title: Posttraumatic midshaft clavicular shortening does not result in relevant functional outcome changes.
abstract: OBJECTIVE
  Shoulder function may be changed after healing of a nonoperatively treated clavicular fracture, especially in cases of clavicular shortening or mal-union. We investigated scapular orientations and functional outcome in healed clavicular fractures with and without clavicular shortening.
  
  
  METHODS
  32 participants with a healed nonoperatively treated midshaft clavicular fracture were investigated. Motions of the thorax, arm, and shoulder were recorded by standardized electromagnetic 3D motion tracking. The DASH score and Constant-Murley score were used to evaluate functional outcome. Orientation of the scapula and humerus at rest and during standardized tasks, and strength and function of the affected shoulders were compared with corresponding values for the uninjured contralateral shoulders.
  
  
  RESULTS
  Mean clavicular shortening was 25 mm (SD 16). Scapula protraction had increased by mean 4.4° in rest position in the affected shoulders. During abduction, slightly more protraction, slightly more lateral rotation, and slightly less backward tilt was found for the affected shoulders. For anteflexion, the scapular orientations of the affected shoulders also showed slightly increased protraction, slightly increased lateral rotation, and slightly reduced backward tilt. Scapulohumeral kinematics, maximum humerus angles, and strength were not associated with the degree of clavicular shortening. All participants had excellent performance on the Constant-Murley score and DASH score.
  
  
  CONCLUSIONS
  Scapulohumeral kinematics in shoulders with a healed clavicular fracture differ from those in uninjured shoulders, but these changes are small, do not result in clinically relevant changes in outcome, and do not relate to the amount of clavicular shortening. These findings do not support routine operative reduction and fixation of shortened midshaft clavicular fractures based on the argument of functional outcome.
authors: a 1 Department of Trauma Surgery.
authors: Sylvia A
authors: SA
authors: Stegeman
authors: b 2 Department of Orthopaedics.|d 4 the Laboratory for Kinematics and Neuromechanics , Leiden University Medical Center, Leiden, the Netherlands.
authors: Pieter Bas
authors: PB
authors: de Witte
authors: a 1 Department of Trauma Surgery.
authors: Sjoerd
authors: S
authors: Boonstra
authors: c 3 Department of Rehabilitation Medicine.|d 4 the Laboratory for Kinematics and Neuromechanics , Leiden University Medical Center, Leiden, the Netherlands.
authors: Jurriaan H
authors: JH
authors: de Groot
authors: b 2 Department of Orthopaedics.
authors: Jochem
authors: J
authors: Nagels
authors: a 1 Department of Trauma Surgery.
authors: Pieta
authors: P
authors: Krijnen
authors: a 1 Department of Trauma Surgery.
authors: Inger B
authors: IB
authors: Schipper
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena / Q000502:physiology; D002968:Clavicle / Q000293:injuries*; D005260:Female; D017102:Fracture Healing / Q000502:physiology*; D050723:Fractures, Bone / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular / Q000502:physiology*; D055815:Young Adult