title: Comparing fracture healing disorders and long-term functional outcome of polytrauma patients and patients with an isolated displaced midshaft clavicle fracture.
abstract: BACKGROUND
  Although clavicle fractures are a common injury in polytrauma patients, the functional outcome of displaced midshaft clavicle fractures (DMCFs) in this population is unknown. Our hypothesis was that there would be no differences in fracture healing disorders or functional outcome in polytrauma patients with a DMCF compared with patients with an isolated DMCF, regardless of the treatment modality.
  
  
  METHODS
  A retrospective cohort study of patients (treated at our level I trauma center) with a DMCF was performed and a follow-up questionnaire was administered. Polytrauma patients, defined as an Injury Severity Score ≥16, and those with an isolated clavicle fracture were compared. Fracture healing disorders (nonunion and delayed union) and delayed fixation rates were determined. Functional outcome was assessed by the Quick Disability of the Arm, Shoulder, and Hand questionnaire.
  
  
  RESULTS
  A total of 152 patients were analyzed, 71 polytrauma patients and 81 patients with an isolated DMCF. Questionnaire response of 121 patients (80%) was available (mean, 53 months; standard deviation, 22 months). No differences were found between polytrauma patients and those with an isolated DMCF with regard to nonunion (7% vs. 5%, respectively), delayed union (4% vs. 4%), and delayed fixation rate (13% vs. 13%). Polytrauma patients had an overall worse functional outcome, regardless of initial nonoperative treatment or delayed operative fixation.
  
  
  CONCLUSIONS
  Polytrauma patients had a similar nonunion and delayed fixation rate but had an overall worse functional outcome compared with patients with an isolated DMCF. For polytrauma patients, a wait and see approach can be advocated without the risk of decreased upper extremity function after delayed fixation.
authors: Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: s.ferree@umcutrecht.nl.
authors: Steven
authors: S
authors: Ferree
authors: Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors: Falco
authors: F
authors: Hietbrink
authors: Department of Orthopedic Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands.
authors: Olivier A J
authors: OAJ
authors: van der Meijden
authors: Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands.
authors: Egbert Jan M M
authors: EJMM
authors: Verleisdonk
authors: Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors: Luke P H
authors: LPH
authors: Leenen
authors: Utrecht Traumacenter, Utrecht, The Netherlands.
authors: Roderick M
authors: RM
authors: Houwert
mesh_terms: D000293:Adolescent; D000328:Adult; D002968:Clavicle / Q000293:injuries*; D005260:Female; D005593:Fracture Fixation, Internal; D017102:Fracture Healing; D050723:Fractures, Bone / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000503:physiopathology* / Q000601:surgery; D020127:Recovery of Function; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Displaced; clavicle; delayed; fixation; fracture; functional; outcome; polytrauma