Significant pain reduction and improved functional outcome after surgery for displaced midshaft clavicular fractures
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RESEARCH ARTICLE
Open Access
Significant pain reduction and improved functional outcome after surgery for displaced midshaft clavicular fractures Lars Eden*, Dirk Ziegler, Fabian Gilbert, Kai Fehske, Annabel Fenwick and Rainer H. Meffert
Abstract Purpose: Displaced midshaft clavicular fractures can be treated conservatively as well as operatively by titan elastic nail (TEN) or plate fixation. This survey was performed to evaluate the clinical results of each treatment method and elaborate advantages or possible complications of each modality. Methods: Between 2008 and 2013, 102 patients were prospectively included in our study—37 patients for conservative treatment with a rucksack bandage for 4 to 6 weeks, 41 patients for plate osteosynthesis, and 24 for intramedullary stabilization with TEN. Disabilities of the Arm, Shoulder and Hand (DASH), Constant Murley Score (CMS), and visual analog scale (VAS) for pain and function as well as time of invalidity were recorded over a 1-year period. Results: The clinical data collected reveals that all three different therapies lead to good or excellent clinical results after 1 year. However, one can observe advantages of operative treatment in comparison to conservative therapy in some characteristics. Conclusion: Our data shows that there are several indications where operative treatment has advantages compared to conservative treatment. In special fracture types (Robinson 2B1), TEN gives the best results. Plate fixation is extraordinarily sufficient in pain reduction within the first 5 weeks and indicated in more-part fractures (Robinson 2B2). Nevertheless, conservative treatment is always a good and promising way to treat clavicular fractures, so that individual indications and thorough patient informative talks are inevitable. Keywords: Clavicular fracture, TEN, AS clavicle plate LCP, Reconstruction plates
Introduction Fractures of the midshaft clavicle account for approximately 4–8 % of all fractures and are thereby a frequently seen injury especially in young and active men [1, 2]. Three different standard treatment options are offered: conservative treatment with a sling or a rucksack bandage, intramedullary stabilization with a titan elastic nail (TEN), and open reduction and fixation with a plate (Fig. 6). Neer’s data from the 1960s with a non-union rate less than 1 % has traditionally been the basis for the recommendation of conservative treatment [1]. Surveys in the 1990s revealed a significantly higher non-union rate for displaced fractures of 15 % and more than 30 % unsatisfied patients treated conservatively [3]. These results * Correspondence: [email protected] Department of Trauma, Hand, Plastic and Reconstructive Surgery, Julius Maximilian University, Oberduerrbacher Straße 6, 97080 Wuerzburg, Germany
were underlined by the work of McKee in 2006 [4]. In 2007, a prospective randomized Canadian multicenter study showed that plate fixation is superior to conservative treatment mainly using non-locking LCDC plates [5]. By 2008, 26 % of all midshaft clavicular fra
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