Does clavicle shaft malunion with more than 20 mm shortening have a clinical and radiological effect on the shoulder joint?

Background: This study assessed functional status in shoulders of patients treated conservatively for clavicular shaft fractures with mid-term follow-up. We also compared clinical and radiological outcomes between patients with ≥20 mm and ≤19 mm shortening. Methods: We retrospectively evaluated 62 patients with clavicular shaft fractures in 2010-2019, categorizing them into 2 groups based on shortening. We assessed various parameters using radiographs and magnetic resonance imaging (MRI), including joint arthrosis and angles. Functional aspects were evaluated using the QuickDASH, Constant Murley scores, and the presence of scapular dyskinesis. Results: Among 62 patients (mean follow-up: 5.2 years), 32 had ≥20 mm shortening (mean: 27.5 ± 6.88 mm), while 30 had ≤19 mm (mean: 12.8 ± 5.4 mm). No correlations were found between critical shoulder angle, clavicle length, and shortening. However, a moderate correlation existed between shortening and unaffected side clavicle length (rho: 0.509, Conclusion: Conservative treatment of clavicle fractures in selected cases yields significantly good clinical and radiological outcomes. Irrespective of the amount of shortening, MRI showed more bursitis and tendinitis on the fractured side. At mid-term follow-up, shortening of ≥20 mm cannot be used as a poor prognostic criterion, neither radiologically nor clinically.