Abstract
Background: Distal third fractures account for 10 to 15% of all clavicle fractures. Traditional management of displaced lateral third fractures has been with internal fixation. Several authors have reported higher rates of non-union and poor outcome in conservatively managed fractures. However, long term follow up of non-operated distal third fractures has shown comparable functional outcomes to those managed with internal fixation. The purpose of this retrospective study was to analyse the clinical and radiographic results of nonoperative treatment of displaced lateral clavicle fractures.
Methods: Eighty six patients with displaced lateral end clavicle fractures were treated primarily with a sling for comfort. The fractures were classified as Neer type IIa in fifty patients, type IIb in twenty nine and type III in seven. Physiotherapy was begun after the sling was removed at an average of two weeks after the injury. Patients were evaluated with regard to shoulder function and general health using a modification of the Constant score and SF-36 respectively. All patients had a repeat radiographic exam at follow up. The average duration of follow up was six years (range two to ten years).
Results: Fourteen patients developed symptoms severe enough to warrant surgery at between seven and twenty four months post-injury. Eleven had radiographically confirmed non-union and three had symptomatic osteoarthritis of the acromioclavicular joint. The remaining seventy two patients had not undergone any further surgery. Twenty one patients (29.2%) from the nonoperatively treated group had non-union of the clavicle fracture. The average adjusted Constant score in the non operated group was 94 (range 82 to 98). There was no significant difference in either Constant score or SF-36 between those with non-union and those fractures which had healed. There was also no significant difference in these scores between those treated nonoperatively and those treated by delayed surgery.
Conclusions: Nonoperative treatment of most displaced lateral third clavicle fractures can achieve good functional results comparable to those reported after surgical treatment. Surgery should be reserved for those with primary complications or for the minority who have painful non-union or acromioclavicular joint problems in the early stages of treatment.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
