Posttraumatic midshaft clavicular shortening does not result in relevant functional outcome changes

Area of Science:

• Orthopedics
• Biomechanics
• Sports Medicine

Background:

• Clavicular fractures can alter shoulder function, particularly with shortening or malunion.
• Nonoperative treatment is common for midshaft clavicular fractures.
• Assessing functional outcomes and scapular kinematics is crucial after healing.

Purpose of the Study:

• To investigate scapular orientations and functional outcomes in healed clavicular fractures.
• To compare shoulders with and without clavicular shortening.
• To determine if clavicular shortening affects shoulder kinematics and function.

Main Methods:

• 32 participants with healed nonoperative midshaft clavicular fractures were studied.
• 3D motion tracking recorded thorax, arm, and shoulder movements.
• DASH and Constant-Murley scores evaluated functional outcomes; scapular and humeral orientations were compared to the contralateral shoulder.

Main Results:

• Mean clavicular shortening was 25 mm.
• Affected shoulders showed slight increases in protraction and lateral rotation, and reduced backward tilt during abduction and anteflexion.
• No association was found between clavicular shortening and scapulohumeral kinematics, strength, or functional scores (Constant-Murley and DASH).

Conclusions:

• Healed clavicular fractures exhibit minor, clinically insignificant differences in scapulohumeral kinematics compared to uninjured shoulders.
• These kinematic changes do not correlate with the degree of clavicular shortening.
• Findings do not support routine surgery for shortened clavicular fractures based solely on functional outcome arguments.