Function plateaus by one year in patients with surgically treated displaced midshaft clavicle fractures

Abstract

Background: Based on short-term (1 year or less) followup, primary fixation of displaced midshaft clavicle fractures reportedly results in better function compared with that reported for nonoperative methods. Whether better function persists beyond 1 year is unclear.

Questions/purposes: For displaced midshaft clavicle fractures, do the better mean Disabilities of the Arm, Shoulder and Hand (DASH) and Constant-Murley Shoulder (CSS) scores for operative versus nonoperative treatment at 1 year change between 1- and 2-year followup?

Patients and methods: We previously reported 132 patients in a randomized prospective trial at 1 year, and here we report a further followup of 95 of the 132 patients (72%) at 2 years after injury. We evaluated all patients with the DASH and CSS scores.

Results: The mean DASH and CSS scores were similar at 2 years compared with 1 year postinjury for both the nonoperated and operated patients. The mean scores for the operated patients remained higher than those in the nonoperative group (DASH operative 4.1 ± 7.0 versus DASH nonoperative 11.4 ± 19.7, CSS operative 97.1 ± 4.5 versus CSS nonoperative 91.6 ± 14.1) at 2 years postinjury.

Conclusions: The improvement in DASH and CSS scores seen with primary fixation of displaced clavicle fractures persists at 2 years but does not differ from values seen after 1 year of followup, suggesting a clinical steady state has been reached whereby outcome is unlikely to change with time.

Level of evidence: Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Figures

Fig. 1

Graphic analysis comparing mean DASH scores in the operative and nonoperative groups. Values were statistically improved in the operative group at three of five followup times, namely, 6 weeks (p = 0.000), 52 weeks (p = 0.005), and 104 weeks (p = 0.014). Error bars indicate one standard error of the mean. DASH = Disabilities of the Arm, Shoulder and Hand.

Fig. 2

Graphic analysis comparing mean CSS scores in the operative and nonoperative groups. Values are statistically improved for the operative group at each followup time, namely, 6 weeks (p = 0.002), 12 weeks (p = 0.003), 24 weeks (p = 0.005), 52 weeks (p = 0.008), and 104 weeks (p = 0.012). Error bars indicate one standard error of the mean. CSS = Constant-Murley Shoulder score.