Comparison between conservative and surgical treatment of midshaft clavicle fractures: outcome of 151 cases.

INTRODUCTION

Midshaft clavicle fractures comprise up to 15% of all adult upper extremity fractures and account for 76% of all clavicle fractures. The treatment of choice remains controversial. The aim of our retrospective study was to compare the outcome of the surgical and conservative procedure in a trauma care unit (single center study).

MATERIAL AND

METHODS

In a cohort of 151 (mean age 36,1y/male 115/female 36) cases, between 2005 and 2009, 70 patients (46.4%) were treated conservatively (mean age 40.8y) and 81 (53.6%) underwent either surgical treatment with a locking compression plate (n=73/mean age 40.3y) or an intramedullary nail system (n=8, mean age 27.1y). Mean follow up was 15 months. Nine patients (5.9%) were lost to follow-up, due to poor compliance. The clinical outcome was assessed by the Disability of Arm, Shoulder and Hand (DASH) score and the Constant shoulder score.

RESULTS

The average DASH score was 7.3 and the Constant score measured 91.7 in the surgical group. The conservative group achieved a DASH score of 11.1 and a Constant score of 88.1. The clinical scores showed a significant superiority for the benefit of the surgical treatment for the DASH (p=0.037) and Constant score (p=0.036). Totally nine patients had a non-union in the conservative group and six a hardware failure in the surgical group which were revised.

DISCUSSION: The treatment options for midshaft clavicle fractures have to be discussed carefully for each patient with regard to the non-union risk, function, cosmesis and revision surgery.

CONCLUSION

Both therapeutic modalities demonstrated comparable efficacy. For active and younger patients we would favour a surgical treatment due to the short time of rehabilitation, the return to sport activities and the high non-union rate after conservative treatment.