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Plate fixation for clavicular fractures reduced risk of nonunion, but led to various complications
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NATIONAL HARBOR, Md. — Although treatment with internal plate fixation in patients with a displaced, midshaft clavicular fracture may reduce the risk for nonunion, this treatment option may lead to a second operation and did not improve shoulder function compared with conservative treatment, according to a speaker here.
“The main benefit for plate fixation is the reduction in risk of nonunion, but it also imposes a considerable risk of complications without [a] clear functional benefit,” Sarah Woltz, MD, said at the Orthopaedic Trauma Association Annual Meeting. “Therefore, it is important to discuss this with the patient and choose the most suitable treatment together.”
In the multicenter prospective study, Woltz and her colleagues randomized 160 patients between 18 years and 60 years of age with a displaced, midshaft clavicular fracture to receive either nonoperative treatment or operative treatment with internal plate fixation.
The primary outcome of the study was nonunion at 1 year, and secondary outcomes were secondary operations, arm function, pain, cosmetic results and general health status. Arm function was measured with the Constant shoulder and DASH scores.
Results showed the incidence of nonunion was 2.4% in the operative group and 23.1% in the nonoperative group, and the rate of secondary operation was 10.7% in the operative group and 15.7% in the nonoperative group. Furthermore, an additional 16.7% of patients in the operative group underwent elective plate removal and 19% of patients in the operative group had persistent loss of sensation around the scar, Woltz said.
There were no differences between Constant and DASH scores between the two groups at 6 weeks, 3 months and 1 year.
“Overall, there is no place for plate fixation for old patients with a displaced, midshaft clavicular fracture.” – by Nhu Te
Reference:
Woltz S, et al. Paper #27. Presented at: Orthopaedic Trauma Association Annual Meeting; Oct. 5-8, 2016; National Harbor, Md.
Disclosure: Woltz reports no relevant disclosures.