Conservative treatment of fractures at the middle third of the clavicle: The relevance of shortening and clinical outcome

Fractures of the clavicle are common and most often occur in the middle third. The clavicle has several important functions, each of which may be affected after fracture and malunion. In this retrospective study, we reviewed 132 patients with united fractures of the middle third of the clavicle after conservative management. Residual symptoms and overall patient satisfaction after treatment were assessed through a questionnaire. Clavicular shortening after union was calculated on a standardized anteroposterior chest radiograph. Intraobserver variability and interobserver variability of measurements by use of this method are insignificant. The mean follow-up was 30 months (range, 12-43 months). The mean modified Constant score was 84 (range, 62-100). Of the patients, 34 (25.8%) were dissatisfied with the result of their management. Final clavicular shortening of more than 18 mm in male patients and of more than 14 mm in female patients was significantly associated with an unsatisfactory result.