Background: Displaced fractures of the midpart of the clavicular
shaft are generally treated nonoperatively, and few functional deficits have
been reported. Whereas prior investigators have presented radiographic and
surgeon-based outcomes, we used a patient-based outcome questionnaire and
objective muscle-strength testing to evaluate a series of patients who had
received nonoperative care for a displaced midshaft fracture of the
Methods: We identified thirty patients (twenty-two men and eight
women with a mean age of thirty-seven years) who had sustained a displaced
midshaft fracture of the clavicle. All patients were treated nonoperatively.
At a mean of fifty-five months, and a minimum of twelve months, outcomes were
measured with the Constant shoulder score and the DASH (Disabilities of the
Arm, Shoulder and Hand) patient questionnaire. In addition, objective shoulder
muscle-strength testing was performed with the Baltimore Therapeutic Equipment
Work Simulator, with the uninjured arm serving as a control.
Results: The range of motion was well maintained, with flexion
averaging 170° ± 20° and abduction averaging 165° ±
25°. Compared with the strength of the uninjured shoulder, the strength of
the injured shoulder was reduced to 81% for maximum flexion, 75% for endurance
of flexion, 82% for maximum abduction, 67% for endurance of abduction, 81% for
maximum external rotation, 82% for endurance of external rotation, 85% for
maximum internal rotation, and 78% for endurance of internal rotation (p <
0.05 for all values). The mean Constant score was 71 points, and the mean DASH
score was 24.6 points, indicating substantial residual disability.
Conclusions: Traditionally, good results with minimal functional
deficits have been reported following nonoperative treatment of clavicular
fractures. However, surgeon-based methods of evaluation may be insensitive to
loss of muscle strength. We detected residual deficits in shoulder strength
and endurance in this patient population, which may be related to the
significant level of dysfunction detected by the patient-based outcome
Level of Evidence: Therapeutic Level III. See
Instructions to Authors for a complete description of levels of evidence.