Conservative Management and Plate Fixation of Mid-Shaft Clavicular Fractures in Adults: Comparative Study

Abstract

Introduction: Fracture clavicle used to be treated conservatively. But, risk of mal-union and shoulder dysfunction has raised many concerns regarding this way of treatment. Operative treatment for clavicle fracture gained popularity recently for displaced fracture clavicle. So, in our study we compared between the two methods of treatment. Patients and methods: We conducted a prospective study for all adult patient presented to our hospital with unstable fracture clavicle from August 2016 to September 2017. Patients were divided in two groups A and B, with exclusion of poly-trauma patients. Group A treated conservatively and group B treated by open reduction and internal fixation with plate and screws on the superior surface of the clavicle. The patients were followed up and assessed by constant shoulder score. Results: The study included 20 patients in two group 10 patient for each group. The demographic data in both groups showed no significant differences. Follow up was 6.2 and 7.3 months in both groups respectively. Union occurred in 5.8 and 5.3 months in both groups respectively. The difference was insignificant for follow up and union; p value> 0.05. Functional outcome was excellent in 8 and good in 2 in group A, and excellent in 6, good in 4 in group B. This difference was found to be significant, p value ˂ 0.05. Conclusion: From our study and supported by others we recommend that conservative treatment should be the first choice for most patients and operative fixation to be reserved for selected cases.

A prospective comparative study of functional outcome in patients treated non-operatively and surgically (by plate osteosynthesis) for mid-shaft clavicle fractures in adults

“…There was no significant association between the groups as per Chi-Square test (p>0.05). This is in concordance to the study of Abu-zeid ME et al [20] . Singh A et al [19] study found as per Robinson classification in type-2 middle third fracture type 2A1 (undisplaced) occurred in 13 patients (43.33%), type-2 B1 (displaced with simple or single butterfly fragment) occurred in 15 patients (50%) and type-2B2 (displaced with comminuted or segmental) fracture occurred in 2 patients (6.67%).…”

“…There was no significant association between the groups as per Chi-Square test (p>0.05). This is similar to the studies of Ethiraj P et al [18] , Singh A et al [19] and Abu-zeid ME et al [20] . Ethiraj P et al [18] prospective study found middle third clavicle fracture commonly occurred between the age group of 19 to 30 years in 41 patients (68.3%).…”

“…Similar observations were noted in the studies of Singh A et al [19] , Ethiraj P et al [18] , Abu-zeid ME et al [20] , Kingsly P et al [21] , Ejagwulu FS et al [22] and Onta PR et al [23] .…”

“…The average patient age was 37.10 years. Abu-zeid ME et al [20] prospective study comparing results of conservative treatment and operative treatment with plate and screws in treatment of mid-shaft clavicular fractures found out of the 20 adult patients in two equal groups, the age in group A ranged from 22-55 years with a mean of 37.7 years and in group B it ranged from 21-41 years with a mean of 30.3 years with no statistically significant difference. Group A included 9 males (90%) and 1 female (10%), group B included 7 males (70%) and 3 females (30%) with no statistically significant difference.…”

“…Type-2B2 (Displaced with communition) occurred in 9 patients (15%). Abu-zeid ME et al [20] prospective study found according to Robinson's classification in Group A included five patients with 2B1 (50%), and five patients with type 2B2 (50%). Group B had three patients with type 2B1 (30%), and seven patients with type 2B2 (70%).…”