Fractures of the clavicle, when to fix?

ABSTRACT

The incidence of clavicular injuries in adults appears to be increasing as a result of several factors, including the high-velocity vehicular injuries, and the increased popularity of contact sports for adults. The classic conservative treatment rarely obtained anatomic reduction. It involves immobilization -Which is always relative- with bandages and uncomfortable postures that are not well accepted. Although it is the role for this fracture to heal with voluminous calluses, their subcutaneous location may make them unsightly. Delayed unions in adults in not unusual with non-union rate ranged from 0.9% to 4%. Was to evaluate indications and results of plate fixation of the fracture clavicle. From August 2001 till February 2004, nine clavicular fractures needed to be fixed internally. They were [2] females and [7] males., [6] were right and [3] were left sided. All patients were right handed. Indications for internal fixation for them were as follows one was non-union, five were marked displacement of the fragments, two of them were associated with tenting of the skin, two because of associated ipsilateral chest wall injuries and one with neurological manifestation. Internal fixation device were; six one-third tubular plates and three reconstruction plates. All fractures were united with healing time ranging from [6] to [14] weeks postoperatively with an average of [10] weeks. Using Constant and Murley scoring system for evaluation, 3 cases [33.33%] were rated excellent, and 5 [55.56%] good with satisfactory results 8 cases [88.89%] and one case [11.11%] rated fair and was unsatisfactory. One case was complicated by superficial infection, 2 cases with painful scar and one case showed delayed union [united after 14 weeks]. Internal fixation of clavicular fractures by plates in cases of non-union, marked displacement, Ipsilateral fracture ribs and neurological compression is a reliable method with satisfactory results in 88.89% of cases