title: Function plateaus by one year in patients with surgically treated displaced midshaft clavicle fractures.
abstract: BACKGROUND
  Based on short-term (1 year or less) followup, primary fixation of displaced midshaft clavicle fractures reportedly results in better function compared with that reported for nonoperative methods. Whether better function persists beyond 1 year is unclear.
  
  
  OBJECTIVE
  For displaced midshaft clavicle fractures, do the better mean Disabilities of the Arm, Shoulder and Hand (DASH) and Constant-Murley Shoulder (CSS) scores for operative versus nonoperative treatment at 1 year change between 1- and 2-year followup?
  
  
  METHODS
  We previously reported 132 patients in a randomized prospective trial at 1 year, and here we report a further followup of 95 of the 132 patients (72%) at 2 years after injury. We evaluated all patients with the DASH and CSS scores.
  
  
  RESULTS
  The mean DASH and CSS scores were similar at 2 years compared with 1 year postinjury for both the nonoperated and operated patients. The mean scores for the operated patients remained higher than those in the nonoperative group (DASH operative 4.1 ± 7.0 versus DASH nonoperative 11.4 ± 19.7, CSS operative 97.1 ± 4.5 versus CSS nonoperative 91.6 ± 14.1) at 2 years postinjury.
  
  
  CONCLUSIONS
  The improvement in DASH and CSS scores seen with primary fixation of displaced clavicle fractures persists at 2 years but does not differ from values seen after 1 year of followup, suggesting a clinical steady state has been reached whereby outcome is unlikely to change with time.
  
  
  METHODS
  Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
authors: Upper Extremity Reconstructive Service, St Michael's Hospital, University of Toronto, Suite 800, 55 Queen Street E, Toronto, Ontario M5C 1R6, Canada.
authors: Laura A
authors: LA
authors: Schemitsch
authors: Emil H
authors: EH
authors: Schemitsch
authors: Christian
authors: C
authors: Veillette
authors: Rad
authors: R
authors: Zdero
authors: Michael D
authors: MD
authors: McKee
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