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Background: With nonunion rates up to 15% and unsatisfactory patient-reported outcomes in around a third of patients treated conservatively, recent research on displaced midshaft clavicular fractures points to a considerable unmet medical need. These findings have prompted a recent increase in surgical fixation of displaced midshaft clavicular fractures. Objective: In addition to open reduction and plate fixation, intramedullary pins, wires, or nails may also be used to treat clavicle fractures. In this study, we compare the clinical, radiological, and functional results of midshaft clavicular fractures managed with open reduction and plate fixation versus conservative therapy, as well as their overall complication rates. Materials and Methods: All skeletally mature patients presenting to outpatient department/inpatient department with clavicle fracture less than 3 weeks old and displacement/loss of cortical contact between fractured ends of more than 2 cm were included in the study. Patients were randomly allocated to either conservative or surgical management. For conservative management, strapping of the involved side and application of figure-of-eight bandage was done. The minimum follow-up requirement of all patients was 1 year. The clinical assessment involved the assessment of complications, grading of results according to Constant and Murley score as well as the Disabilities of the Arm, Shoulder, and Hand score (DASH score). A radiological assessment for the union of the fracture was also done. Results: In the conservative management group (n = 52), the mean age of the group was 36 years (range, 19–58 years), and the mean follow-up was 1.6 years (range, 1–2.2 years). At 1 year follow-up, the mean DASH score was 7.9 ± 2.1, and the mean Constant score was 90.2 ± 15. The overall complication rate was found to be 21/52 (40.3%) in the operative management group. In the operative management group (n = 50), the mean age of the group was 42 years (range, 24–57 years) and the mean follow-up was 1.3 years (range, 1.1–1.8 years). At 1-year follow-up, the mean DASH score was 10.8 ± 1.1, and the mean Constant score was 93.1 ± 13. The overall complication rate was found to be 14/50 (28%) in the operative management group. In comparison, the overall rate of complications was significantly lower in the operative management group compared with the conservative management group (P = 0.001). Conclusions: Conservative management of midshaft clavicular fractures was associated with similar clinical and radiological outcomes compared to operative management. However, the overall complication rate was lower for operatively managed patients.
Background: With nonunion rates up to 15% and unsatisfactory patient-reported outcomes in around a third of patients treated conservatively, recent research on displaced midshaft clavicular fractures points to a considerable unmet medical need. These findings have prompted a recent increase in surgical fixation of displaced midshaft clavicular fractures. Objective: In addition to open reduction and plate fixation, intramedullary pins, wires, or nails may also be used to treat clavicle fractures. In this study, we compare the clinical, radiological, and functional results of midshaft clavicular fractures managed with open reduction and plate fixation versus conservative therapy, as well as their overall complication rates. Materials and Methods: All skeletally mature patients presenting to outpatient department/inpatient department with clavicle fracture less than 3 weeks old and displacement/loss of cortical contact between fractured ends of more than 2 cm were included in the study. Patients were randomly allocated to either conservative or surgical management. For conservative management, strapping of the involved side and application of figure-of-eight bandage was done. The minimum follow-up requirement of all patients was 1 year. The clinical assessment involved the assessment of complications, grading of results according to Constant and Murley score as well as the Disabilities of the Arm, Shoulder, and Hand score (DASH score). A radiological assessment for the union of the fracture was also done. Results: In the conservative management group (n = 52), the mean age of the group was 36 years (range, 19–58 years), and the mean follow-up was 1.6 years (range, 1–2.2 years). At 1 year follow-up, the mean DASH score was 7.9 ± 2.1, and the mean Constant score was 90.2 ± 15. The overall complication rate was found to be 21/52 (40.3%) in the operative management group. In the operative management group (n = 50), the mean age of the group was 42 years (range, 24–57 years) and the mean follow-up was 1.3 years (range, 1.1–1.8 years). At 1-year follow-up, the mean DASH score was 10.8 ± 1.1, and the mean Constant score was 93.1 ± 13. The overall complication rate was found to be 14/50 (28%) in the operative management group. In comparison, the overall rate of complications was significantly lower in the operative management group compared with the conservative management group (P = 0.001). Conclusions: Conservative management of midshaft clavicular fractures was associated with similar clinical and radiological outcomes compared to operative management. However, the overall complication rate was lower for operatively managed patients.
Background and objectiveMidshaft clavicular fractures were managed conservatively in the past, with a significant incidence of nonunion and poor functional outcomes in displaced fractures. Anatomically precontoured clavicle plates, since their introduction, have proved to be a superior method for managing these fractures. While open reduction and internal fixation of displaced clavicular fractures with plates have produced successful functional outcomes, complications like plate prominence, scar, postoperative numbness, wound dehiscence, refracture, and infection continue to discourage surgeons from plating these fractures. This study aimed to evaluate whether the precontoured 3.5-mm locking compression plate (LCP) for the clavicle is effective in the management of displaced clavicular fractures with minimum risk of complications. MethodsA prospective observational study was conducted among 26 patients with displaced clavicular fractures that were managed with 3.5-mm precontoured LCP. The functional outcome was assessed by using the Constant-Murley Score (CMS) and healing was assessed radiographically six months postoperatively. ResultsTwenty-five patients were available for the final follow-up at the end of 24 weeks. All of them achieved excellent functional scores. The mean CMS was 94.9. No complication was observed in 85% of the cases. Implant failure was observed in both fractures of a bilateral clavicle fracture patient within a month of surgery. Implant irritation without prominence was seen in one patient and another had a prominent postoperative scar. The mean time for the radiological union was 13.8 weeks with union time ranging from three to five months. ConclusionsBased on our findings, employing 3.5-mm precontoured clavicular LCPs is a useful technique that can provide good functional outcomes in displaced clavicular fractures.
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