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Symmetric cosmesis of shoulders
6%
105/1785
Decreased shoulder motion
5%
97/1785
Symptomatic nonunion
16%
281/1785
Shoulder instability
0%
6/1785
Decreased shoulder strength and endurance
72%
1284/1785
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Patients who have nonoperative treatment of displaced midshaft clavicle fractures have significant decreases in both strength and endurance to approximately 80% of the contralateral side as described by the McKee article. There was a trend correlating shortening >2cm with poor outcome (p=0.06). Motion was found to be preserved. In the Canadian Orthopaedic Trauma Society's landmark randomized control trial of operative versus nonoperative treatment for displaced clavicle fractures, patients treated non-operatively had lower subjective outcomes scores, slower rates to union, more nonunions, more symptomatic malunions, and were less satisfied with the appearance of their shoulder. There were more hardware related complications in the operatively treated group. The second McKee article describes improvements in subjective outcome scores after midshaft clavicle malunion corrective osteotomy. Figure A shows a comminuted, displaced midshaft clavicle fracture.
3.4
(43)
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