title: An assessment of patient satisfaction with nonoperative management of clavicular fractures using the disabilities of the arm, shoulder and hand outcome measure.
abstract: BACKGROUND
  Clavicle fractures historically have been managed without internal fixation. Current literature is raising questions regarding this management as opposed to offering operative fixation in some instances. This study addresses the use of the Disabilities of the Arm, Shoulder and Hand (DASH) outcomes measure to identify those that have the least satisfaction with nonoperative care of the clavicle fracture based upon clavicular deformity and variation in fracture location based upon Allman Classification.
  
  
  METHODS
  Patients having suffered clavicle fractures were mailed the DASH Outcomes Questionnaire to be completed and returned. A total of 113 surveys were returned completed with 92 being of value for evaluation. Patient chest or clavicle radiographs were evaluated, and measurements were made of the clavicle fractures for amount of separation or shortening and grade according to Allman Classification. Statistical evaluation compared DASH Scores (patient satisfaction as outcome measure) to the Allman Classification and the degree of separation or shortening. Comparison of categorical variables was performed using Fisher's exact test. Comparison of continuous variables was preformed using Student's t test. Statistical significance was demonstrated by a p value of less than 0.05.
  
  
  RESULTS
  Patients with clavicular shortening of greater than 2 cm were found to have the highest DASH score indicating dissatisfaction and disability with their outcome postinjury (p = 0.0001). Separation or lengthening seemed to be associated with lower DASH Scores. Patients with Allmen Classification I (midshaft clavicle) fractures had higher DASH score than other fracture locations (p = 0.0001).
  
  
  CONCLUSIONS
  Patients with midshaft clavicle fractures with shortening of greater than 2 cm may be good candidates for operative repair given the degree of dissatisfaction with nonoperative management of these fractures as assessed by long-term outcome measures of disability.
authors.affiliation: Division of Trauma and Critical Care, Department of Surgery, Maine Medical Center, Tufts University School of Medicine, Portland, Maine, USA.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Thormodsgard
authors.forename: Kayla
authors.initials: K
authors.lastname: Stone
authors.forename: David L
authors.initials: DL
authors.lastname: Ciraulo
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Camuso
authors.forename: Steven
authors.initials: S
authors.lastname: Desjardins
mesh_terms: D001132:Arm / Q000503:physiopathology; D002968:Clavicle / Q000293:injuries*; D004185:Disability Evaluation; D005260:Female; D050723:Fractures, Bone / Q000503:physiopathology* / Q000628:therapy*; D006225:Hand / Q000503:physiopathology; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012042:Registries; D012782:Shoulder / Q000503:physiopathology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome