Background: Clavicle fracture is one of the common fractures accounting for 2.6-12% of all fractures and 44-66% of shoulder fractures with midclavicle fracture accounting for 80% of clavicle fractures. Most of the clavicles were treated conservatively in past but recently there has been an increasing tendency for operative management of clavicle fractures. With studies done showing varying results it is not clear whether primary surgical management provides any better results than conservative management. So, this study was carried out to compare the radiological and functional outcome following conservative management to that of operative management with plating for displaced midshaft clavicle fractures.Methods: In a single center, prospective clinical trial, 60 patients with displaced midshaft fracture of the clavicle were systematically randomized (alternate patient) into either operative treatment with plate fixation or nonoperative treatment with clavicle brace and sling. Outcome was analysed in terms of functional outcome and radiological union by standard follow-up, Constant and Murley shoulder score and plain radiographs. All sixty patients completed sixmonth follow up and there was no difference between two groups with respect to patient demographics, mechanism of injury and fracture pattern.Result: There was no significant difference in Constant shoulder score between the two groups. The mean time of union was 14.57 weeks in operative group compared to 16.04 weeks in nonoperative group (p value=0.191). There were two nonunion in nonoperative group compared to none in operative group. The complications in operative group were mainly hardware related (four had loosening of screw, two had implant failure and one had infection). At six months after surgery patient were more likely to be satisfied with the results in operative group compared to nonoperative group (p=0.02). Conclusion:Six months after a displaced midshaft clavicular fracture, nonoperative treatment resulted in higher malunion and nonunion rate but similar functional outcome and union time compared to operative management. However, patients were more likely to be satisfied in operative group compared to nonoperative group.

Implantable cardioverter-defibrillators (ICDs) have demonstrated efficacy in the prevention of sudden cardiac death secondary to cardiac arrhythmias in eligible patients. Complications with the subcutaneous ICD (S-ICD) are rarer than with the transvenous ICD but do still exist. Our patient presented four weeks after the insertion of S-ICD with complaints of left shoulder pain radiating to the chest wall and swelling over the S-ICD site. He was initially treated for rotator cuff injury and subacromial impingement syndrome but upon obtaining chest radiography was found to have a lead displacement traversing the splenic flexure of the colon. The patient was managed by a treatment team involving cardiology, surgery, and infectious disease and underwent S-ICD removal, exploratory laparotomy with splenic flexure mobilization, and completion of a four-week antibiotic course ultimately leading to reimplantation of S-ICD.

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