Functional and radiological outcome in non-operative versus operative management of fracture clavicle

Background: Clavicle fractures are one of the most common bone injuries seen in adult population. Generally all the fracture clavicles were treated non-surgically by figure-eight bandage and surgical intervention like plating with cortical screws is infrequently required. Non-union rates, strength and endurance deficits are familiar in cases treated conservatively. We evaluated functional and radiological outcomes in non operative versus operative management of fracture clavicle, in patients visiting to orthopedic OPD in a tertiary care hospital in Andhra Pradesh. Material and methods: In a prospective clinical trial study of 80 patients, with displaced mid-shaft fractures of the clavicle were referred to Orthopedic OPD in a tertiary care hospital. These patients were deliberately placed into two treatment groups: non-surgical (with figure-eight bandage) and surgical (with DCR plate fixation). All patients of the surgical group underwent ORIF. Clinical examination, fracture radiography and shoulder scores were recorded for all patients at the end of 12 weeks. Shoulder function is measured by the constant shoulder score which includes the pain score, functional assessment, range of motion and strength measures. Patient satisfaction according to strength, shoulder function and pain was also assessed. Results: There were 32 patients in operative in which 23 males and 9 females whereas in non-operative group (figure of eight) there were 35 males and 13 females. The mean age of the patient was 23±3.4 years in operative and 19±2.5 years in non-operative group. 61 fractures occurred on the right side and 10 on the left side. In the Surgical group mean time to reunion was 8±1.8 weeks where as it was 11.±2 weeks in non surgical group. The overall Constant shoulder score was 93.75% in surgical group where as it was 87.50% in nonsurgical group. Additionally the percentage of patients with excellent results was more in surgical group than non- operative group (figure of eight). Conclusion: In both figure of eight bandage and plating, there was satisfactory union of clavicle but due to appropriate bone proximity in cortical screw and plating, excellent functional outcome in the terms of early mobilization and quick union was much appreciated.