Functional Outcomes and Complications of Non-surgical Management for Midshaft Clavicle Fractures

Introduction Midshaft clavicle fractures are commonly managed conservatively, especially in resource-limited settings. While union rates are generally high, concerns remain regarding functional outcomes and complications such as nonunion and malunion. Objective This study's objective is to evaluate the long-term functional outcomes and complications associated with non-surgical management of middle-third clavicular fractures. Methodology This prospective observational study was conducted at Mardan Medical Complex over 24 months. A total of 110 patients with isolated, closed, middle-third clavicle fractures treated conservatively were enrolled. Functional outcomes were assessed using the QuickDisabilities of the Arm, Shoulder, and Hand (QuickDASH) score and Constant-Murley Shoulder Score (CMSS) at 12-month follow-up. Radiological union, complications, and patient satisfaction were also recorded. Statistical analysis was performed using SPSS version 25.0 (IBM Corp., Armonk, NY). Independent t-tests and chi-square tests were applied where appropriate, with a p-value of < 0.05 considered statistically significant. Results Out of 110 enrolled patients, 102 (92.7%) completed follow-up. Union was achieved in 88 (86.3%) patients within 16 weeks. Nonunion occurred in seven (6.9%), and malunion in 10 (9.8%). The mean DASH score was 9.6 ± 7.2, and CMSS was 88.2 ± 6.8. Patients with union had significantly better scores (p < 0.001). Cosmetic dissatisfaction was reported in 18 (17.6%) patients, mostly associated with malunion. Conclusion Conservative management of midshaft clavicle fractures is generally effective, but functional outcomes are significantly influenced by healing quality. Careful patient selection and follow-up are essential to minimize complications and improve outcomes.