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Primary nonoperative treatment of displaced lateral fractures of the clavicle.

BACKGROUND
The optimal management of displaced fractures of the lateral end of the clavicle remains controversial. Successful results have been reported both with primary open reduction and internal fixation and with nonoperative treatment. The purpose of this study was to analyze the results of employing a policy of primary nonoperative treatment of displaced lateral fractures of the clavicle.


METHODS
We treated a cohort of 127 patients who had sustained a displaced fracture of the lateral end of the clavicle. With the exception of seven patients who had immediate internal fixation, all of these patients were treated nonoperatively. At the time of follow-up, nineteen patients had died or could not be traced and fifteen were interviewed by telephone only. The remaining eighty-six patients were assessed clinically at an average of 6.2 years after the injury. All of these patients had a functional evaluation and were assessed radiographically.


RESULTS
Fourteen (14%) of the 101 patients who could be contacted had had symptoms severe enough to warrant delayed surgical intervention (Group I). The remaining eighty-seven patients had not undergone any surgery, and twenty-one of them (21% of the whole cohort) had a nonunion of the clavicular fracture. The average Constant score in the nonoperatively treated group was 93 points (range, 82 to 98 points). With the numbers available, there was no significant difference in the Constant or Short Form-36 (SF-36) scores between the patients with nonunion (Group II) and those in whom the fracture had healed (Group III) or between the patients who had been treated nonoperatively (Groups II and III) and those who had had delayed surgery (Group I). There was no significant difference between the SF-36 scores in any of the groups and the scores for age-matched controls in the general population.


CONCLUSIONS
Nonoperative treatment of most displaced lateral fractures of the clavicle in middle-aged and elderly patients achieves a good medium-term functional result. Symptoms that were severe enough to warrant a delayed reconstructive procedure developed in only 14% of the patients. Asymptomatic nonunion does not appear to adversely affect the functional outcome in the medium term.