Nail Fixation versus Clavicle Support for Displaced Midshaft Clavicle Fractures: Time to Return to Work and Long Term Results
Piyapong Chinkam-akrapat MD1
Affiliation : 1 Pakchongnana Hospital, Nakhon Ratchasima, Thailand
Background : In the past, conservative treatment was extensively used for both displaced and nondisplaced midshaft clavicle
fractures. Many recent reports have indicated that nail fixation results in superior outcomes.
Objective : To compare the time to return to work and long term results, including and incidence of nonunion, between nail
fixation and clavicle support for displaced midshaft clavicle fractures.
Materials and Methods : In this descriptive retrospective study,68 patients with displaced midshaft clavicle fractures were
randomly and evenly assigned either to receive treatment with nail fixation [NF] or only with clavicle support [CS] provided
in the emergency room. Patients in both groups were followed-up for a minimum of 2 years: mean 5.26 (1.66) and 3.34 (0.99)
years, respectively. Date of return to work was recorded as were Disabilities of the Arm, Shoulder and Hand [DASH] and
Constant-Murley score [CMS] results. Demographic data were analyzed using Chi-square and continuous data were
analyzed using the Independent t-test.
Results : Time to return to work was within 6.5 weeks for the NF group and 7.0 weeks for the CS group (p = 0.104). After
2 years, DASH and CMS results of the two groups were not significantly different: (p = 0.740) and (p = 0.442), respectively.
However, the initial distance of fragments in the NF group was larger than in the CS group (p = 0.078). Nonunion was found
in 20% of the CS group, all of whom required further surgery, but none were found in the NF group.
Conclusion : Patients treated with NF and CS return to work after approximately the same period of time. There are no
significant differences in DASH or CMS scores with the different treatments. Nonunion is more likely to occur with CS
treatment.
Keywords : Displaced midshaft clavicle fracture, Nail fixation, Clavicle support, DASH, CMS constant-murley score?
