Positional Change in Displacement of Midshaft Clavicle Fractures: An Aid to Initial Evaluation
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OBJECTIVES: To determine how change in position affects displacement of midshaft clavicle fractures. DESIGN: Retrospective review. SETTING: Level I Trauma Center. PATIENTS: Eighty patients with displaced midshaft clavicle fractures and presence of supine and semiupright or upright chest radiographs taken within 2 weeks of each other. INTERVENTION: Supine, semiupright, and upright chest radiographs. MAIN OUTCOME MEASUREMENTS: Fracture shortening and vertical displacement on supine, semiupright, and upright radiographs. RESULTS: Mean vertical displacement was 9.42 mm [95% confidence interval (95% CI), 8.07-10.77 mm], 11.78 mm (95% CI, 10.25-13.32 mm), and 15.72 mm (95% CI, 13.71-17.72 mm) in supine, semiupright, and upright positions, respectively. Fracture shortening was -0.41 mm (95% CI, -2.53 to 1.70 mm), 2.11 mm (95% CI, -0.84 to 5.07), and 4.86 mm (95% CI, 1.66-8.06 mm) in supine, semiupright, and upright positions, respectively. Change in position from supine to upright significantly increased both vertical displacement and fracture shortening (P < 0.001). In the upright position, the proportion of patients who met operative indications (fracture shortening >20 mm) was 3 times greater when compared with that in the supine position (upright 17.65%; supine 5.88%, P = 0.06). Positional changes in fracture displacement were not associated with body mass index, age, or gender. CONCLUSIONS: Patient position is associated with significant changes in fracture displacement. Over 3 times more patients meet operative indications when placed in the upright versus supine position. An upright chest radiograph should be obtained to evaluate midshaft clavicle fracture displacement, as it represents the physiologic stress across the fracture when considering nonoperative management. LEVEL OF EVIDENCE: Prognostic level IV. See Instructions for Authors for a complete description of levels of evidence.
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