title: Surgical treatment of displaced middle-third clavicular fractures: a prospective, randomized trial in a working compensation population.
abstract: BACKGROUND
  Surgical treatment with open reduction and internal fixation (ORIF) of displaced middle-third clavicular fractures resulted in shorter complete return to work periods with earlier consolidation documented on computed tomography (CT) scans in this prospective, randomized controlled trial.
  
  
  METHODS
  The study randomized 76 consecutive patients with displaced fractures (2B1-2B2 according to Robinson) to conservative (C, n = 42) and surgical (S, n = 34) treatment with plates and screws. Bone union was documented with CT scans at 6 and 12 weeks.
  
  
  RESULTS
  Risk factors known to increase the risk of nonunion were similar between groups. Time until discharge for complete return to work was 3.7 ± 1.1 months for C and 2.9 ± 0.8 months for S (P = .003). On the CT scan at 6 weeks, 24.1% of the patients presented advanced bone union in S vs 5.3% in C (P = .05). At 12 weeks, 81% of the patients presented advanced bone union in S vs 16.7% in C (P = .005). At final follow-up, 4 nonunions were present in the C group that required surgery; in the S group, 4 patients underwent revision surgery for plate removal. At 6 and 12 months of follow-up, Constant scores were higher for the S group.
  
  
  CONCLUSIONS
  Surgical treatment with ORIF of displaced middle-third clavicular fractures achieved good and excellent functional results, shorter time to complete return to work, earlier bone union, and fewer cases of nonunions in a working population under injury compensation.
authors.affiliation: Shoulder Surgery Unit, Orthopedics Department, Hospital del Trabajador, Santiago, Chile. Electronic address: pmelean@hts.cl.
authors.forename: Patricio A
authors.initials: PA
authors.lastname: Melean
authors.affiliation: Shoulder Surgery Unit, Orthopedics Department, Hospital del Trabajador, Santiago, Chile.
authors.forename: Adrian
authors.initials: A
authors.lastname: Zuniga
authors.affiliation: Shoulder Surgery Unit, Orthopedics Department, Hospital del Trabajador, Santiago, Chile.
authors.forename: Michael
authors.initials: M
authors.lastname: Marsalli
authors.affiliation: Shoulder Surgery Unit, Orthopedics Department, Hospital del Trabajador, Santiago, Chile.
authors.forename: Nelson A
authors.initials: NA
authors.lastname: Fritis
authors.affiliation: Shoulder Surgery Unit, Orthopedics Department, Hospital del Trabajador, Santiago, Chile.
authors.forename: Erik R
authors.initials: ER
authors.lastname: Cook
authors.affiliation: Shoulder Surgery Unit, Orthopedics Department, Hospital del Trabajador, Santiago, Chile.
authors.forename: Matías
authors.initials: M
authors.lastname: Zilleruelo
authors.affiliation: Meds Sports Medicine Clinic, Orthopedic Department, Santiago, Chile.
authors.forename: Cristian
authors.initials: C
authors.lastname: Alvarez
mesh_terms: D000328:Adult; D001860:Bone Plates; D001863:Bone Screws; D002968:Clavicle / Q000000981:diagnostic imaging / Q000293:injuries*; D005593:Fracture Fixation, Internal / Q000295:instrumentation; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D005599:Fractures, Ununited / Q000601:surgery; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D012086:Reoperation; D062707:Return to Work; D013997:Time Factors; D016896:Treatment Outcome; D014942:Workers' Compensation
keywords: Clavicular fracture; middle third; nonoperative treatment; nonunion; off-work period; operative treatment