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Predictive Factors for Functional Outcome after Conservative Treatment of Midshaft Clavicular Fractures: A Retrospective Cohort Study

Hockers NP, Hillen RJ , Fransen BL , Willems JIP, Hoozemans MJM and Burger BJ

Background
The aim of this study is to identify factors based on radiological characteristics and nature of presenting history, that are predictive in functional outcome at two to nine years follow-up, in patients that were treated conservatively after a midshaft clavicle fracture.

Methods
We performed a retrospective cohort study of all patients that presented to the emergency department of Noordwest Ziekenhuisgroep Alkmaar in the Netherlands, between 2004 and 2006. Follow-up was performed at 2 to 3 years and at 7 to 9 years after injury. This resulted in a total amount of 48 and 31 included patients, respectively. The Disabilities of the Arm, Shoulder and Hand score (DASH score) was used to assess patient reported functional outcome. Statistical analyses were performed to detect correlations between characteristics of the patient or fracture and functional outcome.

Results
There was a significant decrease of 4.3 in DASH scores between the mid-term and long-term follow-up of patients with complete angulation of their fracture (p=0.041) and of 2.6 in DASH of patients who were not involved in a high energetic trauma (p=0.031).

Conclusion
With regard to completely angulated clavicular fractures and noninvolvement in a HET, an increase of functional outcome is to be expected from mid- to long-term.