Mohsen Khorami - Department of Orthopedic Surgery, Golestan Hospital, Jonishapur University of MedicalSciences, Ahvaz, Iran.
Hamid Reza Arti - Golestan Hospital, Joundishapour University of Medical Sciences, Ahvaz, Iran
Mohammad Fakour - Imam Khomeini Hospital, Joundishapour University of Medical Sciences, Ahvaz, Iran
Hossein Mokarrami - Imam Khomeini Hospital, Joundishapour University of Medical Sciences, Ahvaz, Iran
Abdolhossein Mahdi Nasab - Imam Khomeini Hospital, Joundishapour University of Medical Sciences, Ahvaz, Iran
Farid Shahrivar - Imam Khomeini Hospital, Joundishapour University of Medical Sciences, Ahvaz, Iran

Background:  Clavicle fractures are common and usually heal without complications. In this study, we evaluated the outcomes of non-operative versus operative management of displaced fractures.   Methods:  In a prospective clinical trial study, sixty-five patients with displaced clavicle mid-shaft fractures were nonrandomly divided in two treatment groups. The first group underwent non-operative treatment with figure of ۸ bandage (۳۰ patients), and the other underwent operative treatment with plate fixation (۳۵ patients). Figure of ۸ bandage and ۳.۵ millimeter DCP plate with at least six cortical screws were used in non-operative and operative groups respectively. We followed up all patients at weeks ۲, ۶ and ۱۲, and at month sixth. In addition to clinical examination and x-ray evaluation, we assessed satisfaction, DASH and Constant Shoulder Score for each individual. Results:  The average durations of union were ۱۹.۳ and ۲۴.۴ weeks in operative and non-operative groups respectively (P=۰.۰۰۶). Satisfaction with operative treatment was ۷۴.۳% and with non-operative treatment was ۶۶.۷%, showing no significant difference (P=۰.۵۰۰). The non-union rate was ۵.۷% in the operative group and ۱۳.۳% in the non-operative group (P=۰.۵۱۸). A significant difference between the two groups in terms of DASH and Constant Shoulder Scores after the six-month follow-up was not found (P=۰.۳۵۲). Conclusions:  According to our results, we recommend operative treatment in mid-shaft clavicle fractures only when there is a definitive indication. 

Clavicle, Constant Shoulder Score, DASH score, Internal Fixation, Non-operative management