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, 11 (8), e5480

Acute Surgery vs. Non-union Surgery of Displaced Midshaft Clavicle Fractures: A Case-control Study


Acute Surgery vs. Non-union Surgery of Displaced Midshaft Clavicle Fractures: A Case-control Study

Michael Marsalli et al. Cureus.


Introduction There is a lack of information about the results of surgical treatment and complications in midshaft clavicle fracture non-unions. Our hypothesis was that there is no difference in functional outcomes between the surgical treatment of an acute displaced middle-third clavicle fracture and the surgical treatment of a chronic symptomatic non-union of a displaced middle-third clavicle fracture. Methods This was a case-control study. Fourteen cases were considered with a displaced midshaft clavicle fracture, initially treated non-surgically, but which developed symptomatic non-union and required surgical treatment. The control group was a cohort of 18 patients with a displaced midshaft clavicle fracture, who had surgical treatment in an acute setting (<3 weeks). Our cases had a median follow-up of 77 months and were retrospectively analyzed. All those in the control group had a 12-month prospective follow-up evaluation. The variables measured were Constant score, time to discharge to work, and bone union rate. Results The median Constant score at final follow-up for surgically treated non-unions was 87.5 (control group 84.5, p > 0.05). The median time to complete return to work was 3.2 months in the control group and 9.7 months in the case group (p=0.001). Hundred percent of those patients who were initially treated with surgery had bone union without other treatment. Two out of 14 cases required a second surgery with a plate and bone graft to achieve bone union. Conclusion Symptoms from displaced midshaft clavicular fracture non-unions are due to related pain and dysfunctional deficits that result from displacement and shortening. According to our study, patients with a displaced midshaft clavicle fracture non-union who needed surgery achieved similar functional results as compared to patients treated in an acute setting for a displaced midshaft clavicle fracture. The median time to discharge and return to work was more than doubled in the non-union surgery group.

Keywords: clavicle fracture; clavicle non-union; clavicle non-union surgery; clavicle surgical treatment; clavicle treatment; midshaft clavicular fractures.

Conflict of interest statement

The authors have declared that no competing interests exist.


Figure 1
Figure 1. X-Ray example of a midshaft clavicle fracture non-union
Red arrow: non-union
Figure 2
Figure 2. Constant score comparison between both study groups
Figure 3
Figure 3. Median time to discharge to work
Figure 4
Figure 4. CT scans and bone union achieved after surgery
CT: computed tomography Red arrow: signs of bone union

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