Long-term results of conservative management of midshaft clavicle fracture

A series of 91 patients (59 males, 32 females, mean age 41 years) with middle-shaft clavicle fracture were assessed at a mean of 8.7 years after injury. Based on Allman’s classification, fractures were placed in group Ia, Ib and Ic. The majority (66%) were allocated to groups Ib or Ic. Clinical evaluation was made using the Constant score and simple shoulder test. On post-injury radiographs, we measured the amount of overlapping of the fracture fragments (OV) both in centimetres and as percentage of the length of the clavicle and the mean distance between cranio-caudally displaced fragments (DS). The mean Constant scores were 87.1% and 85.6% in groups Ib and Ic, respectively. In patients with a Constant score ≥90%, the mean OV was 7.7% and the average DS was 1.59 cm. In those with a Constant score of 81–89% the average OV and DS were 12% and 1.6 cm, respectively, with the greatest OV being 12.9. In the nine patients whose Constant score was ≥80% the mean OV was 13.2 and the average DS was 1.7; however, the majority of patients had an OV > 15% and DS ≥ 2 cm. In these nine patients the mean Constant score was significantly lower than that in the group with a score of ≥90%. The simple shoulder test showed that 20% of patients were dissatisfied with the outcome; a low score was associated with a severe degree of OV or DS. Fracture nonunion occurred in five cases (5.5%). We conclude that there is a clear-cut indication for surgery in patients with OV ≥ 15% or DS ≥ 2.3 cm as well as in those with an OV ≥ 13% associated with a DS ≥ 2 cm. This holds particularly for young and middle-aged patients

Nonoperative treatment of closed displaced midshaft clavicle fractures.

none7BACKGROUND: closed displaced midshaft clavicle fractures used to be treated nonoperatively, and many studies have reported that nonoperative treatment gave good results. However, more recent studies have reported poorer results following nonoperative treatment, whereas the results of operative treatment have improved considerably. The aim of this paper was to report the results of treating closed displaced midshaft clavicle fractures nonoperatively. MATERIALS AND METHODS: one hundred Edinburgh type 2B clavicle fractures (69 type 2B1 and 31 type 2B2) in 100 patients (78 males and 22 females) aged between 18 and 67 ears (mean 32 years) were treated. All patients were treated using a figure-of-eight bandage. Clinical and radiographic assessment was performed at the time of trauma, 1, 2 and 3 months after the trauma, and then at an average follow-up of 3 years (range 1-5 years). The outcome was rated at the last follow-up using the DASH score. RESULTS: ninety-seven of the 100 fractures healed. Three nonunions were observed. Average healing time was 9 weeks (range 8-12 weeks). No statistically significant correlation between the type of fracture and the healing time was observed. The average DASH score was 24 (range 0-78) and, based on this score, 81 patients presented excellent results, 12 good, 5 fair, and 2 poor. No statistically significant correlation between the type of the fracture and the score was observed. CONCLUSIONS: we believe that nonoperative treatment is still appropriate in most cases, as it yields good results without incurring the potential complications of surgery.noneFaldini C.; Nanni M.; Leonetti D.; Acri F.; Galante C.; Luciani D.; Giannini S.Faldini C.; Nanni M.; Leonetti D.; Acri F.; Galante C.; Luciani D.; Giannini S