Abstract
Background
Clavicle fractures account for around 4% of all fractures and up to 44% of fractures of the shoulder girdle. Fractures of the middle third (or mid-shaft) account for approximately 80% of all clavicle fractures. Management of this group of fractures is often challenging and the outcome can be unsatisfactory. In particular it is not clear whether surgery produces better outcomes than non-surgical management. Currently there is much variation in the use of surgery and a lack of good quality evidence to inform our decision.
Methods/Design
We aim to undertake a multicentre randomised controlled trial evaluating the effectiveness and safety of conservative management versus open reduction and internal fixation for displaced mid-shaft clavicle fractures in adults. Surgical treatment will be performed using the Acumed clavicle fixation system. Conservative management will consist of immobilisation in a sling at the side in internal rotation for 6 weeks or until clinical or radiological union. We aim to recruit 300 patients. These patients will be followed-up for at least 9 months. The primary endpoint will be the rate of non-union at 3 months following treatment. Secondary endpoints will be limb function measured using the Constant-Murley Score and the Disabilities of the Arm, Shoulder and Hand (DASH) Score at 3 and 9 months post-operatively.
Discussion
This article presents the protocol for a multicentre randomised controlled trial. It gives extensive details of, and the basis for, the chosen methods, and describes the key measures taken to avoid bias and to ensure validity.
Trial Registration
United Kingdom Clinical Research Network ID: 8665. The date of registration of the trial is 07/09/2006. The date the first patient was recruited is 18/12/2007.
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Details
1 Campus Bio-Medico University, Department of Orthopaedic and Trauma Surgery, Rome, Italy (GRID:grid.9657.d) (ISNI:0000000417575329); Royal Free Hampstead NHS Trust, Department of Orthopaedics, London, UK (GRID:grid.437485.9) (ISNI:0000000104393380)
2 Royal Free Hampstead NHS Trust, Department of Orthopaedics, London, UK (GRID:grid.437485.9) (ISNI:0000000104393380)
3 University College London Hospital NHS Foundation Trust, London, UK (GRID:grid.439749.4) (ISNI:0000000406122754)
4 Yeovil District Hospital NHS Foundation Trust, Yeovil, UK (GRID:grid.440204.6) (ISNI:0000000404870310)
5 Guy's and St Thomas' NHS Foundation Trust, Department of Orthopaedics, London, UK (GRID:grid.420545.2)
6 North Bristol NHS Trust, North Bristol NHS Trust, Frenchay Hospital, Bristol, UK (GRID:grid.418484.5) (ISNI:0000000403807221)
7 University Hospital, Coventry, UK (GRID:grid.412570.5) (ISNI:0000000404005079)
8 St George's Healthcare NHS Trust, Tooting, London, UK (GRID:grid.451349.e)
9 The Ipswich Hospital NHS Trust, Ipswich, UK (GRID:grid.412930.d) (ISNI:0000000404137370)