title: Comminution plays no role in worsening fracture healing of conservatively treated middle third clavicular fractures.
abstract: OBJECTIVE
  Middle third clavicular fracture is effectively treated by conservative means. Previous studies showed that comminution and displacement of clavicular fractures might affect fracture healing. However, the clavicle horizontally aligns in the shoulder girdle and has different biomechanics from vertical weight-bearing bones. Therefore, this study was conducted with the hypothesis that comminution has no effect in worsening fracture healing and union configurations in conservatively treated middle third clavicular fractures.
  
  
  METHODS
  One hundred ninety-eight middle third clavicular fractures treated by conservative means were reviewed and divided into 2 groups. Group 1, simple fractures, included 97 patients. Group 2, comminuted fractures, included 101 patients. Patient demographic data, initial fracture deformities, and union configurations such as angulation, overlying, and displacement were measured. Union rate and union complications such as delayed nonunion were evaluated. Data were analyzed for statistically significant differences (p<0.05).
  
  
  RESULTS
  Initial deformities of Group 1 and Group 2 were 11.94°±9.59° and 9.40°±8.57° angulation, 12.24±12.96 and 11.76±10.06 mm of overlying, and 13.31±8.63 and 13.72±7.42 mm of displacement, respectively, and exhibited no significant differences (p>0.05). Union rate and union complications of Group 1 were 74/97 (76.29%) and 23/97 (23.71%), respectively. For Group 2, the rates were 82/101 (81.19%) and 19/101 (18.81%), respectively. Union configuration of Group 1 and Group 2 were 13.76°±10.63° and 12.80°±8.65° angulation, 11.93±10.75 and 11.52±9.38 mm of overlying, and 9.79±8.33 and 10.74±6.68 mm of displacement, respectively, and showed no significant differences between the groups.
  
  
  CONCLUSIONS
  Comminution plays no role in worsening fracture healing of conservatively treated middle third clavicular fractures in terms of healing rate, union complications, and union configurations.
authors: Mahidol University, Faculty of Medicine Siriraj Hospital, Department of Orthopaedic Surgery, Bangkok, Thailand.
authors: Likit
authors: L
authors: Rugpolmuang
authors: Mahidol University, Faculty of Medicine Siriraj Hospital, Department of Orthopaedic Surgery, Bangkok, Thailand.
authors: Thos
authors: T
authors: Harnroongroj
authors: Mahidol University, Faculty of Medicine Siriraj Hospital, Department of Orthopaedic Surgery, Bangkok, Thailand.
authors: Narumol
authors: N
authors: Sudjai
authors: Mahidol University, Faculty of Medicine Siriraj Hospital, Department of Orthopaedic Surgery, Bangkok, Thailand.
authors: Thossart
authors: T
authors: Harnroongroj
mesh_terms: D000328:Adult; D002968:Clavicle / Q000000981:diagnostic imaging / Q000293:injuries / Q000473:pathology; D000072700:Conservative Treatment / Q000009:adverse effects / Q000379:methods; D005260:Female; D017102:Fracture Healing; D018460:Fractures, Comminuted / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D005599:Fractures, Ununited / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013785:Thailand; D016896:Treatment Outcome