FRACTURES OF THE MIDDLE THIRD OF THE CLAVICLE. OPERATIVE TREATMENT

Abstract

From 1998–2000 inclusive, we treated 155 acute, non-pathological fractures of the clavicle in adults. We reviewed 134, of which 95 were involving the middle third. The average time of follow-up was 24 months (range 9–33). Aim of this retrospective study was to review the results of operative versus conservative treatment in a view to create a standard protocol for these fractures management. Men accounted 67 the average age being 26.8 (range 15–83) and 28 were women with average age 36.8 (range 23–91). We operated on 23 patients: 3 due to neurological symptoms of C6 nerve root irritation, 4 due to a symptomatic non-union, 10 due to severe displacement and comminution with pressure on the overlying skin and 6 due to their request in a view to earlier return to activity as they were skilled athletes. All fractures healed within 6–14 weeks, and return to normal activity level was 8 weeks on average ( range 2–12). A 3.5mm DCP plate was used in all cases. We treated conservatively 76 patients. Non-union was encountered in 4 (4.2%) and was symptomatic in all of them so they were fixed with a 3.5mm DCP plate and bone grafted. The healing rate was 8–20 weeks, and return to pre injury activity level was 16 weeks on average (14–24). Unsatisfactory results reported from 23 patients, 21 of who were treated conservatively (27.6%) and only 2 operatively (8.7%). In the group of patients treated conservatively initial shortening was similar to the final and when 14mm or more was strongly associated with poor results. In the group treated operatively no significant shortening was found. We recommend young, active patients should be given the option of operative treatment in a view to earlier return to activities with a possible better clinical outcome.