FUNCTIONAL OUTCOME OF DISPLACED MIDSHAFT CLAVICLE FRACTURES TREATED BY PLATE OSTEOSYNTHESIS VERSUS MINIMALLY INVASIVE TITANIUM ELASTIC NAIL FIXATION.

Abstract :

The management of clavicle fractures has dramatically changed over the last decade. Classic teaching had suggested that even if both ends of the clavicle were to be widely separated, it wound go on to heal. However longitudinal studies in Sweden and recent experience throughout North America and Europe have suggested that this old aged may no more to valid now.In a review of 690 clavicle fractures 82% involved the middle-third segment of the bone. Patients presenting with fracture clavicle male predominantly (male to female ratio2:1) between the ages of 10 and 40 years, and injured in a road traffic accident, fall from height or sporting activity, especially cycling.This was greatly influenced by two influential articles from 1960s. Neer and Rowe reported a non-union rate of 0.1% in 2235 patients and 0.8% in 69 patients respectively with mid-shaft clavicle fractures treated with closed reduction.Recent literature have tilted the management in favour of operative treatment highlighting the risks of non-operative treatment of displaced mid-shaft fractures developing symptomatic mal-union and the increased risk of nonunion.Complication associated with mal-union of the clavicle can include musculo-skeletal pain related to muscle weakness and shoulder impingement, mal-alignment or winging of scapula (which displaces with the distal fragment), cosmetic concerns such as drooping shoulder and a bump deformity and less commonly neurological symptoms from achial plexus irritation.Clavicle acts as a strut, that keeps the upper limb away from the torso connecting thereby the axial skeleton to the appendicular skeleton, for the efficient function of the shoulder and upper limb. Hence the displaced or comminuted fractures carry a risk of symptomatic mal-union, non-union and poor functional outcome with cosmetic deformity.

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