title: The long-term outcome of displaced mid-third clavicle fractures on scapular and shoulder function: variations between immediate surgery, delayed surgery, and nonsurgical management.
abstract: BACKGROUND
  Conservative management for uncomplicated displaced clavicle fractures is common practice. Delay of surgical fixation may result in less favorable outcomes.
  
  
  METHODS
  A retrospective cohort study was conducted of 60 patients with a closed mid-third clavicle fracture that did not meet current operative or nonoperative guidelines; 20 primary (plate fixation <6 weeks), 20 delayed (plate fixation >6 weeks), and 20 matched conservative patients were included. Each patient completed 2 questionnaires, the Disabilities of the Arm, Shoulder, and Hand and the American Shoulder and Elbow Surgeons, as well as visual analog scales for pain, cosmetic satisfaction, and overall satisfaction. In addition, 10 patients from each group underwent clinical review of scapular rotation by the lateral scapular slide test, clinical impingement, range of motion assessment, and radiologic review of clavicle union and length.
  
  
  RESULTS
  The American Shoulder and Elbow Surgeons patient self-reported questionnaire demonstrated a median score of 5.5 for the delayed group, 2 for the primary group, and 1 for the conservative group (P = .032). The median Disabilities of the Arm, Shoulder, and Hand score was 7.92 for the delayed group, 3.32 for the primary group, and 1.67 for the conservative group (P = .212). Six patients in the delayed group had scapular malrotation compared with 2 in the primary group and none in the conservative group (P = .008). Flexion and external rotation in 90° abduction were decreased in the conservative group (P = .049 and .041, respectively).
  
  
  CONCLUSIONS
  We support the conservative management of uncomplicated displaced clavicle fractures but recognize that a lower threshold for early surgery should be considered where optimal shoulder function is required.
authors.affiliation: Department of Orthopaedics, Flinders Medical Centre, Bedford Park, SA, Australia.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: George
authors.affiliation: Department of Orthopaedics, Flinders Medical Centre, Bedford Park, SA, Australia.
authors.forename: Bartholomew P
authors.initials: BP
authors.lastname: McKay
authors.affiliation: Department of Orthopaedics, Flinders Medical Centre, Bedford Park, SA, Australia. Electronic address: Ruurd.Jaarsma@health.sa.gov.au.
authors.forename: Ruurd L
authors.initials: RL
authors.lastname: Jaarsma
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001860:Bone Plates; D002968:Clavicle / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D005260:Female; D005593:Fracture Fixation, Internal; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D017060:Patient Satisfaction; D011859:Radiography; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D012399:Rotation; D012540:Scapula / Q000503:physiopathology*; D012785:Shoulder Joint / Q000503:physiopathology*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Clavicle; delay; fracture; function; mid-third; outcome; scapular