Radiographic and Clinical Outcomes of Non-Operative Treatment for Patients with Non-Union of Fractures of the Mid-Shaft of the Clavicle in Adults

Abstract

Background: Non-unions of clavicle fracture after conservative treatment have been treated surgically, but carry a risk of complications. The aim of this study is to report the outcomes of non-operative treatment for patients with non-union of fractures of the mid-shaft of the clavicle following initial conservative treatment. Methods: This is a retrospective study done at a single centre. Subjects with non-union after conservative treatment of clavicle mid-shaft fractures between March 2004 and February 2019 were included in this study. The exclusion criteria included follow-up period <1 year after the diagnosis of non-union and concomitant upper extremity injury. Final radiographs were assessed for fracture healing, vertical displacement, and shortening. Visual analog scale (VAS) pain scores, shoulder range of motion (ROM) and self-rated outcomes were obtained. Results: Fourteen patients (five females) with an average age of 58 (range, 29-76) years and a mean follow-up duration of 4.0 (range, 1.5-10.2) years were included in the study. The average vertical fracture displacement was 188.7 (range, 95.4-301.4) percent and the average shortening was 13.2 (range, 2.7-16.9) percent. The average VAS pain score was 0.21 (range, 0-2) points. There was no significant difference in the ROM between the injured and uninjured shoulder (p= 0.715 for forward flexion, 0.070 for abduction and 0.714 for external rotation) and the Constant shoulder score (p = 0.190). Thirteen of the 14 patients were satisfied with the treatment, and 12 returned to their pre-injury level of sports participation. Conclusions: Non-operative treatment resulted in a favourable outcome for patients with non-union of clavicle fracture after conservative treatment. Self-rated outcome score was excellent, regardless of the presence of radiographic abnormalities.