Objective: Middle third clavicular fracture is effectively treated by conservative means. Previous studies showed that comminution and displacement of clavicular fractures might affect fracture healing. However, the clavicle horizontally aligns in the shoulder girdle and has different biomechanics from vertical weight-bearing bones. Therefore, this study was conducted with the hypothesis that comminution has no effect in worsening fracture healing and union configurations in conservatively treated middle third clavicular fractures.Methods: One hundred ninety-eight middle third clavicular fractures treated by conservative means were reviewed and divided into 2 groups. Group 1, simple fractures, included 97 patients. Group 2, comminuted fractures, included 101 patients. Patient demographic data, initial fracture deformities, and union configurations such as angulation, overlying, and displacement were measured. Union rate and union complications such as delayed nonunion were evaluated. Data were analyzed for statistically significant differences (p<0.05).Results: Initial deformities of Group 1 and Group 2 were 11.94°±9.59° and 9.40°±8.57° angulation, 12.24±12.96 and 11.76±10.06 mm of overlying, and 13.31±8.63 and 13.72±7.42 mm of displacement, respectively, and exhibited no significant differences (p>0.05). Union rate and union complications of Group 1 were 74/97 (76.29%) and 23/97 (23.71%), respectively. For Group 2, the rates were 82/101 (81.19%) and 19/101 (18.81%), respectively. Union configuration of Group 1 and Group 2 were 13.76°±10.63° and 12.80°±8.65° angulation, 11.93±10.75 and 11.52±9.38 mm of overlying, and 9.79±8.33 and 10.74±6.68 mm of displacement, respectively, and showed no significant differences between the groups.Conclusion: Comminution plays no role in worsening fracture healing of conservatively treated middle third clavicular fractures in terms of healing rate, union complications, and union configurations.
Faldini C, Nanni M, Leonetti D, Acri F, Galante C, Luciani D, et al. Nonoperative treatment of closed displaced mid- shaft clavicle fractures. J Orthop Traumatol 2010;11:229- 36.
Nordqvist A, Petersson CJ, Redlund-Johnell I. Mid-clav- icle fractures in adults: end result study after conservative treatment. J Orthop Trauma 1998;12:572-6.
Schulz J, Moor M, Roocroft J, Bastrom TP, Pennock AT. Functional and radiographic outcomes of nonoperative treatment of displaced adolescent clavicle fractures. J Bone Joint Surg Am 2013;95:1159-65.
Robinson CM. Fractures of the clavicle in the adult. Epidemiology and classification. J Bone Joint Surg Br 1998;80:476-84.
Robinson CM, Court-Brown CM, McQueen MM, Wake- field AE. Estimating the risk of nonunion following non- operative treatment of a clavicular fracture. J Bone Joint Surg Am 2004;86:1359-65.
Harnroongroj T, Tantikul C, Keatkor S. The clavicular fracture: a biomechanical study of the mechanism of cla- vicular fracture and modes of the fracture. J Med Assoc Thai 2000;83:663-7.
Harnroongroj T, Vanadurongwan V. Biomechanical as- pects of plating osteosynthesis of transverse clavicular fracture with and without inferior cortical defect. Clin Bio- mech (Bristol, Avon) 1996;11:290-4.
Tencer AF. Biomechanics of fractures and fracture fixation. In: Bucholz RW, editor. Rockwood and Green's fractures in adults. 7th ed. Philadephia: Lippincott Williams & Wikins; 2010. p. 3-38.
Harnroongroj T, Jeerathanyasakun Y. Intramedullary pin fixation in clavicular fractures: A study comparing the use of small and large pins. J Orthop Surg (Hong Kong) 2000;8:7-11.
Asavamongkolkul A, Harnroongroj T, Suteeraporn W, Sudjai N, Harnroongroj T. The second fracture of the same clavicle: prevalence and fracture configurations. J Med As- soc Thai 2012;95:1524-7.
De Giorgi S, Notarnicola A, Tafuri S, Solarino G, Moretti L, Moretti B. Conservative treatment of fractures of the clavicle. BMC Res Notes 2011;4:333.
Murray IR, Foster CJ, Eros A, Robinson CM. Risk factors for nonunion after nonoperative treatment of displaced midshaft fractures of the clavicle. J Bone Joint Surg Am 2013;95:1153-8.