Session IV - Upper Extremity


Fri., 10/21/05 Upper Extremity, Paper #14, 9:33 am

A Multicenter Randomized Control Trial of Non-Operative and Operative Treatment of Displaced Clavicle Shaft Fractures

Michael D. McKee, MD, FRCS(C); Jeremy A. Hall, MD, FRCS(C);
and the Canadian Orthopaedic Trauma Association;
(all authors a-OTA/DePuy Grant; Zimmer, Inc. Grant)
St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada

Purpose: This study was conducted to compare patient-oriented outcomes of nonoperative and operative treatment of displaced clavicle shaft fractures.

Methods: Randomization was by sealed envelope. Nonoperative treatment was symptomatic in a sling, while operative patients underwent open reduction and internal fixation (ORIF) using small fragment plates and screws. Constant Shoulder Score (CSS), Disability of the Arm, Shoulder and Hand (DASH) scores, and SF-36 scores were collected at 6 weeks, 3 months, 6 months, and 12 months. Statistical analysis was completed by repeated measures multivariate analysis using SPSS.

Results: 72 of 120 patients have at least 1 year of follow-up. The nonoperative group (n=35) consisted of 25 males with an average age of 32 years injuring 14 dominant clavicles. The operative group (n=37) consisted of 33 males with an average age of 34.5 years injuring 21 dominant clavicles. CSS and DASH scores were statistically different at all time points measured (P=0.001 and P=0.021 respectively). Complications in the nonoperative group included one patient with reflex sympathetic dystrophy, two patients with symptomatic malunions, and six patients with nonunions requiring ORIF. In the operative group, two patients experienced local plate irritation and one late wound dehiscence.

Conclusion: Operative fixation of displaced clavicle shaft fractures provides statistically significant improvement in functional outcome over sling treatment at 1 year of follow-up.

Significance: Recent studies have shown a higher incidence of symptomatic malunions and nonunions after sling treatment. Currently sling treatment is the standard of care for these fractures. Our study shows statistically significant improvement in functional outcome with operative treatment with few complications. This study supports operative fixation of displaced clavicle shaft fractures in selected cases.

A = presentation was funded by an OTA administered grant

If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.