External Fixation of Clavicle Fractures with Comminution or in Highly Active Patients

Conservative treatment of clavicle fractures has the disadvantage of substantial pain and discomfort, whereas internal fixation of these fractures has a high rate of non-union. External fixation is an alternative method permitting early mobilization without disrupting the surrounding soft tissue envelope. These are extremely beneficial in young, athletic and highly functional patients as well as in patients with comminuted fractures. This was a retrospective study of 17 consecutive patients with clavicle fractures. Thirteen of them were young, athletic patients while the remaining four were not highly active patients, but had a comminuted fracture. Mobilization of the shoulder started shortly after the operation and the external fixator was removed when radiological and clinical evidences of fracture union were present. Patients were reviewed up to 1 year postoperatively. Fracture union and functional activity were assessed clinically, radiologically, and with the aid of the VAS and DASH scores. In 16 patients fracture union was achieved 8 weeks postoperatively, while in one patient union was observed at 10 weeks. The mean VAS score was 4 at 2 weeks postoperatively, while by 6 weeks all patients had full range of shoulder motion. The mean DASH score 6 months postoperatively was 8 points. There were no postoperative infections or non-union. In 2 patients with comminuted fractures there was a minor displacement. External fixation is an easier to apply and less invasive method of surgical stabilization relative to internal fixation. Furthermore, it permits early mobilization and guarantees union of the fracture.