RT Journal
A1 Virtanen, Kaisa J.
A1 Remes, Ville
A1 Pajarinen, Jarkko
A1 Savolainen, Vesa
A1 Björkenheim, Jan-Magnus
A1 Paavola, Mika
T1 Sling Compared with Plate Osteosynthesis for Treatment of Displaced Midshaft Clavicular FracturesA Randomized Clinical Trial
JF The Journal of Bone & Joint Surgery
JO The Journal of Bone & Joint Surgery
YR 2012
FD September 5
VO 94
IS 17
SP 1546
OP 1553
DO 10.2106/JBJS.J.01999
UL http://dx.doi.org/10.2106/JBJS.J.01999
AB Background: 
  Few randomized controlled trials have compared operative with nonoperative treatment of clavicular fractures.Methods: 
  Patients with displaced midshaft clavicular fractures were randomized either to nonoperative treatment with a sling or to operative treatment with a stainless steel 3.5-mm reconstruction plate. Outcome measures were the Constant shoulder score, DASH (Disabilities of the Arm, Shoulder and Hand) score, pain, fracture-healing, and complications. The null hypothesis was that the Constant and DASH scores would not differ between the groups at the one-year follow-up evaluation.Results: 
  In accordance with the power analysis, we included sixty patients in the study; thirty-two were randomized to the nonoperative group and twenty-eight to the operative group. We found no difference in the Constant score (p = 0.75), the DASH score (p = 0.89), or pain (p = 0.98) between the groups at the one-year follow-up evaluation. All fractures in the operative group healed, but six nonunions (24%) occurred in the nonoperative group.Conclusions: 
  One year after a displaced midshaft clavicular fracture, nonoperative treatment resulted in a higher nonunion rate but similar function and disability compared with operative treatment.Level of Evidence: 
  Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.