COTS clavicle trial

Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial

Canadian Orthopaedic Trauma Society. The Journal of bone and joint surgery. American volume 2007 · PMID 17200303 · doi:10.2106/jbjs.f.00020

Question

In adults with completely displaced midshaft clavicle fractures, does primary plate fixation improve outcomes over sling treatment?

Design

Multicentre RCT across Canadian trauma centres.

Patients

Active adults aged 16 to 60 with a completely displaced midshaft clavicle fracture.

Intervention

Open reduction and plate fixation

Comparison

Sling immobilisation

Primary outcome

Constant score and DASH score at 1 year

Key result

Plate fixation gave significantly better Constant and DASH scores, faster union and lower rates of non-union and symptomatic malunion than sling treatment.

Limitations

Patients and assessors were not blinded, and loss to follow-up was considerable; functional differences were modest.

Impact on practice

Challenged the view that all midshaft clavicle fractures do well non-operatively and prompted a more selective approach to fixation in active young adults.