Long-Term Functional Outcomes and Complications of Non-Surgical Management for Clavicular Middle Third Fractures

Mahdi  Rezai; Ashkan  Khodamorad; Aidin Mohammad  Valipour; Roxana  Hessam; Mehdi  Mohammadi; Kourosh Javdani  Esfahani; Ahmadreza  Kheradpishe

doi:10.18502/jost.v11i2.18883

Mahdi Rezai Associate Professor, Department of Emergency Medicine, Emergency Medicine Management Research Center, Health Management Research Institute, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
Ashkan Khodamorad General Practitioner, Department of Emergency Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
Aidin Mohammad Valipour General Practitioner, Department of Emergency Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
Roxana Hessam General Practitioner, Department of Emergency Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
Mehdi Mohammadi General Practitioner, Department of Emergency Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
Kourosh Javdani Esfahani General Practitioner, Iranian Hospital, Dubai, UAE
Ahmadreza Kheradpishe Medical Student, Student Research Committee, Iran University of Medical Sciences, Tehran, Iran

DOI: https://doi.org/10.18502/jost.v11i2.18883

Keywords: Clavicle; Fractures; Conservative Treatment; Union

Abstract

Background: Clavicle fractures are relatively common, and most often occur in the middle third. Fractures that are not displaced or are displaced with no other indication for surgical intervention are treated supportively. Displaced fractures that have been managed non-surgically have had acceptable outcomes. The goal of this study is to evaluate pain scores, the resumption of daily activities, rates of acceptable healing, non-union, malunion, and the need for additional surgical intervention.

Methods: This observational study was conducted on 432 patients with midclavicular fractures who were referred to a high-level trauma center. All patients were treated non-surgically and followed for six months. The primary outcomes were patients’ function or disability, assessed using the Disabilities of the Arm, Shoulder, and Hand (DASH) and University of California, Los Angeles (UCLA) scores. The secondary outcomes included the rate of pain relief, measured by the Verbal Numeric Scale (VNS) score, as well as complications such as malunion, nonunion, and the need for secondary surgical intervention.

Results: A total of 432 patients were enrolled. The rates of malunion and nonunion were 63.4% and 2.3%, respectively. Patients with malunion exhibited a higher pain score (P < 0.001). The average UCLA score among patients was 32.53, which corresponds to good and excellent grades; it was significantly lower for those with malunion (P < 0.001). The mean DASH score was 5.92, and there was no significant difference between the two groups regarding malunion and normal union (P > 0.05).

Conclusion: Our study demonstrated a low non-union rate, good functionality, and a high rate of satisfaction among patients with middle third clavicle fractures who were treated non-surgically.