Patient Satisfaction In Relation To Duration of Conservative Management in Midshaft Clavicle Fractures

Abstract

Background: The clavicle, an S-shaped bone, serves as a strut between the sternum and the glenohumeral joint. It also plays a crucial role in suspending the shoulder girdle, with the shoulder hanging from it via the coracoclavicular ligament. The annual incidence of mid-clavicular fractures is approximately 64 per 100,000 individuals. Among clavicle fractures, midshaft fractures are the most common, accounting for 70% to 80% of cases, while lateral fractures make up 15% to 30%, and medial fractures are the rarest, comprising only about 3%. Open clavicular fractures are uncommon, occurring in just 0.1% to 1% of cases. Different strength assessment methods have been used, such as a spring balance to measure force at 90° abduction, with a maximum recorded strength of 25 lb (11.3 kg), and the Nicholas manual muscle tester. However, these techniques may lack the precision needed to detect subtle changes in endurance strength.

Objective: The objective of this study is to determine the number of satisfied patients undergoing non-surgical correction for mid-shaft clavicular fractures.

Methods: This cross-sectional prospective study was conducted from December-2024 to April 2025 among Patients Treated Conservatively for Midshaft Clavicle Fractures presenting to tertiary care hospital, department of orthopedic surgery. After getting ethical approval from Jinnah Post Graduate Medical Center (Ref# F.2-81/2024-GENL/125/JPMC). Data was collected by principle investigator. Pre designed written (DASH) questionnaire was used. The first section included Age, Gender questions on demographic characteristics of study participants and the second section of the questionnaire included the Disabilities of the Arms, Shoulder and Hands (DASH Score) and association between Duration of Conservative Treatment and Patient Satisfaction in Midshaft Clavicle Fracture Patients. Calculated sample size was 80 patients. Data was entered in SPSS version 23. This study was carried out at JPMC's Department of Orthopedics Surgery in Karachi. Patients were counselled on non-surgical options, and informed consent was acquired. A figure-of-eight bandage or clavicular brace was used for six weeks of therapy. Patients were followed up at six and twelve weeks to assess their healing, function, and problems. The chi-square test was used to determine the relationship between the length of conservative treatment and patient satisfaction. A p-value of ≤0.05 was considered statistically significant.

Results: The study had 80 participants, with a mean age of 38.1 ± 10.4 years and an equal gender distribution (40 males, 40 females). Overall, 58.7% of patients were satisfied with their therapy, with the 20-35 age group reporting the highest satisfaction (p = 0.0001). A strong relationship was discovered between follow-up findings and functional outcomes at both 6 and 12 weeks, with improved healing corresponding to higher functional scores (p = 0.0001). Furthermore, a considerable relationship was seen between functional outcomes and patient satisfaction; persons with good or exceptional outcomes expressed great satisfaction, whereas those with fair or poor outcomes were largely dissatisfied (p = 0.0001). These findings emphasize the significance of early healing and imply that coexisting diseases may affect both recovery and patient satisfaction.

Conclusion: This study's findings indicate that non-surgical treatment of mid-shaft clavicular fractures results in successful outcomes for the majority of patients 12 weeks later. Patient satisfaction and healing rates showed a clear relationship with patient age, the existence of diabetic or hypertensive diseases, and their initial improvement at week six of the follow-up period.