Revisiting the surgical indication of mid-shaft clavicle fractures: Clavicle asymmetry

Abstract

These fractures particularly occur in patients below 50 years of age. Approximately 75 to 80% of the clavicle fractures are located in the mid-shaft region. [2] Distal clavicle fractures occur after falling on the open arm or directly on the shoulder and constitute approximately 15 to 20% of all clavicle fractures. [3] Despite being a prevalent injury, the ideal treatment modality remains unclear for mid-shaft clavicle fractures. Traditionally, conservative treatment was the hallmark of the treatment of mid-shaft clavicle fractures. [4] However, conservative treatment has been reported to cause a greater percentage of symptomatic malunion and nonunion, up to 15%, compared to surgical treatment. [5][6][7] On the other hand, surgical treatment has also been Objectives: The aim of the study was to investigate whether clavicular symmetry was a valid assumption and to assess the factors that could predict clavicular asymmetry.Patients and methods: Between January 2021 and April 2021, a total of 100 consecutive patients (61 males, 39 females; mean age: 63.6±15.5 years; range, 27 to 94 years) whose both clavicles were adequately seen on chest computed tomography (CT) were retrospectively analyzed. Clavicular lengths were measured on three-dimensional (3D) reconstruction of chest CTs by two independent orthopedic surgeons on two separate occasions. The longest distance passing the straight line between the most lateral part of the clavicle at the acromioclavicular joint and the most medial point of the clavicle on the sternoclavicular joint was given as the clavicle length after adjusting tilt of convertible 3D CTs. Clavicular length difference was calculated by subtracting the short clavicle's length from the long clavicle's length. Patients' age and sex were noted. The calculated clavicular length differences were assigned into three groups: ≤5 mm, >5 mm and ≤10 mm, and >10 mm. Results:The mean right and left clavicle lengths were 13.9±1.3 cm and 14.1±1.2 cm, respectively (p<0.001). A total of 29 patients (29%) had >5 mm clavicle asymmetry and six patients (6%) had more than 10 mm clavicular length difference. Age, sex, and clavicular length were not associated with the clavicular length difference. Conclusion:Our study results showed that 29% of the patients had >5 mm clavicular length asymmetry. The clavicular symmetry may not be a valid assumption in the decision making for the surgical treatment of mid-shaft clavicle fractures; thus, this assumption may lead to maltreatment. More factors that can predict clavicle asymmetry should be investigated in future studies.