OBJECTIVES: To compare results of primary internal fixation of acute displaced midshaft clavicle fractures with those managed nonoperatively in terms of fracture union and functional outcome. DESIGN: Prospective cohort study. SETTING: Level II military trauma center. PATIENTS/PARTICIPANTS: Seventy-three patients (civilian and military) between 20 and 50 years of age with displaced midshaft clavicle fractures were allocated either to the operative (n = 45) or nonoperative (n = 28) group. INTERVENTION: Patients in the nonoperative group were managed by simple sling immobilization, whereas in the operative group, fractures were reduced and fixed with a contoured reconstruction plate. MAIN OUTCOME MEASUREMENTS: The patients were actively followed up during an 18-month period. Primary outcome measures were the rates of nonunion and symptomatic malunion; secondary outcomes included the assessment of the Constant score and the overall local complication rate. RESULTS: The 18-month follow-up rate was 90%. All fractures in the operative group united compared with eight nonunions (29%) in the nonoperative group (P = 0.002). Ten symptomatic malunions (36%) occurred in the nonoperative group, whereas only two (4%) were reported for the operative group (P = 0.0008). Constant shoulder scores were significantly better for the operative group at all follow-ups (P < 0.0001). All six operative complications were implant-related. CONCLUSIONS: In this prospective cohort study, primary open reduction and internal plate fixation of acute displaced midshaft clavicular fractures resulted in improved outcomes and a decreased rate of nonunion and symptomatic malunion compared with nonoperative treatment.
OBJECTIVES: To compare results of primary internal fixation of acute displaced midshaft clavicle fractures with those managed nonoperatively in terms of fracture union and functional outcome. DESIGN: Prospective cohort study. SETTING: Level II military trauma center. PATIENTS/PARTICIPANTS: Seventy-three patients (civilian and military) between 20 and 50 years of age with displaced midshaft clavicle fractures were allocated either to the operative (n = 45) or nonoperative (n = 28) group. INTERVENTION: Patients in the nonoperative group were managed by simple sling immobilization, whereas in the operative group, fractures were reduced and fixed with a contoured reconstruction plate. MAIN OUTCOME MEASUREMENTS: The patients were actively followed up during an 18-month period. Primary outcome measures were the rates of nonunion and symptomatic malunion; secondary outcomes included the assessment of the Constant score and the overall local complication rate. RESULTS: The 18-month follow-up rate was 90%. All fractures in the operative group united compared with eight nonunions (29%) in the nonoperative group (P = 0.002). Ten symptomatic malunions (36%) occurred in the nonoperative group, whereas only two (4%) were reported for the operative group (P = 0.0008). Constant shoulder scores were significantly better for the operative group at all follow-ups (P < 0.0001). All six operative complications were implant-related. CONCLUSIONS: In this prospective cohort study, primary open reduction and internal plate fixation of acute displaced midshaft clavicular fractures resulted in improved outcomes and a decreased rate of nonunion and symptomatic malunion compared with nonoperative treatment.
Authors: Frans-Jasper G Wijdicks; R M Houwert; Peter J Millett; Egbert J J M Verleisdonk; Olivier A J Van der Meijden Journal: Can J Surg Date: 2013-02 Impact factor: 2.089
Authors: Jonathon D Backus; David J Merriman; Christopher M McAndrew; Michael J Gardner; William M Ricci Journal: J Orthop Trauma Date: 2014-11 Impact factor: 2.512
Authors: Barış Özkul; Mehmet Selçuk Saygılı; Yaşar Mahsut Dinçel; Ilhan Avni Bayhan; Deniz Akbulut; Bilal Demir Journal: Med Princ Pract Date: 2017-10-01 Impact factor: 1.927