Outcome of Precontoured Anatomical Plate in Displaced Middle Third Clavicular Fractures

Abstract

KC (Ghimire) Milan, Pandey Dipendra, Bhandari Pratap Babu and Pokhrel Jhapindra

Introduction: Non operative treatment for middle third clavicle fractures remained the mainstay for until last two decades. But due to the prevalence of nonunion, symptomatic malunion and shortening for displaced fractures, now the trend has shifted towards operative management. Our study is aimed at prospectively evaluating the functional outcome of 120 patients treated with open reduction and plating with precontoured anatomical plate. In addition to patient demographics, this study also estimates the rate of fracture union, lists the complications of clavicular plate fixation, estimate the time of clinical and radiological union of fracture and functional outcome in terms of DASH score.

Methodology: 120 patients from 16 years to 60 years of age, with displaced (>2cm ) and/or shortened (>2cm) or comminuted middle third clavicular fractures were included in this prospective observational study conducted in Bir Hospital and National Trauma Center over a period of four years. Open reduction and internal fixation with precontoured anatomical plate was done. Postoperatively the arm is held in a sling for about 3 weeks with intermittent pendulum exercise of the arm after one week or as soon as the pain is tolerable and passive and active range of motion exercise started after four weeks of the surgery. Patients were followed up on 2, 6, 12 and 24 weeks. Functional outcome was assessed using DASH score and radiographs taken. Statistical analysis was done using SPSS v 22 for Windows.

Results: Mid clavicular fractures were more common in males than in females and left side was more common than right. Younger age group was more commonly affected. All fractures united in a mean radiological union period of 7.1 weeks. 6 cases developed pain, 23 had hardware prominence, 5 case developed superficial infection and none had shoulder stiffness. DASH score was at a significant negligible level by 24 weeks. 98% of patients returned to their work by 12 weeks.

Conclusion: Open reduction and internal fixation with pre-contoured anatomical plate in displaced middle third clavicular fractures is a safe procedure that avoids complications associated with non-operative management and provides good functional outcome with early return to pre-injury activities.

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