Long-term results of conservative management of midshaft clavicle fracture

Abstract

A series of 91 patients (59 males, 32 females, mean age 41 years) with middle-shaft clavicle fracture were assessed at a mean of 8.7 years after injury. Based on Allman's classification, fractures were placed in group Ia, Ib and Ic. The majority (66%) were allocated to groups Ib or Ic. Clinical evaluation was made using the Constant score and simple shoulder test. On post-injury radiographs, we measured the amount of overlapping of the fracture fragments (OV) both in centimetres and as percentage of the length of the clavicle and the mean distance between cranio-caudally displaced fragments (DS). The mean Constant scores were 87.1% and 85.6% in groups Ib and Ic, respectively. In patients with a Constant score > or =90%, the mean OV was 7.7% and the average DS was 1.59 cm. In those with a Constant score of 81-89% the average OV and DS were 12% and 1.6 cm, respectively, with the greatest OV being 12.9. In the nine patients whose Constant score was > or =80% the mean OV was 13.2 and the average DS was 1.7; however, the majority of patients had an OV > 15% and DS > or = 2 cm. In these nine patients the mean Constant score was significantly lower than that in the group with a score of > or =90%. The simple shoulder test showed that 20% of patients were dissatisfied with the outcome; a low score was associated with a severe degree of OV or DS. Fracture nonunion occurred in five cases (5.5%). We conclude that there is a clear-cut indication for surgery in patients with OV > or = 15% or DS > or = 2.3 cm as well as in those with an OV > or = 13% associated with a DS > or = 2 cm. This holds particularly for young and middle-aged patients.

Fig. 1

A patient with severe cranio-caudal displacement and overlapping of the main fracture fragments of the right clavicle, who had a Constant score <80% and a low score on the simpleshoulder test due to shoulder dysfunction and cosmetic defect. a Initial radiograph showing agroup 1c fracture. b Radiograph obtained after six months, when fracture was considered healed.c The patient after fracture healing, showing severe clavicle deformity

Fig. 2

A patient with atrophic nonunion of fracture of the left clavicle. a Initial radiograph of agroup 1b fracture. b Radiograph obtained at the latest follow-up, 6 years after fracture. c Photograph taken at the latest follow-up showing mild loss of flexion of the left shoulder