Observational study to compare the outcome of non-operative and operative management of displaced fracture clavicle: A retrospective study
Authors: Rajinder Kumar, Gaurav Jain, Swapnil Sharma, Nitin Bansal.
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Introduction: For centuries fracture of clavicle has been treated conservatively non-union of clavicle fracture is rare, Mal-union was considered to be of radiographic importance only. The scenario has changed and there has been a shift towards operative treatment on union, cosmesis, early recovery grounds. Both the methods is compared taking into account the union, cosmesis, early recovery, functional outcome and satisfaction of the patient.
Materials and Methods: Total 70 patients of displaced fracture of clavicle (AO B1 & B2) were divided into two groups that is non-operative and operative. The informed consent was taken. The patient were explained about both modalities & procedure, cost, outcome and complications of each modality. After the decision of the patient he was allotted to Group I (conservative) & Group II (operative) the study was carried out till 35 patients were included in each group. The follow-up of both group’s patients were done at 6 weeks, 3 months, 6 months using patients subjective evaluation, DASH score, range of motion, radiological assessment and complication if any.
Observation and Result: Of all 70 patients the age varied between 20-66 years with mean age was 34.5 years. In the conservative group 23(65.7%) and in operative group 26 (74.2%) had dominant side involvement. In non-operative group there were 3(8.75%) cases of non-union, 15 (42.8%) mal-union, 5 (14.2%) muscle wasting, and 4 (11.4%) pressure symptoms in upper limb 2 (5.71%) stiffness of shoulder, 8 (22.85%) pain after union. Of 15 cases of mal-union only 7 (20%). 5 (14.28%) patients complaint of hardware prominence and irritation. Total 4 (11.42%) patients needed implant removal (2 due to infection and 2 due to hardware problem). 6 (17.14%) patients complaint of postoperative infraclavicular hypoesthesia. The DASH score was superior in Group II over I at 6 weeks and at 3 months. Overall in non-operative patients 22 (62.85%) were satisfied (17.14%) were not satisfied in operative group 28(80%) were satisfied while 7 (20%) were unsatisfied. The average follow-up period was 9.5 months (6-18 months).
Conclusion: Though operative treatment is better in terms of early mobilization, union, absence of mal-union, cosmetically well accepted, it has its own complication which should also be taken into consideration while choosing between the two modalities. Seeing at satisfaction level in patient related to functional outcome the conservative treatment plays a vital role in poor patients.