Abstract
BackgroundMid-shaft clavicle fractures account for 35 to 44% of injuries to the shoulder girdle. There is increasing evidence to support surgical repair, but poor functional outcomes have been reported, and associated factors remain unclear.MethodsThe three-dimensional poses of the shoulder bones during arm elevations were measured in 15 patients treated for mid-shaft clavicle fractures by open reduction and internal fixation, and in 15 healthy controls.Results and ConclusionNo significant between-side differences were found in the clavicle length after surgery (p > 0.05). The patients showed increased scapular protraction at lower elevation angles and reduced scapular retraction at higher elevation angles during frontal-plane elevations, with significantly reduced clavicle retraction (p < 0.05), with unaltered scapular rotation and tilt. The ranges of the observed changes were reduced to arm elevations at 60° and 90° in the scapular and sagittal planes. Similar changes were also found on the unaffected side, suggesting symmetrical bilateral compensation. The results suggest that shoulder kinematics in multi-plane arm elevations should be monitored for any signs of compromised bone motions following surgical treatment, and that rehabilitative training may be needed on both sides to improve the bilateral movement control of the shoulder complex.
Highlights
Clavicle fractures account for 2.6 to 10% of all adult fractures and 35 to 44% of injuries to the shoulder girdle
The resulting clavicle shortening deformity is associated with scapular dyskinesis, which may be related to the reported increased risk of persistent shoulder disability (Eskola et al, 1986; Mark and Lazarus, 2006; Postacchini et al, 2010) and unsatisfactory clinical results (Hill et al, 1997)
During arm elevation in the scapular plane, protraction at 30◦ and 60◦ of arm elevation, and significantly the surgical group showed significantly increased scapular less scapular retraction at 90◦ and 120◦ arm elevation angles protraction at 60◦ of arm elevation and significantly increased scapular protraction and anterior tilt at 90◦ of arm elevation when compared to the healthy group (Figure 4)
Summary
Clavicle fractures account for 2.6 to 10% of all adult fractures and 35 to 44% of injuries to the shoulder girdle. Altered alignment and movements of the scapula in scapular dyskinesis are accompanied by modified lines of action and tension of the muscles affecting their efficiency (Myers et al, 2005) Overall, such deviations of skeletal alignment owing to malunions of the clavicle have been found to reduce shoulder function as revealed by self-administered questionnaires (Eskola et al, 1986; Hill et al, 1997; Ledger et al, 2005; Mirzatolooei, 2011). There is increasing evidence to support surgical repair, but poor functional outcomes have been reported, and associated factors remain unclear
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