McKee and colleagues measured patient‑reported function and objective shoulder strength to look for residual deficits after nonoperative care of displaced midshaft clavicle fractures.
Series of 30 of 107 patients treated nonoperatively at one Toronto center from 1994 to 2000, followed a mean of 55 months (range 12 to 72).
Methods
Design
Series of nonoperatively treated patients
Therapeutic Level III
Data source
St. Michael's Hospital, University of Toronto
Patients
30 patients with displaced midshaft clavicle fractures
22 men and 8 women
Mean age 37
30 of 107 identified patients, with 33 not located
Exposure
Sling, with physiotherapy offered after union
Follow-up
Mean 55 months, minimum 12 months
Outcomes
Constant shoulder score
DASH questionnaire
Peak strength and endurance on the BTE Work Simulator, compared with the uninjured arm
Key Findings
Abduction endurance was the most reduced measure at 67% of the uninjured side, and lower abduction endurance tracked with lower Constant scores (r = 0.725, p = 0.001).
Motion was preserved, with flexion averaging 170°, abduction 165° and external rotation 79°, and none differed significantly from the opposite shoulder.
Patient‑reported scores were significantly worse than published population norms, with a mean DASH of 24.6 vs 10.1 (p = 0.02) and a mean Constant score of 71 vs 92 (p = 0.01).
Only 15 of 30 patients were completely satisfied with the shoulder, while 7 were partly satisfied and 8 were dissatisfied.
Shortening did not correlate significantly with the DASH score (r = 0.315, p = 0.11) or the Constant score (r = −0.196, p = 0.44).
18 of 30 patients returned to their preinjury work and recreation, and 8 moved to less strenuous work.
Board pearl
With shortening of 2 cm or more, 7 of 11 patients had a DASH above 30, vs 3 of 19 with less shortening, a trend that did not reach significance (p = 0.06).
Authors' conclusion
Traditionally, good results with minimal functional deficits have been reported following nonoperative treatment of clavicular fractures. However, surgeon-based methods of evaluation may be insensitive to loss of muscle strength. We detected residual deficits in shoulder strength and endurance in this patient population, which may be related to the significant level of dysfunction detected by the patient-based outcome measures.
McKee and colleagues measured patient‑reported function and objective shoulder strength to look for residual deficits after nonoperative care of displaced midshaft clavicle fractures.
Series of 30 of 107 patients treated nonoperatively at one Toronto center from 1994 to 2000, followed a mean of 55 months (range 12 to 72).
Methods
Design
Series of nonoperatively treated patients
Therapeutic Level III
Data source
St. Michael's Hospital, University of Toronto
Patients
30 patients with displaced midshaft clavicle fractures
22 men and 8 women
Mean age 37
30 of 107 identified patients, with 33 not located
Exposure
Sling, with physiotherapy offered after union
Follow-up
Mean 55 months, minimum 12 months
Outcomes
Constant shoulder score
DASH questionnaire
Peak strength and endurance on the BTE Work Simulator, compared with the uninjured arm
Key Findings
Abduction endurance was the most reduced measure at 67% of the uninjured side, and lower abduction endurance tracked with lower Constant scores (r = 0.725, p = 0.001).
Motion was preserved, with flexion averaging 170°, abduction 165° and external rotation 79°, and none differed significantly from the opposite shoulder.
Patient‑reported scores were significantly worse than published population norms, with a mean DASH of 24.6 vs 10.1 (p = 0.02) and a mean Constant score of 71 vs 92 (p = 0.01).
Only 15 of 30 patients were completely satisfied with the shoulder, while 7 were partly satisfied and 8 were dissatisfied.
Shortening did not correlate significantly with the DASH score (r = 0.315, p = 0.11) or the Constant score (r = −0.196, p = 0.44).
18 of 30 patients returned to their preinjury work and recreation, and 8 moved to less strenuous work.
Board pearl
With shortening of 2 cm or more, 7 of 11 patients had a DASH above 30, vs 3 of 19 with less shortening, a trend that did not reach significance (p = 0.06).
Authors' conclusion
Traditionally, good results with minimal functional deficits have been reported following nonoperative treatment of clavicular fractures. However, surgeon-based methods of evaluation may be insensitive to loss of muscle strength. We detected residual deficits in shoulder strength and endurance in this patient population, which may be related to the significant level of dysfunction detected by the patient-based outcome measures.