This prospective outcomes study evaluated 30 patients at a mean of 55 months after nonoperative treatment of displaced midshaft clavicular fractures. It asked whether traditionally reported good results hold up when patient-reported outcomes and objective strength testing replace surgeon-based assessments. It is the first study to document objective residual strength deficits following nonoperative care of this injury.
The displaced midshaft clavicular fracture was called a 'nonoperative injury' for decades — based on preserved range of motion and surgeon assessment, both of which look reassuringly normal even when the shoulder is functionally compromised.
This paper exposes what that exam misses: endurance abduction strength drops to 67% of the contralateral side, DASH scores run more than double the population norm, and only half of patients are fully satisfied four-plus years out.
When you see a displaced midshaft clavicle fracture with shortening approaching or exceeding 2 cm, that patient deserves an explicit conversation about operative fixation. Nearly two-thirds of the ≥2 cm group scored above the DASH disability threshold of 30, compared with fewer than one in six in the less-shortened group. A difference that holds up clinically even without reaching formal statistical significance.
This paper directly motivated the Canadian Orthopaedic Trauma Society randomized trial comparing plate fixation to nonoperative treatment: the RCT that shifted the standard of care for displaced midshaft clavicular fractures in active patients.
This prospective outcomes study evaluated 30 patients at a mean of 55 months after nonoperative treatment of displaced midshaft clavicular fractures. It asked whether traditionally reported good results hold up when patient-reported outcomes and objective strength testing replace surgeon-based assessments. It is the first study to document objective residual strength deficits following nonoperative care of this injury.
The displaced midshaft clavicular fracture was called a 'nonoperative injury' for decades — based on preserved range of motion and surgeon assessment, both of which look reassuringly normal even when the shoulder is functionally compromised.
This paper exposes what that exam misses: endurance abduction strength drops to 67% of the contralateral side, DASH scores run more than double the population norm, and only half of patients are fully satisfied four-plus years out.
When you see a displaced midshaft clavicle fracture with shortening approaching or exceeding 2 cm, that patient deserves an explicit conversation about operative fixation. Nearly two-thirds of the ≥2 cm group scored above the DASH disability threshold of 30, compared with fewer than one in six in the less-shortened group. A difference that holds up clinically even without reaching formal statistical significance.
This paper directly motivated the Canadian Orthopaedic Trauma Society randomized trial comparing plate fixation to nonoperative treatment: the RCT that shifted the standard of care for displaced midshaft clavicular fractures in active patients.