Long-term follow-up of conservatively treated midshaft clavicular fractures on functional outcome

Robert J Hillen; Erik Rgw Schraa; Tom van Essen; Bart J Burger; Dirk-Jan Hej Veeger

doi:10.1016/j.jor.2019.09.009

Long-term follow-up of conservatively treated midshaft clavicular fractures on functional outcome

J Orthop. 2019 Sep 11:18:80-85. doi: 10.1016/j.jor.2019.09.009. eCollection 2020 Mar-Apr.

Authors

Robert J Hillen¹, Erik Rgw Schraa², Tom van Essen¹, Bart J Burger³, Dirk-Jan Hej Veeger²

Affiliations

¹ Dijklanderziekenhuis, Department of Orthopedic Surgery, Hoorn, Noord-Holland, the Netherlands.
² Vrije Universiteit Amsterdam, Department of Human Movement Sciences, Amsterdam, Noord-Holland, the Netherlands.
³ Noordwest Ziekenhuisgroep Alkmaar, Department of Orthopedic Surgery, Alkmaar, Noord-Holland, the Netherlands.

Abstract

Background: The aim of this study was to examine the long-term effect of shortening after a midshaft clavicular fracture on strength deficiency in the shoulder.

Method: This study included 18 participants (14 males, 4 females) with a conservatively treated midshaft clavicular fracture. Mean age was 52.2 ± 13.8 years, range 32-76 years). The mean follow-up time was 13.5 ± 0.4 years. Participants filled in a QUICKDASH questionnaire and both clavicle lengths were measured using a caliper. The isometric strengths in internal rotation, external rotation and abduction of both arms were measured with a handheld dynamometer.

Results: Average shortening of the clavicle in this group was 1.09 cm (SD 0.53). Nearly all strength measurements showed no significant difference between the shortened and the unaffected side. Multiple regression revealed a small (3N per mm length difference) but statistically significant relationship on external rotation between the relative extent of shortening of the clavicle, dominant side of the fracture and the isometric force difference between the unaffected and affected arm, F(2,15) = 5.746, p < .05, adj. R² = .358. Over 14 years there was a reduction in mean DASH-score of 4.4 (8.8 ± 12.3; current DASH = 4.4 ± 7.7)In this group, long term effects of clavicular shortening were small. Based on these results we conclude that on the long term clavicular shortening will not result in significant strength loss.

Keywords: Clavicle malunion; Conservative treatment; Functional outcome; Midshaft clavicle fractures. level of evidence: III.