A retrospective study of the association between shortening of the clavicle after fracture and the clinical outcome in 136 patients

Abstract

Background and purpose: The purpose of this retrospective study was to examine the association between shortening of the clavicle after a united midshaft fracture and clinical outcome. Second, the purpose was to compare the results obtained by conservative treatment with either a figure-of-eight bandage or a simple sling.

Materials and methods: This study included 136 patients with a united, conservatively treated, midshaft clavicle fracture. Mean age was 35 years (range 15-70 years); mean follow-up time was 55 months (range 24-83 months). The shortening of the clavicle was measured on a radiograph including one antero-posterior view of both clavicles on a single film and defined as the difference between the injured and the contralateral clavicle. The clinical outcome was measured using the Constant-Murley Score.

Results: The mean difference in the Constant-Murley Score between the injured and the contralateral shoulder was 7.3, P<0.001 (95% confidence interval (CI) 5.6; 9.1). Mean shortening of the injured shoulder was 11.6mm, P<0.001 (95% CI 10.2; 13.0). A shortening of more than 20mm was not associated with a poorer clinical outcome. The results obtained by conservative treatment with either a figure-of-eight bandage or a simple sling showed no difference in shortening or in the Constant-Murley Score.

Conclusions: We found that conservative treatment of midshaft clavicle fractures resulted in final shortening and mild reduction of shoulder function. A shortening of 20mm or more was not associated with a poorer clinical outcome. The figure-of-eight bandage and a simple sling were equal treatments of midshaft clavicle fractures.