Functional recovery following early mobilization after middle third clavicle osteosynthesis for acute fractures or nonunion: A case-control study

Background: Good outcomes have been reported after surgical treatment for acute or nonunion of displaced midshaft clavicle fractures. However, the postoperative rehabilitation and timeline for a complete functional recovery are poorly documented. The purpose of the current study was to evaluate the efficacy of an immediate motion protocol following plate fixation of a midshaft clavicle fracture and to compare functional recovery between acute and nonunion cases. Methods: Between October 2011 and July 2015, all patients above the age of 18, having either an acute or a nonunion of the midshaft clavicle fracture, were considered as potentially eligible for inclusion in this prospective case-control study. Postoperatively, no immobilization was recommended and patients were to undergo rehabilitation protocol consisting of hourly stretching. Results: Forty-two patients were included (31 with acute and 11 with delayed fixation) at a mean follow-up of 33 months (range, 12 to 78 months). Surgical complications consisted of one transient frozen shoulder, one delayed union, and two superficial infections. All patients returned to work, retrieved full shoulder range of motion (ROM), and returned to heavy sports and activities. Function returned faster in the acute group compared to the nonunion group based on the SANE score at 2 weeks (73 +/- 21 vs. 45 +/- 26 respectively, P = 0.01), SANE score at 6 weeks (89 +/- 15 vs. 66 +/- 23 respectively, P = 0.01), SANE score at 3 months (96 +/- 10 vs. 85 +/- 14 respectively, P = 0.03), and based on return of full ROM (17 +/- 25 vs. 44 +/- 31 days respectively, P = 0.01). A trend was observed for nonunion cases needing more time to return to work and sports activities. Conclusion: Functional outcome is excellent following the treatment of both acute and non-united clavicle fractures, but recovery occurs earlier following acute treatment. An early mobilization rehab protocol can be safely recommended for both types of conditions and may result in substantial healthcare cost-savings, without increasing complication rate and decreasing patient satisfaction. (C) 2017 Elsevier Masson SAS. All rights reserved.