Session VI - Upper Extremity
*Previously Unrecognized Deficits after Nonoperative Treatment of Displaced, Mid-Shaft Fracture of the Clavicle Detected by Patient-Based Outcome Measures and Objective Muscle Strength Testing
Michael D. McKee, MD, FRCS(C)1; Elizabeth M. Pedersen, MD1; Lisa M.Wild,BScN1; Emil H. Schemitsch, MD, FRCS(C)1; Hans J. Kreder, MD1; David J.G. Stephen, MD, FRCS(C)2;
Purpose: We used a patient-based outcome questionnaire and objective muscle strength testing to evaluate a series of patients after nonoperative care of a displaced, mid-shaft fracture of the clavicle.
Methods: From emergency department and trauma database records, we identified 25 patients (17 male and 8 female, with a mean age 39 years) who had sustained a displaced midshaft fracture of the clavicle. All patients were treated nonoperatively. Outcome measures included the Constant shoulder score and the DASH questionnaire. Patients also had objective shoulder muscle strength testing performed on the Baltimore Therapeutic Equipment Work Stimulator.
Results: The mean follow-up was 54 months, with a minimum of 10 months. Range of motion was well-maintained, with flexion of 170 degrees ± 20 degrees and abduction of 165 degrees ± 25 degrees. Strength of the injured compared with the uninjured side was: flexion (maximal), 81%; flexion (endurance), 74%; abduction (maximal), 81%; abduction (endurance), 66%; external rotation, 80%; external rotation (endurance), 84%; and internal rotation (maximal), 86%. The mean Constant score was 69, and the mean DASH score was 25.1, indicating significant residual disability. Patients with clavicular shortening of more than 2 cm had significantly worse DASH scores than those with 2 cm or less of shortening (P = 0.04).
Conclusion: By using objective testing, we detected residual deficits in shoulder strength, especially endurance strength, in this patient population. Clavicular shortening of more than 2 cm was associated with a worse outcome.