title: [Comparisons of clinical effects among three kinds of treatments of 1/3 displaced midshaft clavicular fractures in adults].
abstract: OBJECTIVE
  To compare the clinical effects among three kinds of treatments (external fixation, plate fixation, and non-operation) of 1/3 displaced midshaft clavicular fractures in adults.
  
  
  METHODS
  Retrospective analysis was conducted on 306 patients with clavicular fractures in Trauma Orthopedic Department in Jishuitan Hospital from March 2010 to May 2013, and 89 of these patients met the inclusive criteria.Among them, there were 29 cases of external fixation (Group A), 30 cases of plate fixation (Group B), and 30 cases of non-operation with the clavicle sling in Outpatient and Emergency Department (Group C). The average follow-up period was 32 months.The results were evaluated from four perspectives, respectively, follow-up period, Constant Shoulder Score (CSS), Disability of the Arm Shoulder and Hand Score (DASH), and imaging.There was no significant difference in demography, severity of injuries, mechanism of injury, and fracture type among the patients in the three groups.
  
  
  RESULTS
  Among 29 cases of external fixation, 25 cases were successfully followed up, 4 were lost.60 cases of plate fixationand non-operation were all successfully followed up.Based on the pairwise comparison of CSS and DASH among the three groups, there was no significant difference between external fixation [(94.0±6.4), (15.2±3.4)Score] and plate fixation[(92.9±8.4), (15.7±3.5)Score] (both P>0.05). Mean values of CSS and DASH of non-operation group [(86.0±3.6), (18.0±3.6)Score] were lower than those of the former two groups (P<0.001). The healing time of 3 kinds of treatments were as follows: external fixation 10.4±2.32 weeks; plate fixation 12.1±2.5 weeks; and non-operation 15.7±2.2 weeks.In terms of their complications, for the external fixation group, there was 1 case of nonunion (4%); and 3 cases of angulation deformity in the 12(th) week, whose external fixations were maintained till their unions in the 16(th) week.Shortening and displacement did not appear in any cases.In the plate fixation group, there was 1 case of nonunion (3%) and no malunion in this group.The biggest complications of plate fixation were implants stimulus and to remove the plate in the second operation, accounting for 60%.In the non-operation group, there were 3 cases of nonunion (10%), and 12 cases of malunion (40%) including 10 cases without symptoms and 2 cases with symptoms.The satisfaction rates for the appearance of shoulder after these 3 kinds of treatments among the patients were 96%, 93% and 77%, respectively.
  
  
  CONCLUSIONS
  (1) In treating 1/3 displaced midshaft clavicular fractures in adults, external fixation and plate fixation are overall better than non-operation.And there is no significant difference in curative effects between the two. (2) Both external fixation and plate fixation have its advantages and disadvantages.The choice of treatment must be based on the clinical type of the fracture and the communication with patients.
authors.affiliation: Medical Center, Tsinghua University, Beijing 100084, China.
authors.forename: X Z
authors.initials: XZ
authors.lastname: Ma
authors.forename: B S
authors.initials: BS
authors.lastname: Zhang
authors.forename: Z D
authors.initials: ZD
authors.lastname: Wang
authors.forename: M Y
authors.initials: MY
authors.lastname: Wang
mesh_terms: D000328:Adult; D001860:Bone Plates; D002968:Clavicle; D005592:Fracture Fixation; D050723:Fractures, Bone; D006801:Humans; D012189:Retrospective Studies