Conservative management of ipsilateral clavicle and scapula fractures in adults: a retrospective study

Concomitant ipsilateral clavicle and scapula fractures are uncommon injuries, and their optimal management remains controversial. While surgical treatment has been advocated for selected unstable patterns, the role of conservative treatment, particularly in minimally displaced fractures, has not been clearly established. The aim of this study was to evaluate the prevalence of concomitant clavicle and scapula fractures and to compare the clinical outcomes of conservatively treated patients with those of a matched cohort of patients with isolated clavicle fractures.

We retrospectively reviewed all adult patients treated conservatively for clavicle fractures at our institution between January 2020 and December 2022. After applying the inclusion and exclusion criteria, 84 patients were included in the final analysis. Nine patients (10.7%) presented with a concomitant ipsilateral scapular fracture and constituted the study group. A 1:1 matched control group of patients with isolated clavicle fractures was selected according to age, sex, fracture location, and injured side. Clinical outcomes were assessed at a minimum follow-up of one year using the Constant-Murley Score, the University of California, Los Angeles (UCLA) Shoulder Score (expressed as a percentage of the maximum obtainable score), the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, shoulder range of motion, and muscle strength.

The mean age of the study group was 53.3 ± 20.1 years. Three patients presented with a floating shoulder injury. Conservative treatment consisted of immobilization using either a figure-of-eight bandage or an arm sling followed by progressive rehabilitation. At final follow-up, patients with combined clavicle and scapula fractures achieved a mean Constant-Murley Score of 91.0 ± 4.5, a mean UCLA Shoulder Score of 91.3 ± 4.7%, and a mean DASH score of 4.65 ± 2.08. No statistically significant differences were found between the study group and the matched control group for any functional outcome measure, shoulder range of motion, or muscle strength (all p > 0.05).

In this retrospective cohort, the presence of an undisplaced or minimally displaced ipsilateral scapular fracture did not significantly influence the clinical outcomes of conservatively treated clavicle fractures. Conservative management appears to provide satisfactory functional results in carefully selected patients; however, larger prospective studies are required to confirm these findings.