|Abstract / Summary
The overall aim of this thesis was to improve functional results after treatment of
midshaft clavicular fractures and to reduce the rate of secondary surgery.
Study I was a randomized clinical trial comparing operative and non-operative
treatment of adult patients with displaced midshaft clavicular fractures. 150 patients
were divided into two equal groups and followed for one year. We measured the
functional outcome as well as recorded the incidence of complications and
nonunion. The functional outcome was measured with a patient reported score
(Disabilities of the Arm, Shoulder and Hand, DASH) as well as a part patient
reported and part examiner reported score (Constant Score, CS). We found that
operative treatment reduces the risk of nonunion, but there is no benefit the
functional outcome scores compared to nonoperative treatment. Furthermore, there
is a risk of complications associated with the operative treatment.
Study II was an analysis of the DASH and CS scores from Study I. The
measurement properties of both measuring instruments were analysed and
compared. We found that the instruments had similar properties and future studies
could rely on the use of the DASH questionnaire alone.
Study III was an analysis of the non-operatively treated patients from Study I. We
investigated risk factors for the development of nonunion. We found that minimal
improvement in pain scores in the period week two to week four after fracture was
associated with a high risk of nonunion.
The findings in this PhD dissertation contribute to the understanding of the treatment
of mid-shaft clavicular fractures in adults. Study I contributes to a growing body of
evidence suggesting that the only benefit of operative treatment is the reduced risk
of nonunion. Study II provides an opportunity to ease the administrative and
financial burden in future studies, as it is sufficient to use only DASH as a
measuring instrument for functional outcome. Study III identifying slowly
decreasing pain as a risk factor for nonunion. This finding must be validated in a
new study before clinical use, but has the potential to change the current treatment
of clavicular fractures to a more individual approach, where only patients at high
risk of nonunion are offered surgery.