Functional and radiological outcome of treatment of clavicle- conservative versus open reduction internal fixation

Abstract

Midshaft clavicular fractures have traditionally been treated nonoperatively. Prevalence of non-union or mal-union in displaced midshaft clavicular fractures after conservative treatment is higher as compared to those treated with open reduction and internal fixation. Surgery is believed to be the primary treatment for displaced midshaft clavicular fractures. Operative fixation of the clavicle fractures result in improved function, shorter time for union and early return to activity as compared to those treated conservatively. Objectives: The objective of the study was to compare the functional & radiological outcome of open reduction and internal fixation of clavicle with conservative management. Materials and methods: A prospective study was conducted at Department of Orthopaedics, Govt. TD Medical College Hospital for 2 years. In this study period 100 cases of midshaft clavicle fractures, treated by operative and non-operative methods (50 patients each treated by operative and non-operative methods). All the patients in this study were asked to follow up at 6, 12 and 24 weeks. The patients were evaluated both clinically and radiologically. Clinical evaluation was done based on Constant-Murley and DASH score. Results: Males outnumbered females by 66% (i.e. 83% against 17%). Among 100 patients, 54 patients (54%) had RTA while the remaining 46 patients (46%) had a history of fall. The youngest patient was 19yrs and the oldest was 72yrs old. Mean age was 36.93 years. Complications included plate breakage in 1 patient, nonunion in 13 patients and restriction of range of motion in 18 patients were seen. Constant and Murley scoring system showed, out of 50 patients conservatively treated, 23 patients (46%) fell under Good category, 18 patients (36%) had Fair functional outcome while 9 patient (18%) had Poor outcome. In the Operative group, out of 50 patients, 41 patients (82%) fell under Good category, 8 patients (16%) had Fair functional outcome while 1 patient (2%) had Poor outcome. Conclusion:We conclude that midshaft clavicular fractures treated operatively had a better functional outcome as compared to those treated conservatively.