Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of Orthopaedic surgery

Background: Recent studies have shown a high prevalence of symptomatic malunion and nonunion after nonoperative treatment of displaced midshaft clavicular fractures. We sought to compare patient-oriented outcome and complication rates following nonoperative treatment and those after plate fixation of displaced midshaft clavicular fractures. Materials and methods: From February 2020 to November 2020, a prospective clinical trial study involving 30 patients with displaced mid shaft clavicle fractures. patients were randomized to operative treatment with plate fixation (15 patients) or nonoperative treatment with a sling (15 patients), Outcome analysis included standard clinical follow-up, Quick (DASH) score and plain radiographs. There were no differences between the two groups with respect to patient demographics, mechanism of injury or fracture pattern. Results: The mean time to radiographic union was 20 weeks in the nonoperative group compared with 12.7 weeks in the operative group (p = 0.001). There were three non-unions in the conservative group compared with no one in the nonoperative group (p = 0.005). Symptomatic malunion developed in five patients in the nonoperative group and no one in the operative group (p = 0.005). Most common complications in the operative group were hardware-related problem, Quick DASH scores were improved in the operative fixation group at all time-points. Conclusion: Operative fixation of a displaced fracture of the clavicular shaft results in improved functional outcome and a lower rate of malunion and nonunion compared with nonoperative treatment at six months of follow-up. Hardware removal remains the most common reason for repeat intervention in the operative group Level of evidence: Therapeutic level I

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