Operative treatments compared with nonoperative treatment of displaced midshaft clavicular fractures.

BACKGROUND

Few reports on external fixation to treat displaced midshaft clavicular fractures exist. We sought to compare the clinical effects of external fixation, plate fixation, and nonoperative treatment for treating displaced midshaft clavicular fractures in adults.

MATERIAL AND

METHODS

Eighty-nine patients with a displaced midshaft fracture of the clavicle were selected (according to inclusion criteria) for a retrospective analysis and assigned to either operative treatment with external fixation (29 patients), plate fixation (30 patients) or nonoperative treatment with a sling (30 patients). The average follow-up period is 32 months. Outcome analysis included: Constant shoulder score (CSS); disabilities of the arm, shoulder and hand score (DASH); nonunion rate; satisfaction of shoulder appearance.

RESULTS

Eighty-five cases were successfully followed up. No significant difference was observed between external fixation and plate fixation (p > 0.05 and p = 0.132, respectively). The operative groups achieved better effects (p < 0.001) compared to the nonoperative treatment. The healing time of the three groups were: 10.4 ± 2.3 weeks for external fixation; 12.1 ± 2.5 weeks for plate fixation; and 15.7 ± 2.2 weeks for nonoperative treatment. In the follow-up, patients in the external fixation group (96%) and plate fixation group (93%) were more likely to be satisfied with the appearance of the shoulder than were those in the nonoperative group (77%).

CONCLUSION

The external fixation and plate fixation are overall better than the nonoperative treatment. As to choose between the two, it depends on the local soft tissue condition, surgeon's techniques, communication between doctor and patients and so on.