DOI: 10.36347/sjams.2019.v07i06.025

Pages: 2157-2163

Most of the displaced midshaft clavicular fractures (DMCF) with shortening in adults will unite with non-operative treatment but studies have reported shoulder dysfunction and patient dissatisfaction with high prevalence of malunion, nonunion and cosmetic deformity. Objectives: The present study is undertaken with a primary objective of comparing these parameters among non-operated and operated patients and draw evidence based conclusions. The secondary objective was to find out the incidence, and appraise the real burden of DMCF among all fractures attending orthopedic emergency department. Methods: During the study 98 mid shaft clavicular fractures with displacement of ≥1.5 cm in adults were studied. After applying exclusion criteria 62 remained in the study. They were randomized in to 2 groups. Group-I was treated by non-operative management and Group-II by operative treatment. 25 patients from Group-I and 28 from Group-II were followed up at 3 months, 6 months and 9-12 months and reviewed with radiographs and DASH scoring system. Complications noted during the reviews were documented. At the final review final radiographs and DASH scores were analyzed statistically using the Chi-square test/Fisher’s test. Results: The DASH scores measured at 3 and 6 months were significantly better in the Group-II than in the Group-I, whereas the DASH scores of Group –II and Group –I at the end of 9-12 months were almost similar. Union rates at the end of 3 months were significantly better in Group-II. At the end of 9-12 months the difference in the union rates of Group-II and Group - I were statistically not significant. At the end of 3 months 32% of Group-I and 7% of Group-II had non-union which reduced to 16% and 4% respectively by the end of 9-12 months. Other complications observed in the Group-1were malunion in 32% cases, shortening of clavicle in 24% and bony prominence in 60%. Conclusions: Early primary plate fixation of DMCF results in: Improved patient-oriented outcome