{"id":138,"date":"2024-06-29T03:57:38","date_gmt":"2024-06-29T03:57:38","guid":{"rendered":"https:\/\/orthopaedicsone.com\/viewpoints\/orthopaedicsone-viewpoints-clavicle-fracture-plate-fixation-for-all\/"},"modified":"2024-06-29T03:59:57","modified_gmt":"2024-06-29T03:59:57","slug":"orthopaedicsone-viewpoints-clavicle-fracture-plate-fixation-for-all","status":"publish","type":"page","link":"https:\/\/www.orthopaedicsone.com\/viewpoints\/orthopaedicsone-viewpoints-clavicle-fracture-plate-fixation-for-all\/","title":{"rendered":"Clavicle Fracture – Plate Fixation for All"},"content":{"rendered":"

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Clavicle Fracture – Plate Fixation for All<\/h3>\n

Clavicle fractures are recognized as being among the \u201cbest fractures\u201d to have in the upper limb, since most heal well without complication. Over the last few decades, conservative treatment, or \u201ccareful\u201d neglect, was the standard of care. Closed reduction was considered wishful thinking; thus fracture displacement was accepted.<\/sup><\/p>\n

However, our comprehension of the management of clavicle fractures has evolved as a result of recent studies.<\/p>\n

<\/span>Read more…<\/span><\/p>\n

Nowac et al conducted a prospective study of 208 cases of clavicle fractures and showed that 46% presented with a functional deficit at the 10-year follow-up.11<\/sup> McKee et al also found a significant functional impairment when clavicle fractures were treated conservatively.<\/sup> Moreover, Kulshrestha et al reported 29% nonunion and 36% malunion following conservative treatment of displaced clavicle fractures at 18 months.<\/sup><\/p>\n

In the face of these striking data, standard conservative treatment of clavicle fractures has been put in doubt. We must now ask: 1) Can we obtain better results with surgery? 2) Are the surgical risks worth it? Our answer is YES for a large percentage of patients.<\/p>\n

Advantages of Surgery<\/h3>\n

Two Level 1 articles have illustrated the advantages of surgery over conservative treatment. The study done by the Canadian Orthopedic Trauma Society (COTS) demonstrated improved function, according to the Constant score and DASH score, at 1-year follow-up in the plate group when compared to the conservative treatment group for displaced middle third clavicle fractures.<\/sup> One third of the conservatively treated patients developed significant malunion (18%) or nonunion (15%).<\/p>\n

Furthermore, a smaller randomized study of 60 patients by Mirzatolooei et al reported similar results in terms of improved outcome with surgery.10<\/sup> Several other studies have also demonstrated better functional outcomes in the surgical group, when evaluating the differences between nailing and conservative treatment.7,14,15<\/sup><\/p>\n

Risks of Surgery<\/h3>\n

In the COTS study, 5% of the patients in the surgical group had wound healing problems and 8% required plate removal.<\/sup> The Mirzatolooei study obtained a similar 4% infection rate (1\/26).10<\/sup> The risk of nonunion following surgery was respectively 1\/61 (2%) and 4% in both Level 1 studies.<\/p>\n

Who to Fix<\/h3>\n

The following question must be asked: Who should we fix? The literature offers us guidelines in order to identify patients at risk of nonunion and lower functional outcome.1,5,11,13<\/sup> These risk factors for poorer results with conservative treatment can be used to guide surgeon-patient discussions.<\/p>\n\n\n\n\n
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Factors Orienting Toward Fracture Fixation <\/p>\n<\/th>\n<\/tr>\n

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