Conservative versus Operative Management for Middle Third Clavicle Fractures in Kathmandu Model Hospital

Abstract

Introduction: Middle third clavicle fractures are common, with treatment options including conservative and operative approaches. This retrospective observational study compares the efficacy, functional outcomes, and complications of these methods at Kathmandu Model Hospital. 
Methods: Medical records of 80 patients (40 per group) treated between January 2018 and December 2024 were analyzed. Outcomes were evaluated using the Constant-Murley Score (CMS), Disabilities of the Arm, Shoulder, and Hand (DASH) score, radiological union time, and complication rates. 
Results: Operative management achieved bone union in 10.2 weeks compared to 14.5 weeks for conservative treatment, with better early functional scores at 6 and 12 weeks, but reported higher complications (22.5% versus 15%), including infections and hardware issues. Conservative management had a 10% non-union rate and more malunion but fewer surgical complications. 
Conclusion: Operative management demonstrated faster union and better early functional outcomes, while conservative management had fewer complications but prolonged recovery. These results offer valuable guidance for making treatment decisions in settings with limited resources.