Multicenter, Prospective, Observational Study of Nonoperative Versus Operative Treatment for High-Energy Midshaft...

Area of Science:

• Orthopaedic Surgery
• Trauma Care
• Fracture Management

Background:

• Displaced midshaft clavicle fractures are common injuries.
• Treatment options include nonoperative management and surgical fixation (plate or intramedullary).
• Optimal treatment balancing nonunion rates and functional outcomes remains debated.

Purpose of the Study:

• To compare nonoperative treatment with plate fixation and intramedullary fixation for displaced clavicle fractures.
• To evaluate differences in nonunion rates and Disability of the Arm, Shoulder, and Hand (DASH) scores between treatment groups.

Main Methods:

• Multicenter, prospective, observational study involving 412 adult patients with closed, displaced midshaft clavicle fractures.
• Patients were treated nonoperatively, with plate fixation, or intramedullary fixation.
• Outcomes measured included DASH scores at multiple time points, reoperation rates, and nonunion.

Main Results:

• Nonoperative treatment had a significantly higher nonunion rate (14.6%) compared to plate fixation (0%).
• DASH scores were similar across groups at 2 weeks, 12 months, and 24 months.
• Plate fixation showed better DASH scores than nonoperative treatment at 6 weeks; intramedullary fixation yielded poorer DASH scores than plate fixation at multiple time points.

Conclusions:

• Surgical fixation, particularly plate fixation, is superior in reducing nonunion rates for displaced clavicle fractures.
• Plate fixation offers comparable long-term functional outcomes to nonoperative treatment, with better short-term results at 6 weeks.
• Intramedullary fixation demonstrated inferior functional outcomes compared to plate fixation and nonoperative treatment at several follow-up intervals.