Comparative study of plating versus conservative treatment in mid shaft fractures of clavicle

Authors

  • Johney Juneja Department of Orthopaedics, R. N. T. Medical college, Udaipur, Rajasthan, India http://orcid.org/0000-0001-8787-4314
  • Ankit Damor Department of Orthopaedics, R. N. T. Medical college, Udaipur, Rajasthan, India
  • A. K. Mehra Department of Orthopaedics, R. N. T. Medical college, Udaipur, Rajasthan, India
  • Anurag Talesra Department of Orthopaedics, R. N. T. Medical college, Udaipur, Rajasthan, India
  • Dharmendra Kumar Jatav Department of Orthopaedics, R. N. T. Medical college, Udaipur, Rajasthan, India
  • Anamendra Sharma Department of Orthopaedics, R. N. T. Medical college, Udaipur, Rajasthan, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20214957

Keywords:

Clavicle, Conservative, Fracture, Mid shaft, Plate

Abstract

Background: Clavicle fractures represent up to 4% and 1% of all fractures, respectively. Historically, both fracture types have been treated conservatively with acceptable outcomes. The surgical correction of these fractures is currently being investigated as a viable alternative to conservative management.

Methods: A systematic search of PubMed was performed to identify articles comparing open reduction and internal fixation (ORIF) with conservative treatment for clavicular fractures. Specific outcomes of interest were shoulder function, pain, strength, range of motion, and risk of non-union. 

Results: ORIF of midshaft clavicular fractures results in increased shoulder function within 6 weeks following treatment and a decreased risk of non-union. After 1 year, there was no longer a difference in shoulder function between groups. There was no difference in pain between treatment groups. Both ORIF and conservative treatment of extraarticular scapular fractures yield comparable results in shoulder function, range of motion, and strength following treatment.

Conclusions: This study, early primary plate fixation of comminuted mid shaft clavicular fractures results in improved patient-oriented outcomes, improved surgeon-oriented outcomes, earlier return to function and decreased rates of non-union and malunion. 

References

Hussein M. An ancient Egyptian treatise ontraumatology. J Bone Joint Surg Am. 1949;31B(2):309-12.

Stienberg, Israel: Sub clavian vein thrombosis associated with fracture of the clavicle. Report of two cases. New England J Med. 1961;264:686-8.

Neer CS. Fractures of the distal clavicle with detachment of the coracoclavicular ligaments in adults. J Trauma. 1963;3:99-110.

Allman FLJr. Fractures and ligamentous injuries of the clavicle and its articulation. J Bone Joint Surg [Am]. 1967;49:774-84.

Fowler AW. Treatment of fractured clavicle. Lancet. 1968;1:46-47.

Neer CS. Fractures of the distal third of the clavicle. Clin Orthop. 1968;58:43-50.

Moseley HF. Shoulder lesions. Edinburgh: Churchill Livingstone. 1972.

Sankarankutty M, Turner BW. Fractures of the clavicle. Injury. 1975;7:101-6.

Rockwood CA. Fractures of the outer clavicle in children and adults. J Bone Joint Surg Br. 1982;64:642.

Salter EG, Nasca RJ, Shelley BS. Anatomical observations on the acromio clavicular joint and supporting ligaments. Am J Sports Med. 1987;15:199-206.

Altamimi SA, McKee MD. Canadian Orthopaedic Trauma Society Non operative treatment compared with plate fixation of displaced mid shaft clavicular fractures. J Bone Joint Surg Am. 2008;90(2):1-8.

Stanley D, Trowbridge EA, Norris SH. The mechanism of clavicular fracture. A clinical and biomechanical analysis. J Bone Joint Surg Br. 1988;70:461-4.

Nordqvist A, Petersson C. The incidence of fractures of the Clavicle. Clin Orthop. 1994;300:127.

