DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20174713

Comparison of union rates and functional outcomes for displaced mid-shaft clavicular fractures at Bhuj-Kutch: a prospective study

Chintan Seth, Sangeen Bhundiya

Abstract


Background: Clavicle fracture usually treated conservatively. There is a rising tendency to treat displaced mid-shaft clavicular fractures with primary open reduction and plate fixation; whether such treatment outcome in enhanced patient outcomes is contentious. The aim of this study was to compare union rates and functional outcomes for displaced mid-shaft clavicular fractures that were treated with either primary open reduction and plate fixation or nonoperative treatment.

Methods: Present study was performed at department of orthopedics, Gujarat Adani institute of medical science, Bhuj, Kutch, Gujarat. Ethical clearance was taken from the institutional ethics board and informed consent was obtained from all the participants. In this study, patients who had an acute displaced mid-shaft clavicular fracture were randomized to receive either primary open reduction and plate fixation or nonoperative treatment. Functional evaluation was conducted at 3 months, 6 months, and 1-year with the use of the constant scores. Union was evaluated clinically and radiographically. Complications were recorded and compared.

Results: The rate of nonunion was reduced significantly after open reduction and plate fixation as compared with nonoperative treatment. Constant scores were significantly improved after open reduction and plate fixation than after nonoperative treatment; 93.7 versus 85.5. A major complication was found in 34.9% of patients in the conventional group while they were absent in operative group.

Conclusions: Open reduction and plate fixation decrease the rate of nonunion after acute displaced mid-shaft clavicular fracture compared with nonoperative treatment and is connected with improved functional outcomes. Open reduction and plate fixation using precontoured locking plate have little implant-related complications.


Keywords


Fracture, Kutch, Open reduction, Plate fixation

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References


Nordqvist A, Petersson C. The incidence of fractures of the clavicle. Clin Orthop Relat Res. 1994;300:127-32.

Ali Khan MA, Lucas HK. Plating of fractures of the middle third of the clavicle. Injury. 1978;9:263-7.

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

Bajuri MY, Maidin S, Rauf A, Baharuddin M, Harjeet S. Functional outcomes of conservatively treated clavicle fractures. Clinics (Sao Paulo). 2011;66:635-9.

Böstman O, Manninen M, Pihlajamäki H. Complications of plate fixation in fresh displaced midclavicular fractures. J Trauma. 1997;43:778-83.

Canadian Orthopaedic Trauma Society. Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial. J Bone Joint Surg Am. 2007;89:1-10.

Eiff MP. Management of clavicle fractures. Am Fam Physician. 1997;55:121-8.

Postacchini F, Gumina S, De Santis P, Albo F. Epidemiology of clavicle fractures. J Shoulder Elbow Surg. 2002;11:452-6.

Greene WB. Essentials of Musculoskeletal Care. 2nd ed. Rosemont, Ill: American Academy of Orthopaedic Surgeons; 2001.

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

Ledger M, Leeks N, Ackland T, Wang A. Short malunions of the clavicle: An anatomic and functional study. J Shoulder Elbow Surg. 2005;14:349-54.

Liu HH, Chang CH, Chia WT, Chen CH, Tarng YW, Wong CY. Comparison of plates versus intramedullary nails for fixation of displaced midshaft clavicular fractures. J Trauma. 2010;69:82-7.

Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987;214:160-4.

Nordqvist A, Petersson CJ, Redlund-Johnell I. Mid-clavicle fractures in adults: End result study after conservative treatment. J Orthop Trauma. 1998;12:572-6.

Robinson CM, Court-Brown CM, McQueen MM, Wakefield AE. Estimating the risk of nonunion following nonoperative treatment of a clavicular fracture. J Bone Joint Surg Am. 2004;86:1359-65.