Comparative Results of External Fixation, Plating or Nonoperative Management for Diaphyseal Clavicle Fractures

Objective: The aim of this study was to compare the treatment outcomes of mid-diaphyseal clavicular fractures between external fixator and more widely selected treatment options such as plate osteosynthesis or conservative methods. Material and Method: From 2009 and 2013, the medical records of 64 patients were reviewed. İnclusion criterion was mid-diaphyseal closed clavicular fractures with shortening of more than 2 cm . The Constant and (disabilities of the arm, shoulder and hand DASH) scores at the final follow-up, initial displacement, non-union and complication rates were compared. Statistical differences between groups were assessed with Kruskal-Wallis test and pairwise comparison analysis was used to evaluate the difference within the groups. Results: Of the 64 patients 24(37.5%) were treated with plate osteosynthesis (Group 1); 11(17.2)% with external fixator (Group 2) and 29(45.3%) conservatively with a figure-of-eight bandage (Group 3). The mean follow-up periods were Group 1: 37±10.4 months; Group 2: 33±7 months; and Group 3: 35±9.4 months . The initial amount of displacement and DASH score were Group 1: 89.1±7.8; Group 2: 89.1±7.8 and Group 3: 6.1±6.6) (p=0.079). Constant score of (93±6.1) Group 2 was significantly higher than Group 3 scores: (85±8.4) (p=0.013). No statistical difference was found in the distribution of non-union (p=0.387) However in Group 3, the number of malunion (11/29, 37.9%) was significantly higher compared to the other 2 groups (Group 1: 1/24,4.2% Group 2 : 2/11. 18.2%) (p=0.006). Conclusions: This study revealed that treatment of acute clavicular fractures with external fixator was a good alternative to plate osteosynthesis or conservative treatment.


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