BACKGROUND: Nonoperative treatment is preferred for clavicular fractures irrespective of fracture and patient characteristics. However, recent studies indicate that long term results are not as favourable as previously considered. METHODS: We have identified predictive risk factors associated with demographic and baseline data on clavicular fractures. In particular, the following symptoms were investigated: pain at rest, pain during activity, cosmetic defects, reduction in strength, paresthesia and nonunion until 6 months after injury. We followed 222 patients with a radiographically verified fracture of the clavicle, and who were at least 15 years of age, for 6 months. RESULTS: Nonunion occurred in 15 patients (7%). 93 patients (42%) still had sequelae at 6 months. Displacement of more than one bone width was the strongest radiographic risk factor for symptoms and sequelae. Both radiographic projections used in this study (0 degree and 45 degrees tilted view) provided important information. A comminute fracture and higher age were associated with an increased risk of symptoms remaining at 6 months. Shortening was not predictive of functional outcome; nor was the site of the fracture in the clavicle. INTERPRETATION: The risk for persistent symptoms following nonoperative treatment of clavicular fractures was far higher than expected. Based on these findings it seems reasonable to explore the possibly use of alternative treatment options including surgery for certain clavicular fracture types.
BACKGROUND: Nonoperative treatment is preferred for clavicular fractures irrespective of fracture and patient characteristics. However, recent studies indicate that long term results are not as favourable as previously considered. METHODS: We have identified predictive risk factors associated with demographic and baseline data on clavicular fractures. In particular, the following symptoms were investigated: pain at rest, pain during activity, cosmetic defects, reduction in strength, paresthesia and nonunion until 6 months after injury. We followed 222 patients with a radiographically verified fracture of the clavicle, and who were at least 15 years of age, for 6 months. RESULTS: Nonunion occurred in 15 patients (7%). 93 patients (42%) still had sequelae at 6 months. Displacement of more than one bone width was the strongest radiographic risk factor for symptoms and sequelae. Both radiographic projections used in this study (0 degree and 45 degrees tilted view) provided important information. A comminute fracture and higher age were associated with an increased risk of symptoms remaining at 6 months. Shortening was not predictive of functional outcome; nor was the site of the fracture in the clavicle. INTERPRETATION: The risk for persistent symptoms following nonoperative treatment of clavicular fractures was far higher than expected. Based on these findings it seems reasonable to explore the possibly use of alternative treatment options including surgery for certain clavicular fracture types.