title: Early versus delayed operative intervention in displaced clavicle fractures.
abstract: OBJECTIVE
  Recent evidence to suggest that fixation of clavicle fractures yields better outcomes than conservative treatments has led to an increasing trend toward operative management. There is no evidence, however, to compare early fixation with delayed fixation for symptomatic patients before union.
  
  
  METHODS
  Prospective comparative case series.
  
  
  METHODS
  Level 1 regional trauma center.
  
  
  METHODS
  Displaced clavicle fractures treated operatively in our institution during a 4-year period. Ninety-seven patients were included: 68 with early fixation and 29 delayed. Radiographic and clinical outcomes were available for all patients and scores were available for 62.
  
  
  METHODS
  Early plate fixation (within 3 weeks) of displaced clavicle fractures compared with delayed (3-12 weeks) fixation of displaced clavicle fractures.
  
  
  RESULTS
  Radiographic union, Oxford Shoulder Score, QuickDASH, EQ5D, and a patient interview. Mean follow-up was to 30 months.
  
  
  RESULTS
  There were no statistically significant differences in age (P > 0.05), sex (P > 0.05), and energy of injury (P > 0.05) between the 2 groups. The mean QuickDASH was 8.9 early and 9.1 delayed (P < 0.05) and the Oxford Shoulder Score was 44.2 early and 43.9 delayed (P < 0.05). In the early fixation group, there were 5 wound healing complications, and 8 went on subsequently to have removal of prominent metalwork. In the delayed fixation group, 2 had wound healing complications and 4 required removal of prominent metalwork. There were no statistically significant differences in the EQ5D scores.
  
  
  CONCLUSIONS
  Our series supports delayed fixation of symptomatic clavicle fractures as results do not differ from early fixation.
  
  
  METHODS
  Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Cambridge Shoulder Unit, Addenbrooke's Hospital, Cambridge, United Kingdom.
authors.forename: Avishek
authors.initials: A
authors.lastname: Das
authors.forename: Katie E
authors.initials: KE
authors.lastname: Rollins
authors.forename: Kathleen
authors.initials: K
authors.lastname: Elliott
authors.forename: Philip
authors.initials: P
authors.lastname: Johnston
authors.forename: Lee
authors.initials: L
authors.lastname: van-Rensburg
authors.forename: Graham M
authors.initials: GM
authors.lastname: Tytherleigh-Strong
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Ollivere
mesh_terms: D000328:Adult; D001860:Bone Plates; D002968:Clavicle / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D005260:Female; D005593:Fracture Fixation, Internal; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D013997:Time Factors; D055815:Young Adult