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· DOS Abstracts
Optimal treatment of clavicle fractures is not an
“all operative” or “all non-operative” approach: a
single-blinded randomised controlled trial compar-
ing non-operative and operative treatment of displaced midshaft
fractures.
Ban Ilija, Kristensen Morten Tange , Barfod Kristoffer, Eschen Jacob , Kallemose Thomas ,
Troelsen Anders
Orthopedic Surgery, Clinical Orthopaedic Research Hvidovre, Hvidovre Hospital; Physical
Therapy, Hvidovre Hospital; Orthopedic Surgery, Clinical Orthopaedic Research Hvidovre,
Hvidovre Hospital; Orthopedic Surgery , Køge Hospital; Clinical Orthopaedic Research
Hvidovre, Hvidovre Hospital; Orthopedic Surgery, Clinical Orthopaedic Research Hvi-
dovre, Hvidovre Hospital
Background:
Displaced, midshaft fractures represent approximately 50% of all clavicle
fractures and have been the subject of an on-going debate as to what type of initial
treatment is superior.
Purpose / Aim of Study:
To investigate whether operative treatment (OT) compared
to non-operative treatment (NOT) results in better patient-reported outcomes for dis-
placed midshaft clavicle fractures in adults and to compare union and reoperation rates
between the two groups.
Materials and Methods:
A randomised controlled trial with recruitment of 120 healthy
adults with an acute completely displaced midshaft fracture, at two Danish Hospitals. By
randomisation, patients were allocated to either NOT (simple sling) or OT (locking plate).
Follow-up was at 6 weeks, 6 and 12 months. Primary outcomes: DASH and Constant
Scores. Secondary outcomes: fracture non-union rate and events leading to secondary
surgical interventions.
Findings / Results:
Nine were lost to follow-up. Characteristics: median age 38 years
(18-63), 84% males and 69% Edinburgh type 2B1 fractures with no statistical differ-
ence between the groups. At 6 weeks DASH was better in the OT group (p < 0.001), but
no between-group differences in DASH or Constant Scores were seen at 6 or 12-month
follow-up (p=0.106). Secondary surgical intervention was needed in 15 (26%) patients
in the NOT group compared to 14 (26%) in the OT group. The non- union rate was 14%
(n=8) in the NOT group compared to 2% (n=1) in the OT group (p=0.004).
Conclusions:
Short-term recovery is better, and the overall union rate is significantly
higher following OT. Despite this, we found no difference in functional outcome between
the groups at 6 and 12 months. None of the treatment options can claim absolute supe-
riority, and it seems warranted that future treatment strategies involve stratified path-
ways instead of “all-OT” or “all- NOT” approaches.
No conflicts of interest reported
100.