Prospective study of surgical management of midshaft clavicle fractures

Abstract

Introduction: Fractures of the clavicle constitute 2.6% of all fractures, account for 44% of the injuries around the shoulder girdle, approximately 70%–80% of which occur in the middle third. Even when significantly displaced, conventionally these fractures are treated without surgery. Conservative treatments either by sling/figure of eight bandage/clavicular brace are favored by patients, but the results are much inferior to what was reported previously. The present study conducted to operate fresh fracture with displacement >2 cm, nonunion by open reduction and internal fixation (ORIF) with locking plate with or without bone grafting. The objective is relief from pain, restoration of activities as far as possible and better cosmetic appearance. Materials and Methods: Twenty-eight cases of the clavicle in healthy active individuals between 18 and 65 years of age operated between December 2019 and September 2022 in Hazaribag Medical College, Hazaribag, Jharkhand. Patients with minimally displaced fracture were excluded from the study. Fracture is classified by Allman in three groups as middle 1/3rd, distal 1/3rd, and medial 1/3rd. Indications for surgery are either open fracture, vascular injuries, initial displacement >2 cm, nonunion, cosmetically conscious patients. Results: Fifteen cases of fresh, 6 cases of symptomatic delayed union, and 7 cases of nonunion operated with precontoured plate with or without bone grafting. The average hospital stay was 3–7 days. The average time of fracture union was 10 weeks (8–12 weeks). Patients were followed weekly up to 4 weeks and then after 2 and 6 months. The functional outcome according to Constant and Murley score is excellent in 17 (60.7%) patients, good in 10 (35.7%) patients and satisfactory in 1 (3.6%) case. There was no major complication, one patient had superficial infection, deep infection in 1 case, nonunion in 1 case and plate breakage in one patient. Results were compared with cases treated conservatively. Conclusion: In the present era of competition, cosmesis and advancement with least morbidity and excellent results is required. ORIF in selected cases is a very good option in comparison to accept morbidity, cosmetic disfigurement and below-average functional results.