Conservative treatment of fractures at the middle third of the clavicle: The relevance of shortening and clinical outcome

Outcomes of treatment of displaced midshaft clavicle fractures in adolescents using titanium elastic nails

“…[15][16][17] It has also only recently come to the attention of clinicians and researchers using patient-based outcome measures, as opposed to surgeon-based or radiographic outcomes, that patient dissatisfaction with conservative management of these fractures is unacceptably high. 10,[18][19][20][21] The successful outcomes achieved from fixation of displaced clavicle fractures in adults have raised new questions regarding treatment in the adolescent population and led some orthopaedic surgeons to search for and refine indications for fixation of clavicle fractures in skeletally immature patients, particularly in highly functional and active adolescents. 4 Van der Have et al retrospectively reviewed 42 adolescents with significantly displaced clavicle fractures and showed that symptomatic malunion was more common than initially thought.…”

Impact of Clavicular Shortening after Midclavicular Fracture: A Retrospective Series

“…Gaebler et al [6], showed that 50 % of patients with shortening of 1 cm and 100 % of patients with shortening of 2 cm had accompanying measurable defi cits in shoulder function. Lazarides and Zafi ropoulos [12], reported that shortening of more than 18 mm in male patients and 14 mm in female patients was associated with a poor clinical outcome. In a previous cadaver study [27], it was shown that healing of clavicle fractures with bony and "clinically relevant".…”

“…However, these studies comprised highly specifi c patient cohorts composed exclusively of patients who had undergone corrective osteotomy. Several studies have found inferior clinical outcomes in the presence of shortening of 1.5-2 cm after healing [10][11][12]24], whereas others have not demonstrated such a relationship [14,25,26].…”

“…An increasing number of studies have reported that such shortening deformity is associated with greater disability of the shoulder [10][11][12][13], whereas other studies have reported no such association [2,14,15].…”

Excessive Complications of Open Intramedullary Nailing of Midshaft Clavicle Fractures With the Rockwood Clavicle Pin

“…The rate of nonunion is reportedly increased by the following factors: advanced age, female sex, fracture displacement, and comminution [2,15]. However, initial displacement of the fracture is apparently the most accurate predictor of outcome, with shortening of more than 2 cm leading to a poor functional outcome [2,7,10,11,14]. Traditional indications for acute surgical fixation include open fracture, neurovascular compromise, skin tenting, impending open fracture, and severe displacement.…”