The outcome of surgical fixation of mid shaft clavicle fractures; looking at patient satisfaction and comparing surgical approaches

Abstract

Introduction:Clavicle fractures represent 2.5% of fractures in adults and almost 44% of shoulder injuries. The treatment is usually non-surgical with good results; however, significantly displaced fractures can be associated with high non-union rate and therefore many would advocate surgical fixation. This is traditionally carried out by direct approach over the clavicle but an infraclavicular approach has also been used for clavicular fixation. The aim of this study was to identify the main indications for surgical intervention at our unit and patient satisfaction following surgery. We also wanted to compare the direct and the infraclavicular surgical approaches in relation to the outcome of surgical intervention.Materials and Methods:Retrospective study looking at all the clavicle fractures managed surgically over 5 years at our department. Information relating to surgical indication, surgical approach, complications, outcome, patient satisfaction, and oxford shoulder score were collected.Results:A total of 35 patients were identified, the majority were males (n = 25) and most (n = 29) were working at the time of injury. The commonest indication for surgery was displacement with shortening (n = 16). The infraclavicular approach was used in the majority of patients (n = 21), the rest (n = 14) had direct incision. Evidence of radiological and union was achieved in all patients after an average of 13 (8-24) weeks. There were no major complications but minor complications were reported in 28% and 19% of cases with direct and infraclavicular approaches, respectively. Plates were removed from six symptomatic patients; infraclavicular (n = 2) and direct approach (n = 4). Four asymptomatic plates were removed on patients’ requests. All patients returned to work (after an average 2.6 months), had good oxford shoulder score between 12-20, regardless of the surgical approach used. All patients except one would recommend it to a friend.Conclusion:Our study showed excellent surgical outcome for displaced clavicle fractures supported by the high union rate, good oxford shoulder score, high return to work rate, and good patient's satisfaction. The number of minor complications and symptomatic metal work removal was less in the infraclavicular approach.

Long-term Patient-reported Outcome After Fractures of the Clavicle in Patients Aged 10 to 18 Years

“…36,37 CONCLUSIONS Children and adolescents aged 10 to 18 years at the time of injury reported an overall satisfactory long-term outcome after nonoperatively treated fractures of the clavicle. However, most of the patients were older than 18 years when they answered the questionnaires.…”

Clavicle Fracture Treatment: Operative versus Non- Operative Procedure: A Retrospective Analysis at Tertiary Centre

“…However operatively management has a significantly lower rate of nonunion. [7] Patients who underwent operative treatment had better short term functional outcomes. The cost of treatment was significantly greater for patients undergoing operative treatment as compared to those who were managed conservatively.…”

Open reduction and internal fixation in close middle third fracture clavicle by pre-contoured anatomical clavicle plate: A study of 125 cases

“…Other method is ORIF using recon plates, DCP, etc. Different authors have compared ORIF using plates and IM nailing and come to varying inferences with one better over the other and some suggesting that there is no significant difference after 12 months in functionaloutcome [33][34][35][36][37]16] . Open reduction and plate fixation is superior to IM nailing as it better resists bending and torsional forces that occur during over head abduction of shoulder [38] .…”

“…The proponents who favor ORIF in these fractures emphasize on early and accurate reduction achieving clavicular length resulting in quicker pain relief and early functional recovery. As the consensus for operative treatment picks-up, recent studies show lower incidence of nonunion and mal-union rates and early return to work compared to conservative treatment [13][14][15][16][17][18] With the advent of more advanced anatomically contoured plates, the discussion is shifting from indications for operation to choice of implant for mid shaft clavicle fracture [19][20][21][22][23] . This study prospectively evaluates the functional outcome of infra-clavicular approach and superior anatomical clavicle plating for close fractures of middle third clavicle, their advantages and complications in 125 patients.…”