Functional Outcomes and Complications of Non-surgical Management for Midshaft Clavicle Fractures

Abstract

Introduction Midshaft clavicle fractures are commonly managed conservatively, especially in resource-limited settings. While union rates are generally high, concerns remain regarding functional outcomes and complications such as nonunion and malunion. Objective This study's objective is to evaluate the long-term functional outcomes and complications associated with non-surgical management of middle-third clavicular fractures. Methodology This prospective observational study was conducted at Mardan Medical Complex over 24 months. A total of 110 patients with isolated, closed, middle-third clavicle fractures treated conservatively were enrolled. Functional outcomes were assessed using the QuickDisabilities of the Arm, Shoulder, and Hand (QuickDASH) score and Constant-Murley Shoulder Score (CMSS) at 12-month follow-up. Radiological union, complications, and patient satisfaction were also recorded. Statistical analysis was performed using SPSS version 25.0 (IBM Corp., Armonk, NY). Independent t-tests and chi-square tests were applied where appropriate, with a p-value of < 0.05 considered statistically significant. Results Out of 110 enrolled patients, 102 (92.7%) completed follow-up. Union was achieved in 88 (86.3%) patients within 16 weeks. Nonunion occurred in seven (6.9%), and malunion in 10 (9.8%). The mean DASH score was 9.6 ± 7.2, and CMSS was 88.2 ± 6.8. Patients with union had significantly better scores (p < 0.001). Cosmetic dissatisfaction was reported in 18 (17.6%) patients, mostly associated with malunion. Conclusion Conservative management of midshaft clavicle fractures is generally effective, but functional outcomes are significantly influenced by healing quality. Careful patient selection and follow-up are essential to minimize complications and improve outcomes.

Keywords: clavicle fractures; conservative treatment; disabilities of the arm; fracture; fracture healing; malunited fractures; nonunion; shoulder and hand score; treatment outcome.

Figure 1. Distribution of fracture-healing outcomes following conservative management (n = 102).

Bar graph illustrating the frequencies and percentages of patients achieving union, delayed union, nonunion, and malunion after 12 months of follow-up. Radiological union was defined as cortical continuity on AP and axial clavicle views; delayed union > 16 weeks, nonunion > 24 weeks, and malunion as healed fracture with > 15° angulation or ≥ 1.5 cm shortening.

Figure 2. A representative case sequence illustrating the natural course of a displaced midshaft clavicle fracture.

(A) Initial radiograph showing a completely displaced midshaft clavicular fracture with superior displacement of the medial fragment. (B) Postoperative radiograph following anatomical reduction and fixation using a contoured plate and screws. (C) Follow-up radiograph at 24 weeks demonstrating complete cortical union and restored alignment.

Figure 3. Radiographic comparison demonstrating nonunion and eventual healing following conservative management.

(A) Nonunion evident at 24-week follow-up. (B) Healed fracture at 52-week follow-up.

Figure 4. Reported complications and satisfaction (n = 102).

Frequencies and percentages represent reported complications and satisfaction at 12-month follow-up. A chi-square test was used to assess the association between malunion and cosmetic dissatisfaction. A p-value < 0.05 was considered statistically significant.