Background

Ultrasound and MRI are recommended tools in evaluating postoperative pain in metal-on-metal hip (MoM) arthroplasty.

Introduction and Aims: The clavicle has several important functions each of which may be affected after fracture and malunion of the bone. The aim is to establish any association between shortening of the clavicle, following successful conservative management and clinical outcome.

Method: 132 patients with history of an acute fracture of the clavicle were reviewed. None of them had previous pathology affecting shoulder function, prior to injury. Men accounted 93 with average age 25.4 years, and women 39 with average age 34.2 years. All underwent conservative management with standard protocols and the fracture was united. The length and relative shortening of the united clavicle were assessed on a standardised posteroanterior chest x-ray. Intra- and Inter-observer reliability of measurements were assessed. Clinical outcome was evaluated with the Constant score. Mean follow-up was 30 months.

Results: Clavicular shortening following fracture union was 11.4 mm on average (range 3–25 mm), and was encountered in 120 patients. Intra- and inter-observer variability of measurements were not significant. Fracture healing time averaged 10 weeks (range 6–20 weeks) and 5.3% of patients presented delayed union. Thirty-four patients (25.8%) were unsatisfied with the result. The mean Constant score was 84 (range 62–100). Forty patients were having pain, and 21 had shoulder function impairment. Shortening > 14mm was statistically associated with unsatisfactory results.

Conclusion: Clavicle is an important element in the integral functional mobility of the shoulder and malunion after fracture could lead to unsatisfactory results. We describe a simple, reliable method of Clavicular length-shortening evaluation and we report the results following successful conservative management. Identification of those patients likely to have poor results after conservative treatment, would give the opportunity for alternative treatment modalities. Further prospective randomised trials are necessary.

From 1998–2000 inclusive, we treated 155 acute, non-pathological fractures of the clavicle in adults. We reviewed 134, of which 95 were involving the middle third. The average time of follow-up was 24 months (range 9–33). Aim of this retrospective study was to review the results of operative versus conservative treatment in a view to create a standard protocol for these fractures management. Men accounted 67 the average age being 26.8 (range 15–83) and 28 were women with average age 36.8 (range 23–91). We operated on 23 patients: 3 due to neurological symptoms of C6 nerve root irritation, 4 due to a symptomatic non-union, 10 due to severe displacement and comminution with pressure on the overlying skin and 6 due to their request in a view to earlier return to activity as they were skilled athletes. All fractures healed within 6–14 weeks, and return to normal activity level was 8 weeks on average ( range 2–12). A 3.5mm DCP plate was used in all cases. We treated conservatively 76 patients. Non-union was encountered in 4 (4.2%) and was symptomatic in all of them so they were fixed with a 3.5mm DCP plate and bone grafted. The healing rate was 8–20 weeks, and return to pre injury activity level was 16 weeks on average (14–24). Unsatisfactory results reported from 23 patients, 21 of who were treated conservatively (27.6%) and only 2 operatively (8.7%). In the group of patients treated conservatively initial shortening was similar to the final and when 14mm or more was strongly associated with poor results. In the group treated operatively no significant shortening was found. We recommend young, active patients should be given the option of operative treatment in a view to earlier return to activities with a possible better clinical outcome.