Nonoperative treatment of closed displaced midshaft clavicle fractures

Cesare Faldini, Matteo Nanni, Danilo Leonetti, Francesco Acri, Claudio Galante, Deianira Luciani, Sandro Giannini, Cesare Faldini, Matteo Nanni, Danilo Leonetti, Francesco Acri, Claudio Galante, Deianira Luciani, Sandro Giannini

Abstract

Background: closed displaced midshaft clavicle fractures used to be treated nonoperatively, and many studies have reported that nonoperative treatment gave good results. However, more recent studies have reported poorer results following nonoperative treatment, whereas the results of operative treatment have improved considerably. The aim of this paper was to report the results of treating closed displaced midshaft clavicle fractures nonoperatively.

Materials and methods: one hundred Edinburgh type 2B clavicle fractures (69 type 2B1 and 31 type 2B2) in 100 patients (78 males and 22 females) aged between 18 and 67 ears (mean 32 years) were treated. All patients were treated using a figure-of-eight bandage. Clinical and radiographic assessment was performed at the time of trauma, 1, 2 and 3 months after the trauma, and then at an average follow-up of 3 years (range 1-5 years). The outcome was rated at the last follow-up using the DASH score.

Results: ninety-seven of the 100 fractures healed. Three nonunions were observed. Average healing time was 9 weeks (range 8-12 weeks). No statistically significant correlation between the type of fracture and the healing time was observed. The average DASH score was 24 (range 0-78) and, based on this score, 81 patients presented excellent results, 12 good, 5 fair, and 2 poor. No statistically significant correlation between the type of the fracture and the score was observed.

Conclusions: we believe that nonoperative treatment is still appropriate in most cases, as it yields good results without incurring the potential complications of surgery.

Figures

Fig. 1
Fig. 1
Figure-of-eight bandage. a Anterior and b posterior aspects. c An altered bone profile due to the fracture is noticeable
Fig. 2
Fig. 2
a Radiographic aspect of an Edinburgh type 2B2 clavicle fracture in a 32 year-old man. b Radiographic aspect of the fracture 1 month after the trauma: callus formation is noticeable. c Radiograph shows healing of the fracture two months after the trauma. d Radiographic aspect of the clavicle 6 months after the trauma: the fracture has healed and the bone has been remodeled. A residual prominence of the bone profile is noticeable
Fig. 3
Fig. 3
a Radiographic aspect of an Edinburgh Type 2B2 clavicle fracture in a 28 year-old male, and b radiographic aspect at 2 year follow-up: the fracture has healed with evident bone remodeling. Even though a slight shortening of the clavicle is noticeable, no functional impairment was mentioned by the patient at last follow-up

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Source: PubMed

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