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International Journal of Recent Trends in Science and Technology, ISSN 2277-2812 E-ISSN: 2249-8109

Volume 16, Issue 1, Aug 2015 pp 148-151

Research Article

Outcomes of operative management of midshaft clavicular fractures

Sunil Handralmath1, Chinmay Ghaisas2, P Endigeri3, J Surannawar4

1Associate Professor and Unit Chief, 3,4SR, Department of Orthopaedics, Dr. V M Medical College and Hospital Solapur, INDIA.

2Assistant Professor, Department of Orthopaedics, Government Medical College, Miraj, Maharashtra, INDIA.

Aim: To evaluate the the radiological and functional results of clavicular plating using a precontoured clavicle plate for the treatment of middle-third clavicle fractures in a case-series Materials and Methods: 34 patients with Type II( Robinson) clavicle fractures encountered at a tertiary centre - SCSMGHS Hospital, Solapur were studied prospectively. Mechanism of injury was grouped into fall from height, road traffic accident, sports and direct frontal blunt trauma. Patients between 13 years and 60 years of age were included in the study. They were treated operatively by low contact plating after written informed consent .They were started on passive and active assisted range of motion exercises from post-operative day two and pendulum exercises from day three when they were discharged. Active range of motion was started from day seven and patients were encouraged to start daily activities barring lifting heavy weights. They were followed up for a mean of 14 months and outcomes were evaluated radiologically using Lane and Sandhu system and functionally using Constant Shoulder Score. Results: Mean age group of patients was 23 years with 20 males and 12 female patients. Etiologically, 8(23.53%) patients suffered fracture due to fall from height, 16(47.06%) due to road traffic accident, 6 (17.65%) had sports injuries and 4(11.76%) had direct frontal blow to clavicle. According to Lane Sandhu system of radiological grading, there was 1(2.94%) patient with grade 1, none with grade 2, 9(26.47%) patients with grade 3 and 24(70.59%) patients with grade four changes. Using the Constant score, excellent functional results were obtained in 14(41.18%) patients, good results in 11(32.35%) patients, fair in 7(20.59%) patients and poor results were seen in 2(5.88%) patients. Grade 1 radiological outcome in 1 (2.94%) patient showed poor functional outcome. In grade 3, 2 (5.82%) patients showed excellent, 3 (8.82%) good, 3(8.82%) fair and 1(2.94%) showed poor functional outcomes. In grade 4, 12(35.29%) patients had excellent, 8(23.53%) had good and 4(11.76%) had fair outcomes. In our series, one patient had non-union and infection giving poor functional outcome. Another patient had infection which healed on antibiotics and led to fair functional results. Conclusion: Primary open reduction and internal fixation of midshaft clavicular fractures resulted in excellent radiological outcomes. It also resulted in early mobilisation (as compared to conservative treatment) with good to excellent functional outcomes with few complications.