Closed treatment of clavicle fractures results in reduced shoulder strength

Despite the implication that the clavicle acts as an osseus strut to maintain the width of the shoulder and therefore provide power and stability to the arm-trunk mechanism, there have been inconsistent findings on whether shortening or malunion after clavicle fractures has an effect on shoulder function. We used the Biodex isokinetic assessment and the Constant and Murley scoring system to evaluate shoulder function in patients 3 years after unilateral closed midclavicular fractures (Allman type 1) who were treated nonoperatively. We confined our study group to patients between the ages of 18 and 37 years. The mean degree of shortening was 15 mm, and the mean degree of angular malunion was 13.9°; there was a 74% rate of malunion and a 3% rate of nonunion. The isokinetic function of the shoulder was significantly reduced on the injured side independent of hand dominance. Shortening, angular deformity, and malunion were not associated with this reduction in shoulder function. However, patients with a high degree of shortening and angular malunion reported significantly higher levels of symptoms despite no significant difference in isokinetic function.