Surgical or Conservative? Treatment Options for Clavicle Fractures and Analysis of Scapular Dyskinesis


Ulaş Can Kolaç, MD
TURKEY

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Surgical or Conservative? Treatment Options for Clavicle Fractures and Analysis of Scapular Dyskinesis

Ulaş Can Kolaç, MD, TURKEY Serkan Ibik, MD, TURKEY Taha Aksoy, m.d, TURKEY Gökhan Ayik, PhD, TURKEY Mehmet Kaymakoglu, M.D, TURKEY Orhan Mete Karademir, MD, TURKEY Dilara Kara, phd, TURKEY Irem Duzgun, PhD, TURKEY Gazi Huri, Prof. MD, QATAR

Hacettepe University, Ankara, ankara, TURKEY

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Anatomic Location

Shoulder

Diagnosis / Condition

Fracture

Patient Populations

Female Athletes Gender Specific Elderly Professional Athletes / Olympians Sport Specific Population

Diagnosis Method

X-ray

Sports Medicine

Basic Science Rehabilition / Physical Therapy Evidence Based Medicine

Summary: This study suggests that conservatively treated clavicle shaft fractures may have a higher, though not statistically significant, incidence of scapular dyskinesis, with surgical treatment potentially leading to better functional outcomes and lower pain levels.

Aim

Midshaft clavicle fractures are common and often associated with scapular dyskinesis (ScD), particularly in cases of shortening. While fractures with less than 2 cm shortening are often treated conservatively, emerging evidence suggests that even minor shortening can increase the risk of ScD and impair functional outcomes. This study investigates the impact of surgical versus conservative treatment on ScD and functional recovery.

Methods

A retrospective analysis of 60 patients with isolated midshaft clavicle fractures was conducted. Patients were categorized into surgical and conservative groups. Fracture shortening was assessed using radiographs, outcomes were assessed using the SICK Scapula Rating Scale, Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons Scale and Visual Analog Scale (VAS). Logistic regression and ROC analysis was applied to identify ScD predictors, and critical shortening threshold.

Results

ScD was observed in 43.3% of patients, with a higher incidence in the conservative group (53.6%) compared to the surgical group (34.4%; p = 0.216). Surgical treatment was associated with significantly better SST and VAS scores at the final follow-up (p < 0.05). Logistic regression identified clavicular shortening (p < 0.001) and lower BMI (p = 0.033) as significant predictors of ScD. ROC analysis revealed that a shortening threshold of 0.4 cm had a sensitivity of 73.08% and a specificity of 91.18% for predicting ScD (AUC = 0.874, p < 0.001).

Conclusion

Surgical treatment reduced the prevalence of ScD and facilitated better functional outcomes through early mobilization and anatomical alignment. These findings suggest surgical treatment may benefit patients even in minimally displaced fractures, highlighting the importance of individualized treatment strategies.

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