title: Positional Change in Displacement of Midshaft Clavicle Fractures: An Aid to Initial Evaluation.
abstract: OBJECTIVE
  To determine how change in position affects displacement of midshaft clavicle fractures.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Level I Trauma Center.
  
  
  METHODS
  Eighty patients with displaced midshaft clavicle fractures and presence of supine and semiupright or upright chest radiographs taken within 2 weeks of each other.
  
  
  METHODS
  Supine, semiupright, and upright chest radiographs.
  
  
  METHODS
  Fracture shortening and vertical displacement on supine, semiupright, and upright radiographs.
  
  
  RESULTS
  Mean vertical displacement was 9.42 mm [95% confidence interval (95% CI), 8.07-10.77 mm], 11.78 mm (95% CI, 10.25-13.32 mm), and 15.72 mm (95% CI, 13.71-17.72 mm) in supine, semiupright, and upright positions, respectively. Fracture shortening was -0.41 mm (95% CI, -2.53 to 1.70 mm), 2.11 mm (95% CI, -0.84 to 5.07), and 4.86 mm (95% CI, 1.66-8.06 mm) in supine, semiupright, and upright positions, respectively. Change in position from supine to upright significantly increased both vertical displacement and fracture shortening (P < 0.001). In the upright position, the proportion of patients who met operative indications (fracture shortening >20 mm) was 3 times greater when compared with that in the supine position (upright 17.65%; supine 5.88%, P = 0.06). Positional changes in fracture displacement were not associated with body mass index, age, or gender.
  
  
  CONCLUSIONS
  Patient position is associated with significant changes in fracture displacement. Over 3 times more patients meet operative indications when placed in the upright versus supine position. An upright chest radiograph should be obtained to evaluate midshaft clavicle fracture displacement, as it represents the physiologic stress across the fracture when considering nonoperative management.
  
  
  METHODS
  Prognostic level IV. See Instructions for Authors for a complete description of levels of evidence.
authors: *Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD; and †Department of Orthopaedics, McMaster University, Hamilton, ON, Canada.
authors: Awais
authors: A
authors: Malik
authors: Ehsan
authors: E
authors: Jazini
authors: Xuyang
authors: X
authors: Song
authors: Herman
authors: H
authors: Johal
authors: Nathan
authors: N
authors: OʼHara
authors: Gerard
authors: G
authors: Slobogean
authors: Joshua M
authors: JM
authors: Abzug
mesh_terms: D002968:Clavicle / Q000000981:diagnostic imaging* / Q000293:injuries*; D042241:Early Diagnosis; D005260:Female; D050723:Fractures, Bone / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D017759:Fractures, Malunited / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning / Q000379:methods*; D011856:Radiographic Image Enhancement / Q000379:methods; D013902:Radiography, Thoracic / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity