Volume : 7, Issue : 6, June - 2018

Operative versus conservative management in mid shaft clavicle fracture: A 1 year randomized controlled study

Dr Alizayaagam N. Hasan, Dr Pinkal H. Thakkar, Dr Yogesh C. Patel

Abstract :

<p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align:&#10;justify;line-height:99%;mso-pagination:none;mso-layout-grid-align:none;&#10;punctuation-wrap:simple;text-autospace:none"><b><span style="font-size:16.0pt;&#10;line-height:99%;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;">Background: </span></b><span style="font-size:16.0pt;line-height:99%;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;">Clavicle fractures are common injuries in active individuals, and it is becomingincreasingly apparent that clavicularmalunion is a distinct clinical entity with radiographic, orthopedic, neurologic, and cosmetic features.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height:&#10;.1pt;mso-line-height-rule:exactly;mso-pagination:none;mso-layout-grid-align:&#10;none;text-autospace:none"><span style="font-size:16.0pt;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;"><o:p>&nbsp;</o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height:&#10;normal;mso-pagination:none;mso-layout-grid-align:none;text-autospace:none"><b><span style="font-size:16.0pt;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;">Aims: </span></b><span style="font-size:16.0pt;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;">To analyze the outcome of managements of nonoperative and operative procedures in fracture<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height:&#10;99%;mso-pagination:none;mso-layout-grid-align:none;text-autospace:none"><span style="font-size:16.0pt;line-height:99%;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;">clavicle.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height:&#10;.05pt;mso-line-height-rule:exactly;mso-pagination:none;mso-layout-grid-align:&#10;none;text-autospace:none"><span style="font-size:16.0pt;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;"><o:p>&nbsp;</o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align:&#10;justify;line-height:101%;mso-pagination:none;mso-layout-grid-align:none;&#10;punctuation-wrap:simple;text-autospace:none"><b><span style="font-size:16.0pt;&#10;line-height:101%;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;">Materials and Methods: </span></b><span style="font-size:16.0pt;line-height:101%;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;">This one year randomized controlled trial was conducted in the Department ofOrthopaedicsof <span style="mso-spacerun:yes">&nbsp;</span>medicalcollege,baroda from August 2016 to July 2017. After taking institutional ethical clearance and informed consent of the patients. Injuries were classified according to the Allman classification scheme. Patients were treated either conservatively or operatively and<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height:&#10;91%;mso-pagination:none;mso-layout-grid-align:none;text-autospace:none"><span style="font-size:16.0pt;line-height:91%;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;">followed-up at 1 month and 3month, 6month, and 12 months.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align:&#10;justify;line-height:101%;mso-pagination:none;mso-layout-grid-align:none;&#10;punctuation-wrap:simple;text-autospace:none"><b><span style="font-size:16.0pt;&#10;line-height:101%;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;">Results: </span></b><span style="font-size:16.0pt;line-height:101%;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;">The mean time for fracture healing was significantly shorter in the operative group (14.6 &plusmn; 0.70weeks) than nonoperative group (22.47 &plusmn; 0.74 weeks) . The difference is statistically highly significant (P &lt; 0.000). DASH score and Constant Moore Score were significantly better in the operative group. Constant Moore Score was 94.21 in O (OP &amp; ON) and NO was 78.6 and CM SCORE in OP was 96.8<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height:&#10;90%;mso-pagination:none;mso-layout-grid-align:none;text-autospace:none"><span style="font-size:16.0pt;line-height:90%;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;">and ON was 91.62<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height:&#10;.05pt;mso-line-height-rule:exactly;mso-pagination:none;mso-layout-grid-align:&#10;none;text-autospace:none"><span style="font-size:16.0pt;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;"><o:p>&nbsp;</o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align:&#10;justify;line-height:105%;mso-pagination:none;mso-layout-grid-align:none;&#10;punctuation-wrap:simple;text-autospace:none"><b><span style="font-size:16.0pt;&#10;line-height:105%;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;">Conclusion: </span></b><span style="font-size:16.0pt;line-height:105%;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;">Operative fixation of the clavicle fracture results in improved functional outcome, shortertime for union compared with nonoperative treatment at 1 year of follow-up and primary operative intervention in clavicle fracture in active adults may be of immense importance.<o:p></o:p></span></p>