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Intramedullary Fixation versus Non-Operative Treatment for Mid-Shaft Clavicle Fractures

Authors: Daniel B Judd, MD Tripler AMC HI

References: AAOS 2005

Abstract
Operative fixation with this intamedullary implant did not offer an advantage over non-operative treatment and had a higher complication rate.

Our study compared nonoperative and operative treatment of mid shaft clavicle fractures

Consecutive patients with mid-shaft clavicle fractures were prospectively randomized to operative or non-operative treatment.

The non-operative group received sling immobilization with progressive shoulder use. The operative group received intramedullary pin fixation, followed by the same rehabilitation protocol. Patients were followed-at 3 weeks, 6 weeks, 3 months, 6 months, and 1 year with exam, radiographs, and functional questionnaires

Fifty-seven patients, 28 non-operative and 29 operative were evaluated. The groups were similar with respect to injury severity and radiographic shortening and displacement.

Follow-up at 1 year was 86 percent operative group and 71percent non-operative group. Comparison revealed similar shoulder scores at the time of injury through 1 year, the operative group was slightly higher at 3 weeks (50 operative vs. 41.5 non-operative) and the non-operative group was slightly higher at six months (86.2 operative vs. 91.1 non-operative) and one year (92.6 operative vs. 97.6 non-operative).

Complications were significantly higher in the operative group. Nine patients had symptomatic pin prominence, six patients had superficial infections, two patients had osteomyelitis, and one patient had transient nerve palsy secondary to anesthesia.

One patient in both groups had delayed union, but the operative group had higher non-union (3.4 vs. 0 percent), and refracture (6.9 vs. 3.6 percent) rates

Although operative fixation can yield excellent results, it did not offer an advantage over non-operative treatment. Furthermore operative fixation was associated with a higher complication rate

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