Conboy, Morris RW, Jenokiss, Andrew J. Valuation of the constant-murley shoulder assessment. Veronicab. Carr J Bone Joint Surg [Br]. 1996;78-B:229-32.

Hill JM, McGuire MH, Crosby LA. Closed treatment of displaced middle-third fractures of the clavicle gives poor results. J Bone Joint Surg Bri Vol. 1997;79(4):537-9.

Nordqvist A, Redlund-Johne llI, von Scheele A, Petersson CJ. Shortening of clavicle after fracture. Incidence and clinical significance, a 5-year follow-up of 85 patients. Acta Orthop Scand. 1997;68:349-51.

Jupiter JB, Ring D. Fractures of the clavicle. In: Iannotti JP, Williams GR, eds. Disorders of the shoulder: diagnosis and management. Philadelphia: Lippincott Williams and Wilkins. 1999.

Nowak J, Mallmin H, Larsson S. The aetiology and epidemiology of clavicular fractures. A prospective study during a two-year period in Uppsala, Sweden. Injury. 2000;31:353-8.

Harnroongroj T, Tantikaul C, Keatkor S. The clavicular fracture: A biomechanical study of the mechanism of clavicular fractures and modes of the fracture. J Med Assoc 2000;83:663-7.

Debski RE, Parsons IM, Woo SL. Effect of capsular injury on acromioclavicular joint mechanics. J Bone Joint Surg Am. 2001;83(9):1344-51.

Daniilidis K, Raschke MJ, Vogt B, Herbort M, Schleimann B, Gunther N et al. Comparison between Conservative and surgical treatment of midshaft clavicle fractures: outcome of 151 Cases. Technol Health Care. 2013;21(2):143-7.

Postacchini F, Gumina S, DeSantis P, Albo F. Epidemiology of clavicle fractures. J Shoulder Elbow Surg. 2002;11(5):452-6.

Kloen P, Sorkin AT, Rubel IF. Antero inferior plating of mid shaft clavicular nonunions. J Orthop Trauma. 2002;16:425-30.

Peerensm. Evaluation of the internal fixation of the long bone fractures. The scientific basis of the biological internal fixation. Choosing a new balance between stability and biology. Jbjsbr. 2002;84-b:1093-110.

Egol KA, Zuckermann JD. Handbook of Fracture. LWW.4th edition Handbook of Fracture. 1987;477-9.

Canale TS, Beaty JH. Campbell’s Operative Orthopedics Volume 3, 11th Edition. 2020;3371-6.

McKee MD, Wild LM, Schemitsch EH. Mid shaft malunion of the clavicle. J Bone Joint Surg Am. 2003;85:790-7.

Egol KA, Kubiak EN, Fulkerson E, Kummer FJ, Koval KJ. Biomechanics of locked plates and screws. J orthopaedic trauma. 2004;18(8):488-93.

Zlowodzki M, Zelle BA, Cole PA, Jeray K, McKee MD. Evidence-Based Orthopaedic Trauma Working Group. Treatment of acute Midshaft clavicle fractures: systematic review of 2144 fractures: on behalf of the Evidence-Based Orthopaedic Trauma Working Group. J Orthop Trauma. 2005;19:504-7.

The use of anatomic pre contoured plates in the treatment of midshaft clavicle fractures-Chandrasenanetal. J Bone Joint Surg (Proceedings). 1999;91-B(1)179.

Judd DB, Pallis MP, Smith E, Bottoni CR. Acute operative stabilization versus non operative management of clavicle fractures. Am J Orthop (Belle Mead, N.J.). 2009;38(7):341-5.

Judd DB, Pallis MP, Smith E, Bottoni CR. Intramedullary fixation versus non operative treatment for mid-shaft clavicle fractures: Paper#034. Proceedings of the 72nd Annual Meeting of the Am Academy of Orthopaedic Surgeons. 2005;23-7.

Bucholez R, Heckman JD, Charles Court-Brown, Rockwood Green’s Fractures in Adults volume 16th Edition. 2006;1213-6.

