Surgical treatment of displaced middle-third clavicular fractures: a prospective, randomized trial in a working compensation population

Abstract

Background: Surgical treatment with open reduction and internal fixation (ORIF) of displaced middlethird clavicular fractures resulted in shorter complete return to work periods with earlier consolidation documented on computed tomography (CT) scans in this prospective, randomized controlled trial. Methods: The study randomized 76 consecutive patients with displaced fractures (2B1-2B2 according to Robinson) to conservative (C, n ¼ 42) and surgical (S, n ¼ 34) treatment with plates and screws. Bone union was documented with CT scans at 6 and 12 weeks. Results: Risk factors known to increase the risk of nonunion were similar between groups. Time until discharge for complete return to work was 3.7 1.1 months for C and 2.9 0.8 months for S (P ¼ .003). On the CT scan at 6 weeks, 24.1% of the patients presented advanced bone union in S vs 5.3% in C (P ¼ .05). At 12 weeks, 81% of the patients presented advanced bone union in S vs 16.7% in C (P ¼ .005). At final follow-up, 4 nonunions were present in the C group that required surgery; in the S group, 4 patients underwent revision surgery for plate removal. At 6 and 12 months of follow-up, Constant scores were higher for the S group. Conclusions: Surgical treatment with ORIF of displaced middle-third clavicular fractures achieved good and excellent functional results, shorter time to complete return to work, earlier bone union, and fewer cases of nonunions in a working population under injury compensation. Level of evidence: Level I, Randomized Controlled Trial, Treatment Study.