Open reduction and plating for displaced mid third clavicle fractures - A prospective study

Displaced middle third clavicle fractures were treated conservatively with figure of '8' harness in the past. Current management trend in treating displaced clavicle fractures with internal fixation provide rigid immobilization and pain relief avoiding non-union, shortening and deformity. This study prospectively evaluates the functional outcome of 25 patients with clavicle fractures treated surgically.

25 patients with displaced mid third clavicle fractures were included in the study. Open reduction and internal fixation with clavicular locking plate placed superiorly was done. Patients were followed up on 3, 6, 8, and 12 weeks. Functional outcome was assessed using DASH scores and Simple Shoulder Test (SST). Statistical analysis was done using One-way ANOVA.

Out of the 26 clavicles operated (one patient had bilateral fracture), 6 were comminuted (23%) and the rest were 2 part displaced fractures. Interfragmentary screws were used in 3 cases with butterfly fragment. All fractures united (mean = 6.8 weeks). The DASH scores reduced to a significant negligible level by 8 weeks in all but 4 cases with comminution where it took longer than 8 weeks to reach negligible levels. The SST showed significant improvement in all cases by 8 weeks after surgery. All patients were satisfied with the outcome. 84% of patients returned to their work by 6 weeks.

Primary plating of displaced mid third clavicle fractures with superiorly placed locking plate avoids complications of non-operative management and leads to early return to pre injury activities.