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More nonunions seen with conservative care for clavicle fractures
Similar functional outcomes were seen following operative and nonoperative treatment.
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NEW ORLEANS — The results of a randomized controlled trial comparing operative and nonoperative treatment of midshaft clavicle fractures show no significant functional differences between treatments, but reveal a higher nonunion rate with conservative care.
“In the nonoperative group, there was a high incidence of nonunion, but we definitely found no impact on functional outcomes,” Kaisa J. Virtanen, MD, said during her presentation here at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons.
She added, “From our study, I may recommend the nonoperative treatment for the acute displaced midshaft clavicle fractures. However in the highly active, physical-demanding patients, operative treatment should be considered. [With] operative treatment [we found] 100% union with a low rate of complications.”
1-year follow-up
Virtanen and her colleagues from Finland studied the results of 60 patients with completely displaced middle-third clavicle fractures who received either conservative treatment with a sling for 3 weeks or underwent reconstructive plating followed by 3 weeks of wearing a sling. One-year follow-up was available for 26 patients in the operative group (mean age of 41 years) and 25 patients in the nonoperative group (mean age of 34 years). The investigators found no significant differences between the groups regarding their injury mechanism or fracture severity at baseline.
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Investigators studied middle-third clavicle fractures in 60 patients. They found no difference in clinical scoring between operative and nonoperative treatments. However, they recommended surgical treatment for highly active patients with greater physical demand. Images: Virtanen KJ |
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Complications, healing
“We found no difference [between the groups] in Constant shoulder score at 12-weeks or 1-year follow-up,” Virtanen said. “We found statistical, but not clinical differences in DASH and pain [scores] at 1-year follow-up.”
The study revealed Constant shoulder scores of 86.1 for the nonoperative group and 86.5 for the surgically treated group at 1 year. At the same time point, the investigators found DASH scores of 7.1 for the nonoperative group and 4.3 for the surgically treated group. Visual Analogue Scale scores for pain were 7 for the nonoperative group and 3 for the operative group.
The investigators also discovered that all of the patients in the operative group healed. In addition, they found that a plate broke in one patient in the group and another patient had a re-fracture after a new fall.
“In the nonoperative group, we found five nonunions,” Virtanen said. “There was one re-fracture after a fall and one transient plexus irritation.” — by Gina Brockenbrough
Reference:
- Virtanen KJ, Paavola MP, Remes VM, et al. Nonoperative versus operative treatment of midshaft clavicle fractures — A randomized controlled trial. Paper #331. Presented at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons. March 9-13. New Orleans.
- Kaisa J. Virtanen, MD, can be reached at Helsinki University Central Hospital, Topeliuksenkatu 5, FIN-00260 Helsinki, Finland; + 358 50427 2253; e-mail: kaisa.virtanen@hus.fi.
