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Similar patient-reported outcomes seen with nonoperative vs operative treatment of distal clavicle fractures
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VANCOUVER, British Columbia — Operative treatment was seen as a viable option for patients with distal clavicle fractures. However, patient-reported outcomes were similar with operative compared with nonoperative treatment, according to a presenter here.
“Nonoperative management of type II distal clavicle fractures frequently results in nonunion and symptomatic malunion, and this oftentimes requires secondary surgery,” Jeremy Alan Hall, MD, said during his presentation at the Orthopaedic Trauma Association Annual Meeting. “The operative management provides a safe, reliable treatment option with few complications, but oftentimes requires removal of the implanted hardware.”
He added, “So, in conjunction with patient factors and their interest in surgery, I think that this information can be used by the treating surgeon to make an informed decision as to the treatment with operative or nonoperative management of type II distal clavicle fractures.”
Hall and colleagues conducted the reportedly first, multicenter randomized controlled trial of displaced, distal clavicle fractures. Investigators randomized 27 patients to open reduction and internal fixation (ORIF) with a plate and 30 patients to nonoperative treatment with a sling.
At 1-year postoperatively, there were improvements in DASH scores and Constant scores; however, there were no significant differences between patients treated with ORIF and those treated nonoperatively during any time point. Investigators noted the groups were not different with regard to the rate of return to work or return to activity. Higher rates of nonunion (37%) and malunion (40%) were seen in patients who received nonoperative treatment. Patients who received nonoperative treatment also had a longer time to union, with 42% reaching union at 6 months compared to 95% of patients who underwent ORIF.
The groups also had similar rates of secondary procedures, with seven patients who received nonoperative treatment needing 10 operations and 13 patients who underwent ORIF all requiring hardware removal. – by Monica Jaramillo
Reference:
Hall JA, et al. Paper #66. Presented at: Orthopaedic Trauma Association Annual Meeting. Oct. 11-14, 2017; Vancouver, British Columbia.
Disclosures: The study was funded by a grant from the Orthopaedic Trauma Association. Hall reports no relevant financial disclosures.