Posttraumatic midshaft clavicular shortening does not result in relevant functional outcome changes

Abstract

Background and purposeShoulder function may be changed after healing of a nonoperatively treated clavicular fracture, especially in cases of clavicular shortening or mal-union. We investigated scapular orientations and functional outcome in healed clavicular fractures with and without clavicular shortening.Patients and methods32 participants with a healed nonoperatively treated midshaft clavicular fracture were investigated. Motions of the thorax, arm, and shoulder were recorded by standardized electromagnetic 3D motion tracking. The DASH score and Constant-Murley score were used to evaluate functional outcome. Orientation of the scapula and humerus at rest and during standardized tasks, and strength and function of the affected shoulders were compared with corresponding values for the uninjured contralateral shoulders.ResultsMean clavicular shortening was 25 mm (SD 16). Scapula protraction had increased by mean 4.4° in rest position in the affected shoulders. During abduction, slightly more protraction, slightly more lateral rotation, and slightly less backward tilt was found for the affected shoulders. For anteflexion, the scapular orientations of the affected shoulders also showed slightly increased protraction, slightly increased lateral rotation, and slightly reduced backward tilt. Scapulohumeral kinematics, maximum humerus angles, and strength were not associated with the degree of clavicular shortening. All participants had excellent performance on the Constant-Murley score and DASH score.InterpretationScapulohumeral kinematics in shoulders with a healed clavicular fracture differ from those in uninjured shoulders, but these changes are small, do not result in clinically relevant changes in outcome, and do not relate to the amount of clavicular shortening. These findings do not support routine operative reduction and fixation of shortened midshaft clavicular fractures based on the argument of functional outcome.

Does clavicular shortening after nonoperative treatment of midshaft fractures affect shoulder function? A systematic review

“…Five studies were retrospective [5, 23–26] and one was prospective [27]. In four studies, determining the relationship between shortening and shoulder function was the primary study aim [23, 24, 26, 27]. Follow-up was at least 12 months in all studies, with a frequency-weighed mean of 4.5 years.…”

“…Stegeman and Postacchini additionally calculated the proportional shortening by dividing the overlap of fracture fragments by the sum of the length of the injured clavicle and the measured overlap [23, 25]. Shortening was also measured at different time points: on the index trauma radiographs [24–27], or on radiographs taken after the fracture had united [5, 23]. …”

“…Mean DASH scores ranged from 3.38 to 24.6 in four studies (Table 2) [5, 23, 26, 27]. The mean Constant score (Table 2) was reported in five studies (range 71–96) [5, 23–26].…”

“…Mean DASH scores ranged from 3.38 to 24.6 in four studies (Table 2) [5, 23, 26, 27]. The mean Constant score (Table 2) was reported in five studies (range 71–96) [5, 23–26]. McKee found much poorer mean Constant and DASH scores than the other studies, and both functional scores were significantly worse than the normative value for the general population (71 vs 92 and 24.6 vs 10.1, respectively) [5, 28, 29].…”

Impact of Clavicular Shortening after Midclavicular Fracture: A Retrospective Series

“…However, these studies comprised highly specifi c patient cohorts composed exclusively of patients who had undergone corrective osteotomy. Several studies have found inferior clinical outcomes in the presence of shortening of 1.5-2 cm after healing [10][11][12]24], whereas others have not demonstrated such a relationship [14,25,26].…”