Kotelnicki JJ, Bote HO, Mitts KG. The management of clavicle fractures. J Am Academy Physician Assistants. 2006;19(9):50-6.

Collinge C, Devinney S, Herscovici D, DiPasquale T, Sanders R. Anterior-inferior plate fixation of middle-third fractures and non-unions of the clavicle. J Orthop Trauma. 2006;20:680-6.

Jeray KJ. Acute mid shaft clavicular fracture. J Am Academy orthop Surg. 2007;15(4):239-48.

Canadian Orthopaedic Trauma Society. Non operative treatment compared with plate fixation of displaced mid shaft clavicular fractures. A multi-center randomized clinical trial. J Bone Joint Surg Am. 2007;89(1):1-10.

Shen WJ, Liu TJ, Shen YS. Po-Cheng. Plate Fixation of fresh displaced mid shaft clavicle fractures. Bone Joint Surg [Br]. 2008;90B-1495.

Kulshrestha V. Primary Plating of Displaced Mid-Shaft Clavicular Fractures. MJAFI. 2008;64:208-11.

Shen WJ, Liu TJ, Shen YS, Po-Cheng. Plate Fixation of fresh displaced mid shaft clavicle fractures. Bone Joint Surg [Br]. 2008;90B-1495.

In 2008 Byron Chaldis et al. Concluded that conservatively treated fracture united in 96.9% of cases and the time of union was no different from sling or figure of eight bandage. One third of patients still complained of pain and discomfort during over-head activities and poly trauma patient had lower constant score.

Kale SY, Chaudhari PL, Dhar SB, Mukherjee SK, Ali S. A Comparative Study of the Conservative and Operative Management of Midshaft Clavicle Fracture based on Functional Outcome and Post-Operative Complications. Int J contemporary Med Res. 2016;3(10):2819-23.

Khan K, Bradnock TJ, Scottand C, Robinson M. Fractures of the Clavicle. J Bone Joint Surg Am. 2009;91:447-60.

Schiffer G, Faymonville C, Skouras E, Andermahr J, Jubel A. Midclavicular fracture: Not just atrivial injury-current treatment options. Dtsch Arztebl Int. 2010;107(41);711-7.

Cho CH, Song KS, Min BW, Bae KC, Lee KJ. Operative Treatment of Clavicle Midshaft Fractures: Comparison between Reconstruction Plate and Reconstruction Locking Compression Plate. Clin Orthop Surg. 2010;2(3):154-9.

Stegeman Et Al. Displaced Midshaft Fractures of The Clavicle: Non- Operative Treatment Versus Plate Fixation (Sleutel-TRLAL). A Multicentre Randomised Controlled Trial. BMC Musculoskeletal Disorders. 2011;12:196.

Modi N, Patel AD, Hallam P. Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK. Outcome Of 62 Clavicle Fracture Fixations With Locked Compression Plate: Is This The Right Way To Go? 2011;06:266.

Van Beek C, Boselli KJ, Cadet ER, Ahmad CS, Levine WN. Pre contoured Plating of Clavicle Fractures: Decreased Hardware-related Complications? Clin Orthop Relat Res. 2011;469:3337-43.

Bajuri MY, Maidin S, Rauf A, Baharuddin M, Harjeet S. Functional outcomes of conservatively treated clavicle fractures. Clinics (SaoPaulo). 2012;66:635-9.

Ban I, Branner U, Holck K, Krasheninnikoff M, Troelsen A. Clavicle fractures may be conservatively treated with acceptable results-a systematic review. Danish Med J. 2012;59:1-7.

Karibasappa AG, Srinath SR. Surgical Versus Conservative Treatment in the Management of Displaced Mid Shaft Clavicular Fractures: A Clinical Study. IJSR. 2014;3(2):343-6.

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Published

2021-12-24

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Original Research Articles