Patient outcomes after management of middle third clavicle fractures: A prospective review at a South African tertiary hospital

Abstract

Background: Literature has not reached consensus on a suitable approach for the management of midshaft clavicle fractures in adults, even though recent multicentre, randomised, controlled trials have shown superior functional results following operative intervention. Local literature on this topic is sparse.

Objective: The aim of this study was to compare the functional results of operatively and nonoperatively treated patients with midshaft clavicle fractures in the South African context.

Methods: We conducted a prospective review of 54 patients, aged more than 18 years, who were managed at a single tertiary centre in Johannesburg, South Africa between 2017 and 2023. Outcome analyses included a file audit, the American Shoulder and Elbow Society scoring tool via a telephonic questionnaire, and photographic evaluation of shoulder abduction and flexion.

Results: Overall, 21 of 54 patients (39%) were operatively treated with plate osteosynthesis and 33 of 54 patients (61%) were non-operatively treated with a sling for 6 weeks. There were no statistical differences in demographics, occupation, and dominant side injuries between the groups. More patients in the operative group reported being satisfied with the result (16 of 21; 76%) compared to the non-operative group (17 of 33; 52.5%; Odds Ratio [OR] 3.78). The operative group also showed a superior mean patient reported functional score of 86.2 (Interquartile rage [IQR] 70 to 100; Standard Deviation [SD] 16.5) versus 76.6 (IQR 53 to 99; SD 22; p = 0.124) in the non-operative group. The OR for having significant chronic shoulder pain following non-operative treatment was 2.61. There were no differences in the mean measured shoulder abduction for the operative group (160°; IQR 145 to 180°) compared with the non-operative group (160°; IQR 135 to 180°; p = 0.735). The complication rates between the operative and non-operative groups were also similar (19% vs 15%, respectively; p = 0.279).

Conclusion: Operative treatment of patients with midshaft fractures yields superior pain scores, less chronic shoulder pain, and a higher likelihood of patient satisfaction compared with non-operatively treated patients. This study proposes operative management of midshaft clavicle fractures in the South African context.