A Prospective Study of Clinical and Functional Outcome of Clavicle Fracture Treated With Locking Plates in Adults

Abstract

BACKGROUND Fracture of clavicle accounts for approximately 5%-10% of all fractures. In adults, about 70% of clavicle fractures involve middle third part of the clavicle. Clavicle fractures are more common in young age group. Surgery is accepted more and more as primary treatment for dislocated mid shaft clavicle fractures as studies have shown that operative treatment results in lower rate of fracture non-union, symptomatic mal-union than conservative management. Incidence of high energy clavicle fracture is increasing and may contribute to these findings because, increased initial fracture displacement, shortening, comminution have been predictive of non-union and poor patient outcome with non-operative care. Open reduction & locking compression plating thus may be better options for displaced mid clavicle fracture. The objective of the study is to evaluate the role of open reduction and internal fixation and to evaluate clinical and functional outcome of fracture of the clavicle treated with pre-contoured clavicular anatomical locking plates in adults with six month follow up using 'Disabilities of the Arm, Shoulder and Hand Score'. MATERIALS AND METHODS The study was carried out during the period of June 2015 to June 2017 in the Department of Orthopedics, Inlaks and Budhrani Hospital, Pune, (MH). Study includes 30 cases of clavicle fracture in the population aged between 18 years to 60 years, irrespective of sex, with fracture midshaft of clavicle (amenable to open reduction, internal fixation with LCP with minimum of three screw in medial and lateral fragment). The clinical and radiological outcome was evaluated using DASH score and plain radiograph. Union was evaluated clinically and radiographically. Complications were recorded. RESULTS Highest number of patients were seen mainly in the age group of 21-40 years. 19 patients (63.3%) achieved radiological union in 12 weeks. Other 11 patients (36%) achieved union by the end of 18 weeks. 4 patients (13%) had plate prominence. Restriction of shoulder movement was seen in 3 patients (10%). None of the patients had neurovascular compromise. 83.3% of study subjects showed excellent outcome. CONCLUSION This study showed clinically and radiologically satisfactory results. Overall operative treatment with locking compression plates can be used to obtain stable fixation and excellent outcome.