Abstract
Purpose
There is increasing evidence that primary fixation of displaced mid-shaft fractures of the clavicle results in superior short-term outcomes when compared to traditional non-operative methods. However, the results from published studies are limited to relatively short-term (one year or less) follow-up. Accurate data of longer follow-up is important for a number of reasons, including patient prognostication, counseling and care, the design of future trials, and the economic analysis of treatment. The purpose of this paper was to examine the results of the two year follow up of patients enrolled in a previously published randomized clinical trial of operative versus non-operative treatment of displaced fractures of the clavicle.
Method
Using a comprehensive and standard assessment that included DASH (Disabilities of the Arm, Shoulder and Hand) and CSS (Constant Shoulder Scores) scores, we evaluated ninety-five patients of the original cohort of one hundred and thirty-two patients at two years following their injury.
Results
Statistical analysis performed on the two year follow up data revealed that DASH and CSS scores remained essentially unchanged at two years post-injury compared to one year post-injury for both operative and non-operative groups (p>0.05). Additionally, outcome scores in the operative group remained superior to the non-operative group (DASH operative 4 +/− 7 versus DASH non-operative 11 +/− 20, p<0.014, CSS operative 97 +/− 4 versus CSS non-operative 92 +/− 14, p<0.012) at two years post-injury.
Conclusion
The improvement in outcome seen with primary fixation of displaced clavicle fractures persists at two years but does not differ significantly from values seen after one year of follow-up, suggesting that clinically a steady state has been reached whereby outcome is unlikely to change with time. This has clinical, economic, and research implications.
