Closed treatment of displaced middle-third fractures of the clavicle gives poor results

Abstract

We evaluated 242 consecutive fractures of the clavicle in adults which had been treated conservatively. Of these, 66 (27%) were originally in the middle third of the clavicle and had been completely displaced. We reviewed 52 of these patients at a mean of 38 months after injury. Eight of the 52 fractures (15%) had developed nonunion, and 16 patients (31%) reported unsatisfactory results. Thirteen patients had mild to moderate residual pain and 15 had some evidence of brachial plexus irritation. Of the 28 who had cosmetic complaints, only 11 considered accepting corrective surgery. No patient had significant impairment of range of movement or shoulder strength as a result of the injury. We found that initial shortening at the fracture of > or = 20 mm had a highly significant association with nonunion (p < 0.0001) and the chance of an unsatisfactory result. Final shortening of 20 mm or more was associated with an unsatisfactory result, but not with nonunion. No other patient variable, treatment factor, or fracture characteristic had a significant effect on outcome. We now recommend open reduction and internal fixation of severely displaced fractures of the middle third of the clavicle in adult patients.

Late Thoracic Outlet Syndrome after Clavicle Fractures in Patients with Multiple Trauma: A Pitfall of Conservative Treatment

“…Moreover, the supine position may push the shoulder anteriorly, leading to shortening of clavicle fractures in patients under complete supine bed rest. This shortening of the clavicle might be a potential contributor to late TOS [12]. In our case, the shortened clavicle during 3 weeks of complete bed rest and operative findings strongly suggest that this inevitable process in conservative treatment, which developed the shortened clavicle and soft tissue around the fracture were the main mechanisms of late TOS.…”

Die intramedull�re Osteosynthese der Klavikula mit einem elastischen Titannagel

“…Aus der in den letzten Jahren publizierten Literatur geht hervor, dass 10-30% der konservativ behandelten Patienten klinisch, radiologisch und subjektiv unbefriedigende Ergebnisse aufgrund einer Verkürzung [8,20], einer Pseudarthrose [8,33] oder einer schlechten Schulterfunktion erzielten [20].…”

“…Recent reports stress the fact that 10-30% of conservatively treated patients have an unsatisfactory clinical, radiologic and subjective result on account of shortening [8,20], nonunion [8,33], or poor shoulder function [20].…”

Elastic titanium nails in minimally invasive osteosynthesis for midclavicular fractures

“…So beschrieben Hill et al eine Pseudarthrosenrate von 15% [9]. Auch Plexusirritationen sowie kosmetisch und funktionell schlechte Resultate [9,26] wurden erwähnt.…”

“…So beschrieben Hill et al eine Pseudarthrosenrate von 15% [9]. Auch Plexusirritationen sowie kosmetisch und funktionell schlechte Resultate [9,26] wurden erwähnt. Hill et al [9] und Robinson et al [26] propagieren daher bei deutlich dislozierten Klavikulaschaftfrakturen ein operatives Vorgehen.…”