Short-term outcomes of non-operatively managed Diaphyseal Clavicle fractures in adults at Mulago National Referral Hospital.

Abstract

Introduction: Clavicular fractures constitute around 4% of all fractures globally, majority (80%) of these occurring in the diaphyseal region (Kihlström, Möller et al., 2017). At Mulago National Referral Hospital (MNRH), clavicle fractures are commonly managed non-operatively with good results. Nonetheless, some patients have reported short-term problems such as reduced shoulder function, persistent pain and discomfort. Despite this, there have been no prior investigations into the outcomes of non-operative treatment of diaphyseal clavicle fractures at MNRH. Objective: To describe the short-term outcomes of non-operative management of diaphyseal clavicle fractures and their associated factors among adults at MNRH. Methods: In this cross-sectional study, 54 participants were enrolled and assessed at point between 3 to 6 months following the injury, for outcomes of their treatment. Functional outcomes were assessed using the CMS, while radiologic outcomes were assessed on anteroposterior (AP) and serendipity view radiographs for presence of bridging callus. All collected data was imported into Epidata 4.2 and subsequently imported into STATA version 15 for analysis. Results: The average age (SD) of participants was 34.5 (12.55) years, range 18 to 70 years. The ratio of males to females was 1.7:1. With regards to fracture pattern, 74.07% of participants had class 2B1 and 44.44% had fracture displacement of more than 100% on initial x-rays. 64.8% of participants reported pain around injury site. Majority (70.37%) had good to excellent outcomes with average (SD) functional score of 78.65 (12.61) and ranging from 59 to 100. 66.67% had achieved union while 33.33% had nonunion. A displacement greater than 100% (p=0.032), duration since injury (p=0.000, 0.009) and the presence of pain were found to be significantly associated with poorer outcomes. Conclusion: The outcomes were generally good but with significantly large proportions of patients with unfavorable outcomes. A displacement of 100% or more was associated with higher chances of nonunion and poorer functional scores. We therefore conclude that nonoperative management of diaphyseal clavicle fractures in adults yields satisfactory outcomes for displacements than 100% in the short-term, but recommend surgical treatment for fractures with displacement greater than 100% on anteroposterior (AP) radiographs for better short term outcomes.