Radiological and clinical comparison of surgical and conservative treatment of distal fractures of the clavicle (Neer type 2b)

Abstract

Introduction: In this study, we aimed to compare the patients we treated conservatively with those treated surgically in distal Neer type 2b fractures of the clavicle radiologically and clinically. Patients and Methods: Between May 2015 and June 2020, 67 patients who were treated and followed up with the diagnosis of Neer type 2b distal clavicle fracture were evaluated retrospectively. Thirty-six patients who were followed up conservatively were assigned to Group 1, and 31 patients who were treated surgically were assigned to Group 2. Age, gender, fracture side, fracture type and follow-up period of the patients included in the study were calculated. Preoperative fracture displacement amounts were measured radiologically. As a result of conservative or surgical treatment, the distance between the coracoid process and the clavicle (Coracoclavicular (CC) distance) in the final radiological image was measured. The clinical result at the last follow-up was made according to the Constant-Murley scoring. Those who developed nonunion were detected. Results Group 1 had a higher mean age compared to Group 2. (p = 0.24) Both groups had a similar distribution in terms of gender, fracture side and follow-up time. (p > 0.05) It was observed that the preoperative displacement amount of Group 2 was higher than Group 1. (p = 0.003) CC distance of Group 2 was higher than Group 1. (p = 0.018) Constant-Murley scores of both groups had similar distribution. (p = 0.086) While uneventful union developed in all patients in Group 2, nonunion was observed in 12 (33%) patients in Group 1. Conclusion Even though Neer type 2b distal clavicle fractures have a high nonunion rate, their effect on the clinical outcome is quite low. They do not need surgical treatment unless symptomatic nonunion develops. Level of evidence: Level 3, Retrospective comparative study