Abstract

CONSERVATIVE VERSUS OPERATIVE TREATMENT OF DISPLACED MID SHAFT CLAVICLE FRACTURE- A TWO YEARS RANDOMIZED CONTROLLED STUDY

Author(s): Anoop Kumar, Devinder Singh Gulati

BACKGROUND Clavicle fractures were considered non-troubling entity in the past. Majority of mid shaft fractures used to be treated conservatively and many studies reported relatively good results. However, more recent studies have reported poor results following conservative treatment regarding non-union, disabilities and cosmetic reasons. Surgeons in the past use to fix clavicle fractures with pins, simple plates and external fixators having high failure rates. Whereas the results of operative treatment improved considerably with introduction of better implants and awareness regarding disability specially among young people and sports persons. The aim of this study was to compare results of closed versus operative treatment. MATERIALS AND METHODS Total of 80 patients with displaced mid shaft clavicle fractures in two groups of 40 each in conservative and operative groups were compared. Mean age was 30 years (18 years - 60 years). All patients in conservative group were treated using figure of eight bandage with arm sling, and in operative group curved locking plate was used. All patients were evaluated clinically and radiologically at three weeks, six weeks and after three months of treatment respectively. All patients were followed for 2 years following treatment. The outcome was rated using DASH score and Constant Moor scores. RESULTS Union resulted in all 40 patients in operative group whereas 2(5%) patients reported non-union in conservative group. The mean fracture union time was significantly lower in operative group (14.4 weeks) as compared to conservative group (24.2 weeks). The difference is statistically highly significant (p<0.000). Dash score and Constant Moore score were significantly better in operative group. They were 94.2 and 96.4 in operative and 78.2 and 84.4 in conservative group respectively. CONCLUSION After 2 years of analysis it was found that operative treatment has better results in terms of improved functional outcome, early anatomical union and cosmetic appearance as compared to conservative treatment while treating displaced midshaft clavicle fractures in young active individuals, especially in sportsmen.