Measurement of clavicular symmetry: A hint for midshaft clavicle fracture management.

Abstract

Clavicle fractures represent approximately 2.6∼4 % of all fractures. The management of midshaft clavicle fractures is a topic of debate. The evaluation of clavicular shortening relies on the assumption of clavicular symmetry. Our hypothesis posited that clavicles were not of identical length, challenging the assumption of clavicular symmetry. This retrospective study was conducted at a level 1 hospital between February 1, 2022, and February 28, 2022, with a total of 200 consistent thoracic CT scans from patients with suspected pneumonia reviewed. Bilateral clavicle lengths were measured using thoracic CT plain scans. Intraclass correlation coefficients (ICC) were examined. Linear and logistic regression were performed. In a total number of 170 patients, the left clavicles were 1.96 mm longer than the right clavicles on average (95 % CI 1.25-2.68, p < 0.001). In 118 patients (69.4 %), the bilateral clavicle length difference was between 0-5 mm; In 45 patients (26.5 %), the difference was 5-10 mm, and in 7 patients (4.1 %), the difference was greater than 10 mm. Positive correlations were found between height (p = 0.002), male gender (p < 0.001), and the absolute difference, respectively. Clavicle asymmetry is present with a positive correlation with male gender and height. Surgeons shall be aware of this asymmetry in managing midshaft clavicle fractures.