OBJECTIVETo compared surgical and nonsurgical treatment of clavicular midpiece fracture.

METHODSFrom September 2002 to September 2011, 254 adult cases of displaced midshaft clavicle fractures were retrospective analyzed, including 188 males and 66 females who ranged in age from 19 to 62 years (mean 39.3 years). There were 38 cases of transverse fracture, 71 cases of oblique fracture,and 145 cases of comminuted fracture. All cases were fresh single fractures. According to the treatment methods, these patients were divided into conservative group and surgical group. In conservative group, 127 patients (96 male and 31 female; mean age 40.1 +/- 6.02) were treated by manipulative reduction and fixation with "infinity" shaped bandage. In surgical group, .96 patients (92 male and 35 female; mean age 39.0 +/- 5.11) were treated by open reduction and internal fixation with reconstruction plates. Appearance satisfaction, the cost of treatment and the incidence of complications were compared between the two groups. Therapeutic efficacy was evaluated according to Han's standard.

RESULTSAll patients of both groups were followed up for 8-10 months (mean 9.8 months). In surgical group,the curative effect was excellent in 110 cases, good in 12 cases and fair in 3 cases; in conservative group, the curative effect was excellent in 62 cases,good in 28 cases and fair in 37 cases. The therapeutic efficacy in surgical group was better than that in conservative group. The appearance satisfaction of conservative group was higher than that of surgical group. The cost of treatment and complications were lower in conservative group than those in surgical group.

CONCLUSIONTreatment modalities for adult clavicle fractures should be selected on the basis of comprehensive analysis. Non-surgical treatment should be the treatment of choice, and indication for surgical treatment should be controlled strictly.