Session VII - Reconstruction / Upper Extremity/ Wrist & Hand

Sat., 10/15/11 Recon, UE, Wrist & Hand, Paper #85, 3:53 pm OTA-2011

Acute Versus Late Intervention in Clavicle Fractures

Benjamin Ollivere, MD, FRCS; Avishek Das, MRCS; Katie Rollins, MRCS;
Kathleen Elliott, MBBS; Phillip Johnston, MD, FRCS; Lee van Rensburg, FRCS; Graham Tytherleigh-Strong, FRCS;
Addenbrooke’s Hospital, Cambridge University NHS Trust, Cambridge, United Kingdom

Purpose: The evolution of locked anatomic clavicular plating in combination with evidence to suggest that fixation of clavicle fractures yields better outcome than conservative treatments has led to an increasing trend towards operative management. There is no evidence, however, to compare early fixation with delayed reconstruction for symptomatic nonunion or malunion. We hypothesize that early intervention yields better functional results to delayed fixation.

Methods: Between August 2006 and May 2010, 97 patients were managed with operative fixation for their clavicular fracture—68 with initial fixation and 29 delayed fixation for clavicular nonunion or malunion. Patients were prospectively followed up to radiographic union, and outcomes were measured with the Oxford Shoulder Score, QuickDASH (a shortened version of the Disabilities of the Arm, Shoulder and Hand questionnaire), the EuroQol EQ-5D, and a patient interview. Mean follow-up was to 30 months. All patients were managed with Acumed anatomic clavicular plates.

Results: The radiographic and clinical outcomes were available for all patients. Scores were available for 62 of 97 patients. There were no statistically significant differences in age (P >0.05), sex (P >0.05), energy of injury (P >0.05), or number of open fractures (P >0.05) between the 2 groups. The mean quickDASH was 8.9 early, 9.1 delayed (P <0.05); Oxford Shoulder score was 15.7 early, 16.1 delayed (P <0.05). In the early fixation group, 5 patients had wound healing complications, and 8 went on subsequently to have removal of prominent metalwork. In the delayed fixation group, 2 had wound healing complications and 4 had removal of prominent metalwork. There were no statistically significant differences in the EQ-5D quality of life questionnaire.

Conclusion: There are no statistically significant differences in shoulder performance, or wound or operative complications between early and delayed fixation of clavicular fractures. Our series does not support early fixation of clavicular fractures, as results for delayed intervention in those who become symptomatic appear comparable.

Alphabetical Disclosure Listing (628K PDF)

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing. Δ OTA Grant.