Recent evidence to suggest that fixation
fractures yields better outcomes
than conservative treatments has led to an increasing trend toward operative management. There is no evidence, however, to compare early fixation
with delayed fixation
for symptomatic patients before union.
Prospective comparative case series.
Level 1 regional trauma center.
fractures treated operatively in our institution during a 4-year period. Ninety-seven patients were included: 68 with early fixation
and 29 delayed. Radiographic and clinical outcomes
were available for all patients and scores were available for 62.
Early plate fixation
(within 3 weeks) of displaced clavicle
fractures compared with delayed (3–12 weeks) fixation
of displaced clavicle
Radiographic union, Oxford Shoulder Score, QuickDASH, EQ5D, and a patient interview. Mean follow-up was to 30 months.
There were no statistically significant differences in age (P
> 0.05), sex (P
> 0.05), and energy of injury (P
> 0.05) between the 2 groups. The mean QuickDASH was 8.9 early and 9.1 delayed (P
< 0.05) and the Oxford Shoulder Score was 44.2 early and 43.9 delayed (P
< 0.05). In the early fixation
group, there were 5 wound healing complications, and 8 went on subsequently to have removal of prominent metalwork. In the delayed fixation
group, 2 had wound healing complications and 4 required removal of prominent metalwork. There were no statistically significant differences in the EQ5D scores.
Our series supports delayed fixation
of symptomatic clavicle
fractures as results do not differ from early fixation
Level of Evidence:
Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.