Improved outcomes with surgical management of clavicular fractures? A retrospective study of matched pairs comparing conservative and surgical approach.

Abstract

Clavicle fractures represent one of the most frequent type of fractures. However, there is no consensus on the treatment of these fractures and their relative indications for surgery. The purpose of this study is to determine whether surgical treatment of mid-diaphyseal clavicular fractures indeed results in fewer complications and better radiological outcomes, as current trends suggest, in comparison to conservative treatment. A retrospective multicenter study was conducted between January 2005 and April 2017, involving adult patients aged 16 to 75 years with mid-diaphyseal clavicular fractures. Out of a total of 715 clavicle fractures assessed, 220 met the inclusion criteria for this study. The research encompassed a matched-pair cohort, comparing clavicle fractures treated surgically and those managed conservatively. The consolidation rate was respectively 94.5% In the operative group, and 89.1% in the conservative group. There was no statistically significant difference in terms of consolidation (p-value: 0.219). The surgical group had an infection rate of 1.8%. Additionally, 31.8% of patients experienced hardware-related discomfort, and 43.6% required a secondary surgery to remove the plate. The results of this study reveal a similar rate of consolidation between the two treatment approaches. However, there is a noticeable but not significant difference in pseudarthrosis incidence in the conservative group, which is typically asymptomatic and does not usually require surgical intervention. On the other hand, patients who have undergone osteosynthesis often experience hardware-related discomfort and may require a subsequent procedure for hardware removal. Low profile dual plating might reduce this inconvenient.