Early Versus Delayed Operative Intervention in Displaced Clavicle Fractures

OBJECTIVES:Recent evidence to suggest that fixation of clavicle fractures yields better outcomes than conservative treatments has led to an increasing trend toward operative management. There is no evidence, however, to compare early fixation with delayed fixation for symptomatic patients before union. DESIGN:Prospective comparative case series. SETTING:Level 1 regional trauma center. PATIENTS:Displaced clavicle fractures treated operatively in our institution during a 4-year period. Ninety-seven patients were included68 with early fixation and 29 delayed. Radiographic and clinical outcomes were available for all patients and scores were available for 62. INTERVENTION:Early plate fixation (within 3 weeks) of displaced clavicle fractures compared with delayed (3–12 weeks) fixation of displaced clavicle fractures. OUTCOMES:Radiographic union, Oxford Shoulder Score, QuickDASH, EQ5D, and a patient interview. Mean follow-up was to 30 months. RESULTS:There were no statistically significant differences in age (P > 0.05), sex (P > 0.05), and energy of injury (P > 0.05) between the 2 groups. The mean QuickDASH was 8.9 early and 9.1 delayed (P < 0.05) and the Oxford Shoulder Score was 44.2 early and 43.9 delayed (P < 0.05). In the early fixation group, there were 5 wound healing complications, and 8 went on subsequently to have removal of prominent metalwork. In the delayed fixation group, 2 had wound healing complications and 4 required removal of prominent metalwork. There were no statistically significant differences in the EQ5D scores. CONCLUSION:Our series supports delayed fixation of symptomatic clavicle fractures as results do not differ from early fixation. LEVEL OF EVIDENCE:Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.