Functional and radiological outcome of comminuted middle third clavicle fractures treated with plate osteosynthesis and primary bone grafting

Abstract

Clavicle fractures are very common accounting for 5-10% of all fractures and 44% of all shoulder injuries. Biomechanical studies reveal that the middle third is the weakest and accounts for 80% of all clavicle fractures and more than 50 percent of these fractures are displaced. Traditionally displaced middle third clavicle fractures were treated conservatively with figure of '8' harness with its own complications such as malunion, shortening of the clavicle and non-union in cases of increased displacement. Modern day trend in treating them with internal fixation provide rigid immobilization and pain relief avoiding non-union, shortening and deformity. Earlier studies reported non-union rate of less than 1% with conservative management. But those studies were not standardized. They had variable proportions of patients in various ages, with variable sites of fracture and of variable fracture configuration. Recent studies have shown that displaced mid-shaft clavicular fractures do not have assured favourable outcomes with non-operative management and non-union rates could be as high as 20%. In this study we evaluated 30 patients with middle third displaced comminuted clavicular fractures treated by open reduction and internal fixation with anatomical S plate and primary bone grafting. These patients were followed up at 6 weeks, 12 weeks and 6 months with radiological (X-rays) and functional assessment with DASH score and Constant shoulder score questionnaire. At the end of 6 months all these patients went on to union with a statistically significant functional outcome at various study intervals (DASH score with p value <0.05 and Constant scoring with p value <0.05). Hence we conclude as mid third comminuted clavicle fractures treated with open reduction and internal fixation with anatomical S plate and primary bone grafting, unite early with excellent functional outcome, assessed by DASH and Constant shoulder score.