Functional outcome of open reduction and internal fixation of clavicle fracture

Abstract

INTRODUCTIONClavicle is the bony link between thorax and shoulder girdle which contributes movement at shoulder girdle. Clavicle fracture is one of the common bony injury around the shoulder joint due to their subcutaneous position. It is more common in young active individual, who participate in activities or sports where high speed fall (e.g. Bicycling, motorcycle) or violent collision (e.g. Football, hockey) are frequent, road traffic accident, fall from height, fall directly over the shoulder or fall on outstretched hand (indirect trauma). Fracture clavicle accounts for approximately 5% to 10% of all fracture and up to 44% of injuries of shoulder girdle. Majority of clavicle fracture occur in mid-shaft of the bone around 80% to 85% where the typical compressive forces applied to the shoulder and the narrow cross section of the bone combine and result in bony failure. Distal third accounts for 20%14-18 and medial third fracture are rarest 5%. 1-3Fracture clavicle have been traditionally treated conservatively with closed manipulation and various method of immobilization; figure of eight splint most commonly used. Older studies suggested that clavicle fracture, even when significantly displaced, was an essentially benign injury with inherently good prognosis when treated non operatively. 4,5 Proponent of early fixation of fresh clavicle fracture is to prevent complication, like non-union, malunion, shoulder ABSTRACT Background: Clavicle fracture is one of common bony injury; which is more common in young active individual. It has been traditionally treated with non-operative method. This present study was undertaken to study the role of the surgical management in the fresh middle third clavicle fracture. Methods: 30 adult patients (21 male and 9 female) of average age of 32 years presented with fresh middle third clavicle fracture and treated surgically with open reduction and internal fixation with plate and screws and followed. Study conducted between November 2011 to November 2012. Results: In 27 patients fracture were united at end of 12 weeks, in 2 patients fracture were united at end of 24 weeks and 1 patient went for non-union. One patient had superficial infection. None had deep infection. One patient had plate loosening at 4week but fracture was united at the end of 24 weeks. 2 patients had persistent pain which is controlled with occasional analgesic but not effecting ordinary work. One patient had gross restriction of shoulder movement. Functional outcome assessed according to near shoulder scoring system. 24 patients had excellent result, 4 patients had satisfactory result, 1 patient had unsatisfactory result and 1patients had failure. Conclusions: The study showed rigid fixation with plate and screw for fresh middle third clavicle fracture especially displaced and comminuted give immediate pain relief and prevent the development of shoulder stiffness &non-union and give good functional outcome.