Comparison Between The Operative And Nonoperative Treatment Of The Clavicle Fracture

Background: The clavicle is the only long bone connected the upper limbs with trunk. The clavicle not only adjusts the movement of the upper limbs, keeps the appearance of the shoulder, but also protects the vessel and nerve under it. The clavicle fracture is very common, about 5.98% of all the fracture. But there is still an argument of its treatments. Someone consider the nonoperative treatment is minimal traumatic, easy operation, little cost. But someone consider the nonoperative treatment needs a long time to fixed, more complication, and many patients couldn't persist in. Nowadays the operative treatment is more important, thanks to the less cost, advanced technique of the medicine, fixation and sterilization. But most of the researches of the clavicle fracture are little sample, non-randomized controlled trials and the summary of the clinical experience. Their guidance are very little. We need numbers of high quality research. Our study analysis differences of the effect between the operative and nonoperative treatment by the Meta-analysis and the retrospective case analysis.Objectives: To analysis differences of the effect between the operative and nonoperative treatment by the Meta-analysis and the retrospective case analysis.Methods: We got 122 patients with clavicle fracture from January 2004 to June 2007 in our hospital. But after the follow-up (6-36 months), there were only 48 patients left. They were divided into two groups. Group A consisted of 38 patients treated operatively. There were 30 female, 8 female with an average of 37.1(range: 3 to 69 years). Group B consisted of 10 patients treated nonoperatively. There were 8 male, 2 female with an average of 42.7(range: 8 to 66 years). The average duration of follow-up was 28.9months (range: 6 to 42 months) and 15.9 months (range: 5 to 29 months) for Group A and Group B, respectively. The location of the fracture(by Allman type): type I 41,type II 7, type III 0. The fracture type: transverse fracture 1, oblique fracture 19, splintered fracture 28. Combined with craniocerebral injury 4, with pneumothorax or rib fracture 3, nonunion 3, implants dysfunction 1, brachial plexus injury 1. Group A were operated with plate 31, Kirschner aiguille 6, bolt 1. Group B were treated by"8"type sling immobilization. We assessed with University of California at Los Angeles (UCLA scoring system), Dawson scoring system and calculate the rate of union. time in hospital: 1-45 days,average 12.0 days, cost in hospital: 175.5-25864.73 RMB,average 8069.1 RMB.Results: Meta-analysis: We got 4 controlled studies comparing operative with nonoperative treatment of clavicle fracture, including a total of 270 patients. One study is RCT. We found there was no significant difference in the shoulder dysfunction (OR=0.94, 95%CI (0.46, 1.91), P=0.44 homogeneity, P=0.84). There was no significant difference in the shoulder pain (OR=1.05, 95%CI (0.54,2.02), P=0.16 homogeneity, P=0.86). There was no significant difference in the satisfaction of patients (OR=1.13, 95%CI (0.43, 2.92), P=0.51 homogeneity, P=0.81). We also found an higher risk of nonunion in nonoperative treatment than in operative treatment (OR=4.10, 95%CI (1.31, 9.28), P=0.06 heterogeneity, P=0.01). The risk of complication was unknown in our study (OR=1.04, P=?, P=0.004)Clinical analysis: in UCLA scoring system, the operative treatment is better than nonoperative treatment (P<0.05); there is no difference in Dawson scoring system (P>0.05); in union rate, the operative treatment is better than nonoperative treatment (P<0.05); time in hospital: the nonoperative treatment is better than operative treatment (P<0.05), cost in hospital: the nonoperative treatment is better than operative treatment (P<0.05).Conclusions: The operative treatment is better in the shoulder function, union rate and satisfaction, but the nonoperative treatment can decrease the complication, pain, time and cost in hospital. We choose nonoperative treatment first, but we must be cautious for the complicated fracture. We hope there will be more RCTs about the clavicle fracture in the future.