A prospective comparative study on management of midshaft clavicle fractures: Conservative versus surgical

Background: With nonunion rates up to 15% and unsatisfactory patient-reported outcomes in around a third of patients treated conservatively, recent research on displaced midshaft clavicular fractures points to a considerable unmet medical need. These findings have prompted a recent increase in surgical fixation of displaced midshaft clavicular fractures. Objective: In addition to open reduction and plate fixation, intramedullary pins, wires, or nails may also be used to treat clavicle fractures. In this study, we compare the clinical, radiological, and functional results of midshaft clavicular fractures managed with open reduction and plate fixation versus conservative therapy, as well as their overall complication rates. Materials and Methods: All skeletally mature patients presenting to outpatient department/inpatient department with clavicle fracture less than 3 weeks old and displacement/loss of cortical contact between fractured ends of more than 2 cm were included in the study. Patients were randomly allocated to either conservative or surgical management. For conservative management, strapping of the involved side and application of figure-of-eight bandage was done. The minimum follow-up requirement of all patients was 1 year. The clinical assessment involved the assessment of complications, grading of results according to Constant and Murley score as well as the Disabilities of the Arm, Shoulder, and Hand score (DASH score). A radiological assessment for the union of the fracture was also done. Results: In the conservative management group (n = 52), the mean age of the group was 36 years (range, 19-58 years), and the mean follow-up was 1.6 years (range, 1-2.2 years). At 1 year follow-up, the mean DASH score was 7.9 ± 2.1, and the mean Constant score was 90.2 ± 15. The overall complication rate was found to be 21/52 (40.3%) in the operative management group. In the operative management group (n = 50), the mean age of the group was 42 years (range, 24-57 years) and the mean follow-up was 1.3 years (range, 1.1-1.8 years). At 1-year follow-up, the mean DASH score was 10.8 ± 1.1, and the mean Constant score was 93.1 ± 13. The overall complication rate was found to be 14/50 (28%) in the operative management group. In comparison, the overall rate of complications was significantly lower in the operative management group compared with the conservative management group (P = 0.001). Conclusions: Conservative management of midshaft clavicular fractures was as