title: Sling compared with plate osteosynthesis for treatment of displaced midshaft clavicular fractures: a randomized clinical trial.
abstract: 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.
authors: Department of Orthopaedics and Traumatology, Helsinki University Central Hospital and University of Helsinki, Topeliuksenkatu 5, 00260 Helsinki, Finland. kaisa.virtanen@hus.fi
authors: Kaisa J
authors: KJ
authors: Virtanen
authors: Ville
authors: V
authors: Remes
authors: Jarkko
authors: J
authors: Pajarinen
authors: Vesa
authors: V
authors: Savolainen
authors: Jan-Magnus
authors: JM
authors: Björkenheim
authors: Mika
authors: M
authors: Paavola
mesh_terms: D000328:Adult; D001860:Bone Plates; D002968:Clavicle / Q000000981:diagnostic imaging / Q000293:injuries*; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D017102:Fracture Healing / Q000502:physiology; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000534:rehabilitation* / Q000601:surgery*; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007103:Immobilization / Q000379:methods; D015601:Injury Severity Score; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000534:rehabilitation / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009989:Orthotic Devices; D018579:Patient Selection; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult