Improved Functional Outcomes Following Operative Treatment of Midshaft Clavicle Fractures in an Active Duty Population

Abstract

Clavicle fractures are common orthopedic injuries that occur in a young active population and are even more common in the military. Military fitness test data presents the unique opportunity to analyze functional ability with regard to military-specific activities. The primary goal of this study was to compare functional outcomes using military fitness test data between operative and non-operative treatment of midshaft clavicle fractures. We performed a retrospective review of active-duty U.S. Navy and Marine patients with midshaft clavicle fractures treated at our institution over a seven-year period. There were 94 and 153 patients in our operative and non-operative cohorts, respectively. Average follow-up time from the date of injury or surgery was 28 months. The rate of infection in the operative group (4%) was significantly greater than in the nonoperative group (0%, p = 0.023). The rate of non-union in the operative group (3%) was significantly lower than in the non-operative group (14.5%, p = 0.004). The rate of symptomatic malunion in the operative group (0%) was significantly different from that in the non-operative group (4.6%, p = 0.036). There was no significant difference in the rate of revision surgery between the operative (9.2%) and non-operative (13.2%) groups (p = 0.105). A total of 51 marines met inclusion criteria for our functional outcome analysis using Marine Corps Physical Fitness Test (PFT) data. Of those who underwent operative fixation, 68% were able to meet or surpass their pre-injury average amount of pull-ups in their first PFT after surgery and 88% by the next PFT at least one year after surgery. While 69% of non-operative patients met their pre-injury average in their first PFT, only 57% maintained this level at least one year after surgery. This difference was statistically significant.

Displaced Midshaft Clavicular Fractures among Patients with Clavicular Fracture Admitted to the Orthopaedic Department of a Tertiary Care Centre: A Descriptive Cross-sectional Study

“…The prevalence of Robinson type 2B1 and type 2B2 was 45% and 55% respectively whereas, in one of the studies, the prevalence was 27.9% and 15.2% respectively.6 Our study showed excellent functional outcomes in 82.50% of cases and no cases of nonunion or malunion which was similar to the results shown by studies. 4,[17][18][19] In our study, the mean age of the patients was 31.45±4.97 years. This finding was similar to various similar studies suggesting the higher prevalence of clavicular fractures in young and active populations.…”

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

“…Numerous previous studies have used FE analysis to gain a better understanding of the disease consequences in terms of timing, outcomes, and healthcare costs [35,[42][43][44]. Several authors have demonstrated improved early functional outcomes with lower rates of nonunion and symptomatic aesthetic deformity with surgical treatment of clavicle fractures compared to non-surgical treatment [45,46]. The decision between surgical and non-surgical treatment should be based on several factors, such as the severity of the injury, the occurrence of complications, the patient's age, and the activity level [14].…”

Closed midshaft clavicle fractures

“…14 In patients with highly physical jobs (e.g. active military personnel or sportsmen) or those with active lifestyles, surgery can be offered to improve functional outcomes, as suggested by Lake et al 32 Shortening on its own is not an indication for surgery, in accordance with the evidence presented by Goudie et al 51 and Malik et al 52 In line with the management strategy developed by Nicholson et al, 42 all patients should be reassessed at six weeks for the following criteria. If they have two of the following three features -a QuickDASH score greater than 40, no callus on radiograph, and movement at the fracture site -they should be advised that there is a 60% chance of progressing to a nonunion, and operative intervention should be considered.…”

“… 14 In patients with highly physical jobs (e.g. active military personnel or sportsmen) or those with active lifestyles, surgery can be offered to improve functional outcomes, as suggested by Lake et al 32 …”