Functional Outcome in Midshaftclavicle Fracture Plating: Our Experience

Abstract

Fracture of the clavicle constitute approximately up to 44% of injuries to the shoulder girdle most of which (upto 80%) occur in the middle one-third of clavicle shaft. Poor outcomes associated with mal-union and non-union (15%) following middle third clavicle fracture has been observed after conservative treatment of severely displaced fractures. In past few years, many have suggested operative treatment as an alternative to conservative treatment. AIM: To analyze the outcomes of the operative management using plate to fix mid-shaft fractures compared to conservative treatment. MATERIALS AND METHODS: 33 patients of clavicular fractures were treated conservatively (n=17) and surgically (n=16) according to fracture pattern and patient demands between June 2011 to June 2013 with 1 year of follow-up. Fractures were classified according to Robinson's classification and Constant and Murley shoulder score was used to access functional outcome. All patients were followed up weekly for 4 weeks then at 8 wks, 12 wks, 6 months and 1 year. Local examination, shoulder movements were assessed and check x-rays were done at each visit. RESULT: Our study showed statistically significantly better union time in operative group (~7.8 weeks) compared to conservative group (~9.4 weeks). Malunion was seen in 11 (64.7%) of conserved patients with 1 (5.8%) going into non-union. 81.5% patients in operative group (13 out of 16) had good to excellent functional outcome compared to 58.8% in conservative group (10 out of 17). 4 (23.5%) had poor outcome in conservative group compared to only 1 (6.25%) in operative group. CONCLUSION: Our study concludes that operative treatment i.e. Open reduction and internal fixation with plating gives better functional outcome in both short and long term period compared to conservative treatment and the same should be preferred especially for type B variety fracture. Complications seen following surgery were infection (1 patient-6.25%), implant failure (1 patient-6.25%) and implant prominence (11 out of 16 patients-68.7%). However none of the patients agreed for implant removal in view of implant prominence for cosmetic reason at 1 year follow-up.