A comparative study on management of mid-shaft clavicular fractures between conservative and operative treatment

Abstract

Background: Mid-shaft clavicular fractures are very common and can be treated operatively or nonoperatively. Traditionally, conservative treatment has been practiced, with malunion occurring commonly as a complication. However, there is still no uniform consensus on to leave mid shaft clavicular fracture or to fix it surgically. Aim: To compare the results of surgical management with established modality of conservative treatment, and comparison among operative group (TEN vs Plate). Material and Methods:The prospective Cohort study, with consenting 110 patients (nonoperative and operative treatment, n = 30, loss to follow up 38 & 12, respectively), with mean age of 36.98±12.23 years, who had mid shaft clavicular fractures, was conducted at Level 1 trauma centre in D.Y. Patil Medical College, Kolhapur, between April 2010 to March 2013. Data was analysed using R software v 3.6.0. Functional outcome, union time and complication rate were assessed using, chi-square and independent t-test. Results: Significantly, higher mean Constant and Murley score (CMS), less union time (P<0.01), and less complications (P=0.014), was noted among operative group. Among surgical group, nail vs. plate method used (n=16 vs. 14), excellent outcome (n=11 vs. 9), and CMS score (90.64 vs. 89.57), respectively. Conclusion: Surgical management could be used in, severely displaced mid-shaft clavicular fractures. Further prospective trials are required to establish it. Level of Evidence: Therapeutic Level III.