Acute Surgery vs. Non-union Surgery of Displaced Midshaft Clavicle Fractures: A Case-control Study

摘要

Introduction There is a lack of information about the results of surgical?treatment?and complications in?midshaft?clavicle fracture?non-unions. Our hypothesis was that there is no difference in functional outcomes between the surgical treatment of an acute displaced middle-third clavicle fracture and the surgical treatment of a chronic symptomatic non-union of a displaced middle-third clavicle fracture. Methods This was a case-control study. Fourteen cases were considered with a displaced?midshaft?clavicle fracture, initially treated non-surgically, but which developed symptomatic non-union?and required surgical treatment. The control group was a?cohort of 18 patients with a displaced?midshaft?clavicle fracture, who had surgical treatment in an acute setting (3 weeks). Our?cases?had a median follow-up of 77 months?and were retrospectively analyzed. All those in the control group had a 12-month prospective follow-up evaluation. The variables measured were Constant score, time to discharge to work, and bone union rate. Results The median Constant score at final follow-up for surgically treated non-unions was 87.5 (control?group 84.5, p 0.05). The median time to complete return to work was 3.2 months in the?control?group and 9.7 months in the?case group?(p=0.001). Hundred percent of those patients who were initially treated with surgery had bone union without other treatment. Two out of 14?cases?required a second surgery with a plate and bone graft to achieve bone union. Conclusion Symptoms from?displaced?midshaft?clavicular fracture?non-unions?are due?to related pain?and?dysfunctional deficits that result from displacement and shortening.?According to our study, patients with a displaced?midshaft?clavicle?fracture?non-union who needed surgery achieved similar functional results as compared to patients treated in an acute setting for a displaced?midshaft?clavicle fracture. The median time to discharge and return to work was more than doubled in the non-union surgery group.