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

Abstract

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. 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. 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. 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.