Comparison of surgical and conservative treatment of clavicle fractures

COMPARISON OF SURGICAL AND CONSERVATIVE TREATMENT OF CLAVICLE FRACTURES Aim: In this study, the results of surgical and conservative treatment of adult clavicle fractures were compared and their clinical, functional and radiological outcomes were evaluated. Methods: In our clinic, conservative and surgical treatments were applied to 77 patients who retrospectively diagnosed with clavicular fracture and admitted to Düzce University, Düzce Medical Faculty, Orthopaedics and Traumatology Clinic and emergency service between January 2006 and October 2013 and their treatment results clinically, functionally and radiologicaly were evaluated. Allman and Neer classification system was used in the classification. Functional results were assessed by using Constant (Murley) Score (CS) and Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire. Results: 28 (36.4%) the patients were female, 49 (63.6%) patients were male according to the distribution of sexuality. In total 40 patients who were treated conservatively, 20 patients have right clavicle fracture and 20 patients have left clavicle fracture. Among total 37 patients who were treated surgically, 20 patients have right clavicle fracture and 17 patients have left clavicle fracture. In our study, 24 in-vehicle traffic accident patients, 13 out-vehicle traffic accident patients patients, 6 motorcycle accident patients, 15 fall from a height patients, 15 simple fall patients and 4 direct trauma patients were admitted to our study. In our study, there are malalignment cases in 11 patients. Nine malalignment patients were monitored after conservative treatment and two malalignment patients were detected after surgical treatment. Four nonunions were detected. Two of these were developed in conservative treatment patients and the other two were developed in surgical treatment patients. Hypertrophic union was developed in four patients. Two of these patients were patients who were applied conservative treatment and the other two were patients undergoing surgical treatment. Patients were classified to according to Allman and Neer fracture classification system. Most of patients who were applied the conservative and surgical treatment were determined as group 1 according to the Allman and Neer classification. Fracture union duration in both group were determined as 30 days minimum and 60 days maximum. When evaluated starting work time, starting work time in Clavicle fractures conservatively treated group was 47.6 days and in the surgical group, starting work time is 72.16 days. Considering the cost of treatment, conservative treatment has much lower cost than surgical treatment. Significant brevity difference were determined in patients treated conservatively when compared to the surgical treatment Conservative group's average DASH score was found to be 28.2 with a subjective inquiry. Mean DASH score of clavicle fracture surgery group was found to be 35.4. Conclusions: Although clinical and functional results of surgical and conservative treatment of clavicle fractures were similar, conservative treatment can be more effective and can be used when considering the advantages of it. Keywords: adult, fractures, surgical, conservative, treatment.