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Backgrounds <p>Clavicle fractures are a common injury, with lesions of the middle third accounting for 80% of all clavicle fractures. The most suitable approach to address these fractures remains debated, especially at long term. The aim of this study was to compare surgical and conservative treatments of displaced midshaft clavicle fractures at long-term follow-up.</p> Materials and methods <p>A total of 123 patients (≥18 years) with a displaced midshaft clavicle fracture, treated surgically with plate fixation (68 patients) or conservatively (55 patients) and evaluated at a mean follow-up 6.7±2.6 years, were included in this study. Shoulder function was evaluated with the Constant–Murley score (CMS) and disabilities of the arm, shoulder, and hand (DASH) score. Aesthetic satisfaction, scapular dyskinesia, radiological outcomes, and overall patient satisfaction were documented as well. A sub-analysis was performed to evaluate the influence of the radiological outcome on the functional outcome.</p> Results <p>The mean CMS was 94.1±10.6 points in the surgical group and 88.5±16.8 points in the conservative group (<i>p</i>=0.03). The DASH score was 5.1±11.3 in the surgical, 6.7±13.1 in the conservative group (n.s). The incidence of scapular dyskinesis was significantly lower (<i>p</i>&lt;0.001) in the surgical group. Radiological follow-up documented a lower rate of non-unions (<i>p</i>&lt;0.001) and mal-unions (<i>p</i>&lt;0.001) in the surgical group. Regarding patient satisfaction, there was no difference in terms of aesthetic satisfaction, while the overall satisfaction favored the surgical treatment (<i>p</i>=0.02). Patient with a non-union or a mal-union showed a worse outcome regarding CMS, overall and aesthetic satisfaction, and incidence of scapular dyskinesis.</p> Conclusions <p>These findings support surgical fixation in patients at risk of malalignment or with high activity demands, as it significantly improves long-term function, biomechanics, and patient satisfaction compared to non-operative management.</p> <p><b>Level of evidence</b>: III.</p>

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Surgical fixation reduces scapular dyskinesis and mal-union rates in midshaft clavicle fractures: a retrospective comparative analysis

  • 期刊论文

  • 发表日期：

    2026年2月5日

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  • L. M. Oldrini,
  • D. Previtali,
  • S. Tamborini,
  • G. Filardo,
  • C. Candrian

摘要

Backgrounds

Clavicle fractures are a common injury, with lesions of the middle third accounting for 80% of all clavicle fractures. The most suitable approach to address these fractures remains debated, especially at long term. The aim of this study was to compare surgical and conservative treatments of displaced midshaft clavicle fractures at long-term follow-up.

Materials and methods

A total of 123 patients (≥18 years) with a displaced midshaft clavicle fracture, treated surgically with plate fixation (68 patients) or conservatively (55 patients) and evaluated at a mean follow-up 6.7±2.6 years, were included in this study. Shoulder function was evaluated with the Constant–Murley score (CMS) and disabilities of the arm, shoulder, and hand (DASH) score. Aesthetic satisfaction, scapular dyskinesia, radiological outcomes, and overall patient satisfaction were documented as well. A sub-analysis was performed to evaluate the influence of the radiological outcome on the functional outcome.

Results

The mean CMS was 94.1±10.6 points in the surgical group and 88.5±16.8 points in the conservative group (p=0.03). The DASH score was 5.1±11.3 in the surgical, 6.7±13.1 in the conservative group (n.s). The incidence of scapular dyskinesis was significantly lower (p<0.001) in the surgical group. Radiological follow-up documented a lower rate of non-unions (p<0.001) and mal-unions (p<0.001) in the surgical group. Regarding patient satisfaction, there was no difference in terms of aesthetic satisfaction, while the overall satisfaction favored the surgical treatment (p=0.02). Patient with a non-union or a mal-union showed a worse outcome regarding CMS, overall and aesthetic satisfaction, and incidence of scapular dyskinesis.

Conclusions

These findings support surgical fixation in patients at risk of malalignment or with high activity demands, as it significantly improves long-term function, biomechanics, and patient satisfaction compared to non-operative management.

Level of evidence: III.