Sling Compared With Plate Osteosynthesis for Treatment of Displaced Midshaft Clavicular Fractures: A Randomized Clinical Trial

J Bone Joint Surg Am. 2012 Sep 5;94(17):1546-53. doi: 10.2106/JBJS.J.01999.


Background: Few randomized controlled trials have compared operative with nonoperative treatment of clavicular fractures.

Methods: Patients with displaced midshaft clavicular fractures were randomized either to nonoperative treatment with a sling or to operative treatment with a stainless steel 3.5-mm reconstruction plate. Outcome measures were the Constant shoulder score, DASH (Disabilities of the Arm, Shoulder and Hand) score, pain, fracture-healing, and complications. The null hypothesis was that the Constant and DASH scores would not differ between the groups at the one-year follow-up evaluation.

Results: In accordance with the power analysis, we included sixty patients in the study; thirty-two were randomized to the nonoperative group and twenty-eight to the operative group. We found no difference in the Constant score (p = 0.75), the DASH score (p = 0.89), or pain (p = 0.98) between the groups at the one-year follow-up evaluation. All fractures in the operative group healed, but six nonunions (24%) occurred in the nonoperative group.

Conclusions: One year after a displaced midshaft clavicular fracture, nonoperative treatment resulted in a higher nonunion rate but similar function and disability compared with operative treatment.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Bone Plates*
  • Clavicle / diagnostic imaging
  • Clavicle / injuries*
  • Female
  • Follow-Up Studies
  • Fracture Fixation, Internal / instrumentation*
  • Fracture Fixation, Internal / methods
  • Fracture Healing / physiology
  • Fractures, Bone / diagnostic imaging
  • Fractures, Bone / rehabilitation*
  • Fractures, Bone / surgery*
  • Fractures, Ununited / diagnostic imaging
  • Fractures, Ununited / surgery
  • Humans
  • Immobilization / methods
  • Injury Severity Score
  • Joint Dislocations / diagnostic imaging
  • Joint Dislocations / rehabilitation
  • Joint Dislocations / surgery
  • Male
  • Middle Aged
  • Orthotic Devices*
  • Patient Selection
  • Prospective Studies
  • Range of Motion, Articular / physiology
  • Recovery of Function
  • Risk Assessment
  • Statistics, Nonparametric
  • Time Factors
  • Tomography, X-Ray Computed / methods
  • Treatment Outcome
  • Young Adult