Functional Outcomes of Displaced Midshaft Clavicular Fractures — A Comparison of Plate Fixation and Non-operative Treatment

Open Access

Abstract

Introduction: Displaced midshaft clavicular fractures are still disputed regarding the treatment. While conventional nonoperative treatment has been the standard, new research indicates that surgical fixation produces superior outcomes. In this study, the complications and functional outcomes of plate fixation and nonoperative treatment for these fractures are compared. Methods & Materials: This prospective observational study took place from July 2018 to June 2022, involving 200 patients with displaced midshaft clavicular fractures. Group A (n=100) had open reduction and internal fixation using precontoured locking plates. Group B (n=100) received nonoperative treatment with figure-of-eight bandages or slings. Patients were followed for one year. We assessed outcomes using Constant-Murley scores, checked for radiographic union, and recorded complication rates. Cox proportional hazards models, t-tests, and chi-square tests were used for data analysis on SPSS v26. Results: Group A showed significantly lower complication rates compared to Group B (5% vs 20%, p=0.01), shorter mean union time (6.8 vs 9.4 weeks, p<0.0001), and better functional results, with 88% achieving excellent outcomes in Group A compared to 71% in Group B (p=0.001). Surgical patients had a 3% infection rate, with no malunion or delayed union, while nonoperative patients experienced rates of 10% malunion, 5% nonunion, and 5% delayed union. Cox regression identified nonoperative treatment as an independent risk factor for complications (HR=2.80, p=0.008). Conclusion: Surgical fixation of displaced midshaft clavicular fractures leads to better functional results, fewer complications, and quicker union than nonoperative treatment. These findings support the use of surgery for displaced fractures in suitable patients who want the best functional recovery.