Nonoperative Treatment Compared with Plate Fixation of Displaced Midshaft Clavicular Fractures in Adults

Abstract
Background: Fracture clavicle is one of the most common fractures, it constitutes about 4% of all fractures. 76% of clavicular fractures are fracture of the mid shaft. Clavicular fractures have classically been treated conservatively with favourable results. However, unsatisfactory results were found in recent clinical series as nonunion and malunion. The debate is still present between conservative and operative treatment of displaced fracture clavicle. This study is meant to compare the outcomes of nonoperative conservative treatment and operative treatment with plate fixation of the completely displaced midshaft clavicular fractures to clarify the merits and possible disadvantages of each method.
Aim of Study: Comparison between the outcomes of the non-operative and operative treatment of displaced mid-shaft clavicular fracture to reveal the advantages and disadvantages of each method to refine the indications of each method.
Patients and Methods: This study was performed on fourty adult patients with mid-shaft clavicular fracture, sub grouped randomly in two matched groups regarding age, sex and type of fracture. 20 patients (Group A) were treated non-operatively by immobilization with broad arm sling and 20 patients (Group B) were treated operatively by open reduction and internal fixation (ORIF) with plate and screws. Patients were collected from orthopedic surgery department, Tanta University Hospitals, followed up at a period of 18 months and assessed using the constant shoulder score (CSS).
Results: Results were functionally satisfactory in 90% of group A patients and in 70% of group B patients according to CSS. ORIF was attended with higher complication rate, inferior overall outcome and more unsatisfied patients.
Conclusions: According to the study results, non-operative treatment by broad arm sling is the preferred line of treatment in solitary closed uncomplicated mid-shaft clavicular fractures. ORIF is recommended in cases of associated scapular neck fracture “floating shoulder”.