Observational study on open reduction and internal fixation of fractures of the clavicle in adults in terms of functional and radiological outcome in the valley of Kashmir

Abstract

Background: The clavicle is one of the most commonly fractured bones, accounting for 2.6% to 4% of all fractures. Not all types of clavicle fractures are amenable to conservative treatment. Recent studies have shown that closed treatment of displaced middle-third fractures of the clavicle gives poor results. One study of displaced middle-third fractures of the clavicle reported a 15% incidence of non-unions and 31% unsatisfactory results after conservative treatment. Its results also concluded that almost 30% of patients with malunion of the clavicle fractures are dissatisfied with their results. In another study, thes came to the conclusion that clavicular plating is the gold standard of the operative treatment of clavicle fractures. Our study was conducted to assess the results and complications of plating, when indicated, in the management of clavicular fractures.

OBJECTIVES: To observe and study the results of open reduction and internal fixation of fractures of the clavicle in adults in terms of functional and radiological outcome in the valley of Kashmir.

STUDY DESIGN: Prospective Observational Study

PARTICIPANTS: The study consisted of a total of 30 adult patients from both sexes with clavicle fractures, satisfying the inclusion criteria.

METHODS: This study was carried out in the Post-graduate Department of Orthopaedics, SKIMS Medical College And Hospital, Bemina, Srinagar, from February 2018 to June 2019 after obtaining approval from the hospital ethics committee. All of the patients were treated with Open Reduction and Internal Fixation of fractures of the clavicle with a Pre-contoured Superior Clavicle Locking Plate.

RESULTS: The time to union in our patients ranged from 8 to 16 weeks. All the fractures in our study united with an average time to union of 12.9 weeks. The average 6-month QuickDASH score was 1.44, whereas the mean constant score was 94.8 at the final follow-up. The complications in our study included numbness below the incision area in 4 cases (13%) and hardware irritation in 2 cases (7%) .

CONCLUSION: There has been a resurgence of interest in operative treatment for fractures that are displaced, comminuted, or that display significant shortening. Most of the clavicle fractures are best managed conservatively. Operative treatment is beneficial to a subset of patients in whom functional expectations and fracture characteristics have both been taken into account before taking the final decision.

IMPLICATIONS: When indicated, open reduction and internal fixation of fractures with plating rapidly restores the anatomy and provides stable fixation, resulting in early pain resolution, a high rate of bony union, and a lower complication rate, when compared to the literature documenting conservative means for clavicle fracture management.