title: Correlation of the degree of clavicle shortening after non-surgical treatment of midshaft fractures with upper limb function.
abstract: BACKGROUND
  Despite the use of non-surgical methods to treat for the majority of midshaft fractures of the clavicle, it is remains controversial whether shortening of this bone following non-surgical treatment of a middle third fracture affects upper limb function.
  
  
  METHODS
  We conducted a cohort study by sequentially recruiting 59 patients with a fracture of the middle third of the clavicle. All patients were treated nonsurgically with a figure-of-eight bandage until clinical and radiological findings indicated healing of the fracture. Functional outcome was assessed using the Disability of Arm, Hand and Shoulder (DASH) score revalidated for the Portuguese language, other outcomes assessed included: pain measured by visual analogue scale (VAS); radiographies to measure the degree of shortening, fracture consolidation and fracture malunion. Information were also collected regarding the mechanism of injury, patient's daily activities level and epidemiological features of the patient cohort. The results of our findings are expressed as the comparison of the functional outcome with the degree of shortening.
  
  
  RESULTS
  Patients were assessed six weeks and one year after injury. In the first evaluation, the mean DASH score was 28.84 and pain measured by VAS was 2.57. In the second evaluation (one year after injury) the mean DASH score was 8.18 and pain was 0.84. The mean clavicle shortening was 0.92 cm, ranging from 0 to 3 cm (SD = 0.64). There were no correlation between the degree of shortening and DASH score after six weeks and one year (p = 0.073 and 0.706, respectively). When only patients with of shortening greater than 2 cm were assessed for correlation, the result did not change.
  
  
  CONCLUSIONS
  We conclude that clavicle shortening after nonsurgical treatment with a figure-of-eight bandage does not affect limb function, even when shortening exceeds 2 cm.
  
  
  BACKGROUND
  ISRCTN85206617 . Registered 12 May 2014.
authors.affiliation: Orthopaedics and Traumatology Department, São Paulo Federal University, Napoleão de Barros Street 715, São Paulo, Brasil. gustavoslf@hotmail.com.
authors.forename: Gustavo Santiago de Lima
authors.initials: GS
authors.lastname: Figueiredo
authors.affiliation: Orthopaedics and Traumatology Department, São Paulo Federal University, Napoleão de Barros Street 715, São Paulo, Brasil. marceltamaoki@terra.com.br.
authors.forename: Marcel Jun Sugawara
authors.initials: MJ
authors.lastname: Tamaoki
authors.affiliation: Orthopaedics and Traumatology Department, São Paulo Federal University, Napoleão de Barros Street 715, São Paulo, Brasil. dragonebruno@gmail.com.
authors.forename: Bruno
authors.initials: B
authors.lastname: Dragone
authors.affiliation: Orthopaedics and Traumatology Department, São Paulo Federal University, Napoleão de Barros Street 715, São Paulo, Brasil. artur.utino@gmail.com.
authors.forename: Artur Yudi
authors.initials: AY
authors.lastname: Utino
authors.affiliation: Orthopaedics and Traumatology Department, São Paulo Federal University, Napoleão de Barros Street 715, São Paulo, Brasil. narchetti@uol.com.
authors.forename: Nicola Archetti
authors.initials: NA
authors.lastname: Netto
authors.affiliation: Orthopaedics and Traumatology Department, São Paulo Federal University, Napoleão de Barros Street 715, São Paulo, Brasil. marcelohmatsumoto@gmail.com.
authors.forename: Marcelo Hide
authors.initials: MH
authors.lastname: Matsumoto
authors.affiliation: Orthopaedics and Traumatology Department, São Paulo Federal University, Napoleão de Barros Street 715, São Paulo, Brasil. jcbelloti@gmail.com.
authors.forename: Fábio Teruo
authors.initials: FT
authors.lastname: Matsunaga
mesh_terms: D000293:Adolescent; D000328:Adult; D001134:Arm Injuries / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D001458:Bandages; D001696:Biomechanical Phenomena; D001938:Brazil; D002968:Clavicle / Q000000981:diagnostic imaging / Q000293:injuries* / Q000503:physiopathology; D004185:Disability Evaluation; D005260:Female; D017102:Fracture Healing; D050723:Fractures, Bone / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011859:Radiography; D020127:Recovery of Function; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult