CLOSED TREATMENT OF DISPLACED MIDDLE-THIRD FRACTURES OF THE CLAVICLE GIVES POOR RESULTS

We evaluated 242 consecutive fractures of the clavicle in adults which had been treated conservatively, Of these, 66 (27%) were originally i n the middle third of the clavicle and had been completely displaced, We reviewed 52 of these patients at a mean of 38 months after injury. Eight of the 52 fractures (15%) had developed nonunion, and 16 patient s (31%) reported unsatisfactory results, Thirteen patients had mild to moderate residual pain and 15 had some evidence of brachial plexus ir ritation, Of the 28 who had cosmetic complaints, only 11 considered ac cepting corrective surgery, No patient had significant impairment of r ange of movement or shoulder strength as a result of the injury. We fo und that initial shortening at the fracture of greater than or equal t o 20mm had a highly significant association with nonunion (p < 0.0001) and the chance of an unsatisfactory result. Final shortening of 20mm or more was associated with an unsatisfactory result, but not with non union, No other patient variable, treatment factor, or fracture charac teristic had a significant effect on outcome. We now recommend open re duction and internal fixation of severely displaced fractures of the m iddle third of the clavicle in adult patients.