Comparing the effects of surgical and conservative treatment on scapular dyskinesis in minimally displaced midshaft clavicle fractures.

PURPOSE: 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 all patients, with 53.6% of the conservative group, and 34.4% of the surgical group; however, the difference was not statistically significant (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 - univariate) 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 may reduce residual shortening and lower the prevalence of ScD, indicating a possible benefit in limiting dyskinesis even in minimally displaced fractures. LEVEL OF EVIDENCE: Level III, retrospective comperative study.