Comparison between conservative and surgical treatment of midshaft clavicle fractures: Outcome of 151 cases

摘要

INTRODUCTION: Midshaft clavicle fractures comprise up to 15% of all adult upper extremity fractures and account for 76% of all clavicle fractures. The treatment of choice remains controversial. The aim of our retrospective study was to compare the outcome of the surgical and conservative procedure in a trauma care unit (single center study). MATERIAL and METHODS: In a cohort of 151 (mean age 36,1y/male 115/female 36) cases, between 2005 and 2009, 70 patients (46.4%) were treated conservatively (mean age 40.8y) and 81 (53.6%) underwent either surgical treatment with a locking compression plate (n=73/mean age 40.3y) or an intramedullary nail system (n=8, mean age 27.1y). Mean follow up was 15 months. Nine patients (5.9%) were lost to follow-up, due to poor compliance. The clinical outcome was assessed by the Disability of Arm, Shoulder and Hand (DASH) score and the Constant shoulder score. RESULTS: The average DASH score was 7.3 and the Constant score measured 91.7 in the surgical group. The conservative group achieved a DASH score of 11.1 and a Constant score of 88.1. The clinical scores showed a significant superiority for the benefit of the surgical treatment for the DASH (p=0.037) and Constant score (p=0.036). Totally nine patients had a non-union in the conservative group and six a hardware failure in the surgical group which were revised. DISCUSSION: The treatment options for midshaft clavicle fractures have to be discussed carefully for each patient with regard to the non-union risk, function, cosmesis and revision surgery. CONCLUSION: Both therapeutic modalities demonstrated comparable efficacy. For active and younger patients we would favour a surgical treatment due to the short time of rehabilitation, the return to sport activities and the high non-union rate after conservative treatment.