Clinical and Radiological Outcome after Surgical Treatment in Displaced Clavicular Midshaft Fracture



Gwak, Heui-Chul;Kim, Jung-Han

  • 투고 : 2015.07.10
  • 심사 : 2016.01.06
  • 발행 : 2016.06.30


Background: The first purpose of this study is to compare the clinical and radiological outcomes of surgical treatment for displaced midshaft clavicle fracture (Robinson type 2B1 vs. 2B2) with 3.5-mm low profile clavicular locking compression plate. The second purpose is to evaluate the difference of the results depending on the presence of accompanying injuries. Methods: Forty-nine patients who underwent an operation for the fractures were reviewed retrospectively. Fracture patterns were classified according to group 2B1 and 2B2 using Robinson's classification. For radiological outcome, time to union after operation was evaluated and for clinical outcome, American Shoulder and Elbow Society (ASES) score, University of California in Los Angeles (UCLA) score, visual analogue scale (VAS), and range of motion (ROM) were evaluated from preoperative period to last follow-up period. Results: The mean time for union was not significantly different in the 2B1 group and 2B2 group (p=0.062). No statistically significant difference in ASES score, UCLA score, and VAS was observed between 2B1 and 2B2 (p=0.619, p=0.896, p=0.856, respectively). In ROM, significant higher mean forward flexion and abduction was observed in 2B2 (p=0.025, p=0.017, respectively) and there was no difference in external rotation and external rotation at shoulder $90^{\circ}$ abduction position (p=0.130, p=0.180, respectively). There was no significant difference in clinical outcomes according to the accompanying injuries. Conclusions: There was no difference in clinical and radiological outcome between Robinson 2B1 and 2B2 type fracture after the operation. Accompanying injuries may not affect the clinical result of displaced midshaft clavicle fractures.


Clavicle;Fracture, closed;Displacement;Treatment outcome


  1. Johnson EW Jr, Collins HR. Nonunion of the clavicle. Arch Surg. 1963;87(6):963-6.
  2. Paffen PJ, Jansen EW. Surgical treatment of clavicular fractures with Kirschner wires: a comparative study. Arch Chir Neerl. 1978;30(1):43-53.
  3. Khan LA, Bradnock TJ, Scott C, Robinson CM. Fractures of the clavicle. J Bone Joint Surg Am. 2009;91(2):447-60.
  4. Haidukewych GJ. Innovations in locking plate technology. J Am Acad Orthop Surg. 2004;12(4):205-12.
  5. Perren SM. Evolution and rationale of locked internal fixator technology. Introductory remarks. Injury. 2001;32 Suppl 2:B3-9.
  6. McKee MD, Schemitsch EH, Stephen DJG, Kreder HJ, Yoo D, Harrington J. Functional outcome following clavicle fractures in trauma patients. J Trauma Inj Infect Crit Care. 1999;47(3):616.
  7. Hill JM, McGuire MH, Crosby LA. Closed treatment of displaced middle-third fractures of the clavicle gives poor results. J Bone Joint Surg Br. 1997;79:537-9.
  8. Neer CS 2nd. Nonunion of the clavicle. J Am Med Assoc. 1960;172:1006-11.
  9. Kulshrestha V, Roy T, Audige L. Operative versus nonoperative management of displaced midshaft clavicle fractures: a prospective cohort study. J Orthop Trauma. 2011;25(1):31-8.
  10. Eskola A, Vainionpaa S, Myllynen P, Patiala H, Rokkanen P. Outcome of clavicular fracture in 89 patients. Arch Orthop Trauma Surg. 1986;105(6):337-8.
  11. Wilkins RM, Johnston RM. Ununited fractures of the clavicle. J Bone Joint Surg Am. 1983;65(6):773-8.
  12. Wick M, Muller EJ, Kollig E, Muhr G. Midshaft fractures of the clavicle with a shortening of more than 2 cm predispose to nonunion. Arch Orthop Trauma Surg. 2001;121(4):207-11.
  13. Davids PH, Luitse JS, Strating RP, van der Hart CP. Operative treatment for delayed union and nonunion of midshaft clavicular fractures: AO reconstruction plate fixation and early mobilization. J Trauma. 1996;40(6):985-6.
  14. Robinson CM, Court-Brown CM, McQueen MM, Wakefield AE. Estimating the risk of nonunion following nonoperative treatment of a clavicular fracture. J Bone Joint Surg Am. 2004; 86(7):1359-65.
  15. Poigenfurst J, Rappold G, Fischer W. Plating of fresh clavicular fractures: results of 122 operations. Injury. 1992;23(4):237-41.
  16. Schwarz N, Hocker K. Osteosynthesis of irreducible fractures of the clavicle with 2.7-MM ASIF plates. J Trauma. 1992;33(2): 179-83.
  17. Jupiter JB, Ring D. Fractures of the clavicle. In: Iannotti JP, Williams GR, eds. Disorders of the shoulder: diagnosis and management. Philadelphia: Lippincott Williams & Wilkins; 1999. 1427-70.
  18. Canadian Orthopaedic Trauma Society. Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial. J Bone Joint Surg Am. 2007;89(1):1-10.
  19. Moseley HF. The clavicle: its anatomy and function. Clin Orthop Relat Res. 1968;58:17-27.
  20. Robinson CM. Fractures of the clavicle in the adult. Epidemiology and classification. J Bone Joint Surg Br. 1998;80(3):476-84.
  21. Stanley D, Trowbridge EA, Norris SH. The mechanism of clavicular fracture. A clinical and biomechanical analysis. J Bone Joint Surg Br. 1988;70(3):461-4.