A prospective comparative study of surgical management verses conservative management of clavicle fracture

Abstract

Background: Fracture of the clavicle accounts for 5 to 10% of all fractures and almost half of the shoulder girdle injuries and70- 80% of clavicular fractures are mid clavicular fractures. Most clavicular fractures are benign. Non operative treatment has been a mainstay of a modality of treatment, and irrespective of the type of fracture and amount of comminution, all these fractures were treated non-operatively. Different surgical methods for clavicle midshaft fractures have been described and these are locking compression plate fixation, intramedullary K-wires, Steinmann pin fixation, and intramedullary nailing with TENS. Therefore in this study we have compared the functional outcome of displaced clavicle fractures treated by non-surgical management with that of surgical management by TENS and by open reduction and internal fixation with clavicular locking compression plate. Methodology: 30 Patients of age above 18 years having closed clavicular fracture who are admitted in DR. B.R. Ambedkar Medical College and Hospital, meeting the inclusion criteria are taken for study after obtaining their written informed consent. Patients were followed up for a period of 6 months at 1,6 and 24 weeks after surgery. In total 15 patients were operated and 15 patients were treated conservatively. Outcome was analysed in terms of radiological union and functional outcome of the patient. Results: Among 30 patients with clavicle fractures, majority of the injury occurred in male patients- 21 cases (70%), whereas a total of 9 cases (30%) were seen in females. The functional outcome at the end of 6 months in 15 conservatively managed cases showed, 2 cases (13.3%) with excellent outcome, 3 cases (20%) had good outcome, 8 cases (53.3%) had fair and 2 cases (13.3%) had poor outcome. While in surgically managed 15 cases, the functional outcome at the end of 6months showed a total of 11(73.3%) cases with excellent outcome, 2 cases (13.3%) had good outcome, 1 cases (6.6%) had a fair, and 1case (6.67%) had poor outcome. At the end of 6 months, functional outcome of both the groups were compared and in our study operative group had fewer complications, early bony union and better functional outcome as compared to the conservative group. Conclusion: This study concludes that irrespective of surgical modalities of management used, surgically treated cases have better functional outcome, fewer complications, early bony union and better overall patient satisfaction.