Prospective evaluation of early functional recovery of displaced fractures of the middle third of the clavicle whether operated or not

Orthop Traumatol Surg Res. 2021 Feb;107(1):102768. doi: 10.1016/j.otsr.2020.102768. Epub 2020 Dec 24.

Abstract

Introduction: Several studies have analyzed the functional recovery after plate fixation of a displaced fracture of the middle third of the clavicle beyond the 6th week. The aim of this study was to assess the early functional recovery in the first 6 weeks, which has not yet been investigated.

Hypothesis: Functional recovery in the first 6 weeks after surgical treatment is better than in the first 6 weeks of functional (non-operative) treatment.

Methods: Any patient who had a closed displaced fracture of the middle third of the clavicle - Edinburgh types 2B1 or 2B2 - was informed of the treatment options within a week of their fracture: surgical fixation by anatomic plate or functional treatment. A QuickDASH score was filled out weekly for 6 weeks and at 3 and 6 months. Similarly, the Constant score was determined at 3 and 6 weeks and at 3 and 6 months. Any complications were documented and time to union was determined.

Results: Sixty-five fractures in 65 patients were followed for 6 months. Twenty-six patients chose surgical treatment (S) and 39 chose functional treatment (F). The Constant and QuickDASH scores were significantly better in the S group from the 2nd to the 6th week. At 3 weeks, we found a Constant score of 57.7 in group F versus 74.9 in group S (p<0.01) and a QuickDASH of 55.9 in group F versus 27.4 in group S (p<0.001). At 6 weeks, the Constant score was 71.3 versus 86.1 (p<0.001) and the QuickDASH was 28.3 versus 10.6 (p<0.01), respectively. At 3 and 6 months, the recovery was comparable in both groups for these two scores. Return to work was earlier in the S group (34.3 versus 59.7 days; p<0.05).

Discussion: This is the first study reporting the functional results during the first 6 weeks after a displaced fracture of the middle third of the clavicle in adults. Further studies should be conducted to better identify target patients for whom fracture fixation may be beneficial.

Conclusion: This study supports open reduction and internal fixation with an anatomical plate of displaced fractures of the middle third of the clavicle since the functional recovery is better in the first 6 weeks.

Level of evidence: III; prospective case-control study.

Keywords: Clavicle fracture; Functional recovery; Middle third; Plate fixation.

MeSH terms

  • Adult
  • Bone Plates
  • Case-Control Studies
  • Clavicle* / diagnostic imaging
  • Clavicle* / surgery
  • Fracture Fixation, Internal
  • Fractures, Bone* / diagnostic imaging
  • Fractures, Bone* / surgery
  • Humans
  • Prospective Studies
  • Treatment Outcome