Open Reduction and Plate Fixation Versus Nonoperative Treatment for Displaced Midshaft Clavicular Fractures

作者：C. M. Robinson, Ewan B. Goudie, Iain Robert Murray, Paul J. Jenkins, M.A. Ahktar, E.O. Read, Caroline Foster, K. Clark, Andrew J. Brooksbank, Angus Arthur, Mark Andrew Crowther, Iain N. Packham, Tim J.S. Chesser · 发表于：Journal of Bone and Joint Surgery · 年份：2013 · DOI：10.2106/jbjs.l.00307 · 被引用次数：405 · 研究领域：Shoulder and Clavicle Injuries、Shoulder Injury and Treatment、Trauma Management and Diagnosis

BACKGROUND: There is a growing trend to treat displaced midshaft clavicular fractures with primary open reduction and plate fixation; whether such treatment results in improved patient outcomes is debatable. The aim of this multicenter, single-blinded, randomized controlled trial was to compare union rates, functional outcomes, and economic costs for displaced midshaft clavicular fractures that were treated with either primary open reduction and plate fixation or nonoperative treatment. METHODS: In a prospective, multicenter, stratified, randomized controlled trial, 200 patients between sixteen and sixty years of age who had an acute displaced midshaft clavicular fracture were randomized to receive either primary open reduction and plate fixation or nonoperative treatment. Functional assessment was conducted at six weeks, three months, six months, and one year with use of the Disabilities of the Arm, Shoulder and Hand (DASH) and Constant scores. Union was evaluated with use of three-dimensional computed tomography. Complications were recorded, and an economic evaluation was performed. RESULTS: The rate of nonunion was significantly reduced after open reduction and plate fixation (one nonunion) as compared with nonoperative treatment (sixteen nonunions) (relative risk = 0.07; p = 0.007). Group allocation to nonoperative treatment was independently predictive of the development of nonunion (p = 0.0001). Overall, DASH and Constant scores were significantly better after open redu...