Can we predict long-term sequelae after fractures of the clavicle based on initial findings? A prospective study with nine to ten years of follow-up.

The aim of this long-term, prospective study was to identify risk factors associated with the outcome of clavicular fractures. During 1989 through 1991, 245 patients aged 15 years or older with a radiographically verified fracture of the clavicle were included. Clinical and radiographic examinations were standardized. Of the 208 patients seen at the 9- to 10-year follow-up, 112 (54%) had recovered completely whereas 96 (46%) still had sequelae. Nonunion occurred in 15 patients (7%). No bony contact was the strongest radiographic predictor for sequelae. Comminuted fractures with transverse fragments had a significantly increased risk for remaining symptoms, as did older patients, whereas there was no significant difference between sexes. Fracture location and shortening did not predict outcome except for cosmetic defects. Angulation of the fracture had no effect on cosmetic defects. Patients with predictive risk factors, such as fractures with no bony contact or displacement, especially if comminuted, and also elderly patients with fractures should be considered for more active treatment options.