Evaluation of area and volume changes in the costoclavicular region in patients treated nonoperatively after mid-shaft clavicle fracture.

Abstract

Objective: The aim of this study is to radiologically compare area and volume changes in the costoclavicular region with the unaffected side in patients treated nonoperatively after unilateral midshaft clavicle fracture and to evaluate functional outcomes.

Methods: This study included 16 patients (14 males, 2 females) with midshaft clavicle fractures who were admitted between 2017-2018 and union was achieved with conservative methods. Magnetic resonance imaging (MRI) of the shoulder including the costoclavicular region was performed after union. Area and volume calculations of the fractured and unaffected costoclavicular region of the patients were performed on the standard MR sections under the guidance of a specialist radiologist. The Short Version of Disabilities of the Arm, Shoulder and Hand (QDASH) score was used for functional assessment. Range of motion was measured on the affected and unaffected sides at the last follow-up visit.

Results: The mean age of the patients was 30.4±20.8 years (5-69) and the mean follow-up was 8.3±1.3 (6-10) months. The mean shortening was 14.3 mm±8.2 (3-29). The area measurements of the costoclavicular region were divided into 3 levels in axillary section: acromioclavicular joint, mid 1/3 of the clavicle, and sternoclavicular joint level. The median area measurements were 1115 (364-3675) mm², 1495 (365-4199) mm², and 1201 (197-3812) mm² on the unaffected side and 895.5 (351-3670) mm², 1098.5 (340-3191) mm², and 1037.5 (166-3237) mm² on the fractured side, respectively (p=0.905, p=0.491, p=0.888). In volume measurements, the median volumes of the unaffected side and the fractured side were 34.3 (10.7-69.7) mm³ and 28.9 (8.1-60.9) mm³, respectively (p=0.268). No significant difference was found in the statistical analysis of area and volume measurements. At the end of the follow-up period, the QDASH score and functional outcome of the patients were good.

Conclusion: Conservative treatment of midshaft clavicle fractures did not result in significant area and volume changes in the costoclavicular region. The inability to clinically demonstrate the theoretical expectation of decreased area and volume on the fractured site suggests that other biomechanical factors are involved in the healing process of the human body.