Comparative study of surgical management versus conservative management of displaced fractures of the clavicle

Abstract

Abstract Back ground and objectives: Clavicle fracture accounts for approximately 2.6% of all the skeletal fractures. These fractures are often associated with shoulder girdle injuries in approximately 44% of cases. Non operative treatment has been a mainstay of a modality of treatment, and irrespective of the type of fracture and amount of comminution, all these fractures were treated non-operatively. Different surgical methods for clavicle midshaft fractures have been described and these are locking compression plate fixation, intramedullary K-wires, Steinmann pin fixation, and intramedullary nailing with TENS. Therefore in this study we have compared the functional outcome of displaced clavicle fractures treated by non-surgical management with that of surgical management by TENS and by open reduction and internal fixation with clavicular locking compression plate. Methods: 60 patients with clavicle fractures presenting to the Orthopaedic Department of R L Jalappa hospital from Nov. 2017 to April 2019 are included in the study after obtaining informed consent. Result: Among 60 patients with clavicle fractures, majority of the injury occurred in male patients- 45 cases (75%), whereas a total of 15 cases (25%) were seen in females. The functional outcome at the end of 6 months in 30 conservatively managed cases showed, 4 cases (13.3%) with excellent outcome; 6 cases (20%) had good outcome. 16 cases (53.3%) had fair and 4 cases (13.3%) had poor outcome. While in surgically managed 30 cases, the functional outcome at the end of 6months showed a total of 23(76.6%) cases with excellent outcome, 4 cases (13.3%) had good outcome 2 cases (6.6%) had a fair, and 1 case (3.33%) had poor outcome. At the end of 6 months, functional outcome of both the groups were compared by applying chi square test, the p value was <0.001, showing the results, statistically significant. Thus, in our study operative group had fewer complications, early bony union and better functional outcome as compared to the conservative group. Conclusion: This study concludes that irrespective of surgical modalities of management used, surgically treated cases have better functional outcome, fewer complications, early bony union and better overall patient satisfaction.