Function Plateaus by One Year in Patients With Surgically Treated Displaced Midshaft Clavicle Fractures

Abstract

Background Based on short-term (1 year or less) followup, primary fixation of displaced midshaft clavicle fractures reportedly results in better function compared with that reported for nonoperative methods. Whether better function persists beyond 1 year is unclear. Questions/purposes For displaced midshaft clavicle fractures, do the better mean Disabilities of the Arm, Shoulder and Hand (DASH) and Constant-Murley Shoulder (CSS) scores for operative versus nonoperative treatment at 1 year change between 1-and 2-year followup? Patients and Methods We previously reported 132 patients in a randomized prospective trial at 1 year, and here we report a further followup of 95 of the 132 patients (72%) at 2 years after injury. We evaluated all patients with the DASH and CSS scores. Results The mean DASH and CSS scores were similar at 2 years compared with 1 year postinjury for both the nonoperated and operated patients. The mean scores for the operated patients remained higher than those in the nonoperative group (DASH operative 4

High Irritation and Removal Rates After Plate or Nail Fixation in Patients With Displaced Midshaft Clavicle Fractures

“…Fourth, the QuickDASH score is not specifically designed for patients with a displaced midshaft clavicle fracture. Nevertheless, it often is used as one of the tools to measure function [1,4,[18][19][20]. Fifth, because patients experience and recall symptoms differently, we know this study could be susceptible to recall bias.…”

“…Results of one study indicated that shoulder disability scores reached a steady state 1 year postoperatively [19]. After 1 year, the improvement in shoulder disability scores of patients treated surgically was less than 10 and 8 points, which are the minimal numbers for a clinically important difference for the DASH and QuickDASH, respectively [8,13,19].…”

“…It often is treated by surgical implant removal (a second operation) [1,4,6,[20][21][22][23]. However, comparative studies or studies regarding the development of implant-related irritation with followup beyond the first year or two are scarce [1,4,14,19,23].…”

Operative versus nonoperative interventions for common fractures of the clavicle: a meta-analysis of randomized controlled trials

“…43 Five studies compared different operative implants. [37][38][39][40][41] One placebo-controlled trial managed all fractures nonoperatively.…”

“…30,33,38 †Only enrolled patients with comminuted fractures (3 or more fragments). ‡Data for 2 years in a subsequent publication (Schemitsch et al 43 ). §Open reduction and plate fixation (44 patients with limited contact dynamic compression plates; 15 with 3.5-mm reconstruction plates; 4 with precontoured plates, and 4 with other plates.…”