A Prospective Comparative Study On Outcomes Of Conservative Vs Operative Management In Clavicle Fractures

Abstract

Background: Clavicle fractures are among the most common skeletal injuries, accounting for approximately 2.6–5% of all fractures and 35–45% of shoulder girdle injuries. While most clavicle fractures have traditionally been managed conservatively, recent evidence suggests that displaced fractures, particularly those involving the middle third, may benefit from operative fixation by reducing the incidence of nonunion, malunion, and delayed functional recovery. The present study was undertaken to compare the clinical, radiological, and functional outcomes of operative and conservative management of displaced clavicle fractures.

Methods: A prospective comparative interventional study was conducted over a period of 24 months at the Department of Orthopaedics, VMKV Hospital Salem Tamilnadu India. Fifty adult patients (18–60 years) with fresh clavicle fractures fulfilling the inclusion criteria were enrolled. Patients were managed either conservatively using a figure-of-eight bandage or arm sling, or operatively with open reduction and internal fixation using plate osteosynthesis or intramedullary fixation, based on fracture characteristics and treatment indications. Patients were followed clinically and radiologically at regular intervals until fracture union. Functional outcome was assessed using the Constant–Murley Shoulder Score. Time to radiological union, complications, shoulder function, and patient satisfaction were compared between the two treatment groups.

Results: Operatively managed patients demonstrated earlier radiological union, improved early functional recovery, and higher Constant–Murley scores compared with patients treated conservatively. The operative group experienced lower rates of delayed union, nonunion, and symptomatic malunion, whereas implant-related complications were the most common adverse events following surgical fixation. Conservative treatment achieved satisfactory outcomes in minimally displaced fractures but was associated with prolonged immobilization and a higher incidence of fracture-related complications in displaced injuries. Overall, surgical fixation facilitated earlier return to daily activities and greater patient satisfaction.

Conclusion: Operative management of displaced clavicle fractures provides superior early functional outcomes, faster fracture union, and lower rates of nonunion and symptomatic malunion compared with conservative treatment. Conservative management remains an effective option for selected patients with minimally displaced fractures or those unsuitable for surgery. Treatment decisions should be individualized based on fracture morphology, degree of displacement, patient characteristics, functional demands, and associated comorbidities.