COMPARISON OF SURGICAL VERSUS NON-SURGICAL MANAGEMENT OF MID-SHAFT CLAVICULAR FRACTURES

Background: Mid-shaft clavicle fractures represent a common orthopedic injury, comprising approximately 80–85% of all clavicle fractures and 2–5% of adult fractures. These injuries are frequently encountered in both trauma and sports-related settings. Although non-surgical management has long been the standard due to its simplicity and traditionally favorable outcomes, recent literature suggests that surgical fixation may offer improved functional recovery in displaced cases. However, consensus remains lacking regarding the most effective treatment modality for optimal shoulder function. Objective: To compare the functional outcomes of surgical management versus non-surgical management of mid-shaft clavicle fractures using the Constant-Murley Shoulder Score at three months. Methods: This randomized controlled trial was conducted at the Department of Orthopedic Surgery, Benazir Bhutto Hospital, Rawalpindi, from April 15 to October 16, 2023. A total of 60 patients aged 18–80 years with displaced mid-shaft clavicle fractures were enrolled and randomized into two equal groups. Group A received non-surgical management with a figure-of-eight bandage and arm sling, while Group B underwent surgical fixation using plate osteosynthesis. Patients were followed up at three months, and functional outcomes were assessed using the Constant-Murley Shoulder Score. Data were analyzed using SPSS version 22, with a p-value ≤ 0.05 considered statistically significant. Results: The mean time since injury was 3.67 ± 1.78 hours in the non-surgical group and 3.50 ± 1.55 hours in the surgical group (p = 0.701). At the third-month follow-up, the mean Constant score was significantly higher in the surgical group (77.23 ± 4.79) compared to the non-surgical group (68.97 ± 5.14), with a p-value < 0.001. Conclusion: Surgical management of displaced mid-shaft clavicle fractures resulted in significantly better functional outcomes than non-surgical treatment when assessed at three months post-intervention.