A fracture of the clavicle has been greatly underrated in respect to pain and disability. Clavicle is the bony link from thorax to shoulder girdle and contributes to movements at shoulder girdle. Clavicle fracture is a common traumatic injury around shoulder girdle due to its subcutaneous position. It is caused by either low-energy or high-energy impact about 69 to 82% of these fractures are in the middle third of bone and less often in the lateral third (12% to 15%) and medial third (5% to 8%). Prompt fixation of these clavicle fractures permits increased patient comfort and early shoulder mobility. The proponents of early fixation of fresh clavicular fractures to prevent complications like malunion and nonunion emphasize the value of accurate reduction and rigid fixation in affording quick pain relief and promoting early functional recovery.
Material and methods: Thirty patients were taken into the study and were divided into operative (O) and conservative (C) category. Approval from ethical committee was taken with written informed consent by the patient. The outcome was evaluated clinically radiologically for union, complications, cosmesis and functional scoring by Constant and Murley score.
Observation and Result: Out of 30 patients, 18 were treated conservatively, Among them good anatomical results were found in 13 patients (72.22%), poor results were found in 5 patients (27.78%). 12 patients were treated surgically, Among them good anatomical results were found in 11 patients (91.67%) and poor were found in 1 patient (8.33%).patients were treated conservatively and had excellent functional outcome (27.78%) in 5 patients, good functional outcome (55.56%) in 10 patients, and fair functional outcome (16.67%) in 3 patients. 12 patients were treated surgically with precontoured clavicle plate and had excellent functional outcome (91.67%) in 11 patients and fair functional outcome (8.33%) in 1patients. Out of 30 patients, 4 patients (22.22%) of displaced middle third clavicle fractures which were treated conservatively had developed malunion, 1 patient (5.56%) had developed delayed union and no non-union was reported. In 12 patients which were treated surgically with precontoured plate, 1 patient (8.33%) was reported with hardware irritation and 1 patient (8.33%) was reported with implant failure. The average union time is longer in conservatively treated patients (12.33) weeks as compared to operative group i.e; (8.67) weeks.
Conclusion: primary open reduction and internal fixation with precontoured clavicle plate for displaced, comminuted middle third clavicle fractures provides a more rigid fixation and allows early mobilization higher functional outcome compared with conservative treatment which require longer periods of immobilization till fracture union. Simple, undisplaced fractures can be treated with conservative treatment which gives good results in terms of functional and anatomical aspects but when this method is used for displaced, comminuted fractures it gives complications such as malunion and non-union.