An Institutional Standardised Protocol for the Treatment of Acute Displaced Midshaft Clavicle Fractures (ADMCFs): Conservative or Surgical Management for Active Patients?

Abstract

Background and Objectives: The treatment of acute displaced midshaft clavicle fractures (ADMCFs) is still under debate. The aim of this study was to verify the effectiveness of our institutional protocol by comparing the clinical and radiographic outcomes of two groups of patients with ADMCFs treated operatively and non-operatively. Materials and Methods: active patients with a traumatic, isolated non-pathological ADMCF with at least 1-year clinical and radiographic follow up were included. Surgical treatment was performed in the cases where the residual displacement was higher than 140% after the application of a figure-of-eight bandage (F8-B). All other cases were treated conservatively with a F8-B. A total of 134 patients were enrolled and divided into two groups: surgical and conservative groups, with 59 and 75 patients, respectively. Radiological and clinical parameters were evaluated. Results: Good clinical (Constant-Murley Score, the Quick Disability of the Arm, Shoulder and Hand score, and VAS satisfaction) and radiographic outcomes (initial and residual shortening, initial and residual displacement) were obtained for ADMCFs in both groups. Multivariate analysis showed that patients treated conservatively had better clinical outcomes compared to surgically treated patients (p < 0.001). Return to sports was longer in those treated with surgery. Initial shortening was found to impact clinical outcomes as well as initial displacement. None of the patients showed signs of non-union in both groups. Conclusions: Very good mid-term clinical results can be obtained in adult patients with ADMCFs, conservatively or operatively managed, by applying our institutional treatment protocol based on objective radiographic parameters evaluated in the ER.

Comprehensive comparison between conservative therapy and surgical management for completely displaced and comminuted mid-shaft clavicle fractures

“…The superiority of surgical therapy over non-surgical therapy for midshaft clavicle fractures, particularly in the middle and long term, is still a topic of controversy. Previous studies have provided inconclusive suggestions due to differences in candidates, surgical techniques, patient compliance, follow-up time, observation targets, and statistical methods, which have led to varying and even contradictory conclusions [ 6 , 7 ]. Furthermore, although the cosmetic issue of clavicle fractures has been noted before, there has never been a direct comparison between conservative and operative patients [ 8 ].…”

Screw Stress Distribution in a Clavicle Fracture with Plate Fixation: A Finite Element Analysis

“…Most patients with compound or minimally compound fractures of the middle third of the clavicle (less than 1.5 cm shortening) can be managed non-operatively with a sling that supports the weight of the elbow, with a gradual return to motion approximately four weeks after the traumatic event [21]. As the indications for surgical treatment have expanded due to the excellent results, the effectiveness of non-surgical treatment has been questioned, with mixed results for both types of approach [21,23,24]. Surgery is indicated in cases of severe diastasis of the fragments, fractures with a third vertical fragment protruding under the skin, pseudoarthrosis, irreducible fractures after immobilization, and rapid return to work [25].…”