title: Radiological and functional outcomes 2.7 years following conservatively treated completely displaced midshaft clavicle fractures.
abstract: OBJECTIVE
  It is unclear whether all completely displaced midshaft clavicle fractures require primary surgical intervention. The aim of this study was to elucidate the radiological and clinical outcomes after conservative treatment, and to identify subgroups at risk of an inferior outcome.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Level II trauma center.
  
  
  METHODS
  Between 2005 and 2008, 122 patients were conservatively treated for a completely displaced midshaft clavicle fracture of whom 92 were eligible for inclusion in this study. Of these, 59 completed the study after a median of 2.7 years after the fracture (min-max, 1.1-4.9).
  
  
  METHODS
  The patients received the standard treatment administered at our institution at the time: nonsurgically with a sling without physiotherapy. Patients with painful nonunions were subsequently offered surgery.
  
  
  METHODS
  At follow-up, the patients' Disabilities of Arm, Shoulder, and Hand (DASH) and the Constant scores were evaluated. Radiographs were taken at follow-up and compared to those taken acutely.
  
  
  RESULTS
  Nonunion was found in 9 of the 59 (15.3%) patients. Twenty-four (24%) patients reported a fair-to-poor DASH score (i.e. >20). Patients with fractures that were vertically displaced by more than 100% (one bone width) were significantly less satisfied than those with fractures vertically displaced at 100% (p = 0.04). Initial shortening of more than 15 mm was not associated with a worse outcome or nonunion. The odds ratio of developing a nonunion increased with age (p = 0.04).
  
  
  CONCLUSIONS
  By treating completely displaced midshaft clavicle fractures conservatively with a sling and offering plate fixation for eventual painful nonunions, we found a 24% risk of a fair or poor clinical result with a DASH score over 20. A vertical displacement of more than 100 % between the main fragments on the initial radiograph was associated with an inferior clinical outcome in this study.
  
  
  METHODS
  IV.
authors.affiliation: Orthopaedic Department, Akershus University Hospital, Lørenskog, Norway. drhendrik@me.com.|Faculty of Medicine, University of Oslo, Oslo, Norway. drhendrik@me.com.
authors.forename: Hendrik F S
authors.initials: HF
authors.lastname: Fuglesang
authors.affiliation: Orthopaedic Department, Oslo University Hospital, Oslo, Norway.
authors.forename: Gunnar B
authors.initials: GB
authors.lastname: Flugsrud
authors.affiliation: Orthopaedic Department, Akershus University Hospital, Lørenskog, Norway.
authors.forename: Per-Henrik
authors.initials: PH
authors.lastname: Randsborg
authors.affiliation: Orthopaedic Department, Akershus University Hospital, Lørenskog, Norway.|Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Knut
authors.initials: K
authors.lastname: Stavem
authors.affiliation: Orthopaedic Department, Akershus University Hospital, Lørenskog, Norway.|Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Stein E
authors.initials: SE
authors.lastname: Utvåg
mesh_terms: D000328:Adult; D002968:Clavicle / Q000000981:diagnostic imaging / Q000293:injuries*; D005260:Female; D005500:Follow-Up Studies; D005592:Fracture Fixation / Q000295:instrumentation / Q000379:methods*; D017102:Fracture Healing; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009984:Orthopedic Fixation Devices; D011859:Radiography; D012189:Retrospective Studies
keywords: Clavicle; Conservative treatment; Constant score; DASH score; Displaced; Fracture; Midshaft; Nonunion