures resulting in early healing, faster return to functional activity and better functional outcome while avoiding complications such as non-union and mal-union. It may be considered the standard of care in patients with high functional demand.