Long-Term Functional Outcomes After Surgical Treatment of Displaced Midshaft Clavicle Fractures: A Retrospective Cohort Study

Introduction: Long-term studies on clavicle fractures are scarce, making new data in this field particularly valuable. This study aimed to assess long-term clinical and radiographic outcomes, as well as the quality of life in patients treated with pre-contoured plates for midshaft clavicle fractures, while identifying potential outcome-associated risk factors. Methods: Between 2010 and 2020, 91 patients with displaced midshaft clavicle fractures treated by open reduction and internal fixation with pre-contoured plates were identified from 987 cases. Seventy-six of these patients were prospectively reviewed to assess clinical status (using DASH, Constant score, and EQ-5D/EQ-VAS for quality of life) and hardware-related outcomes at the most recent follow-up. Results: At an average follow-up of 64 months (range: 39–179), patients reported excellent outcomes: a mean Constant score of 91, a QuickDASH of 0.3, an EQ-5D of 0.94, and an EQ-VAS of 81.5. Active forward flexion, abduction, and external rotation were 177º, 175º, and 60º, respectively. Hardware removal was required in 11% of patients, with 30.7% reporting discomfort. Complications were minimal (5.5%), including 2 cases of non-union, 2 superficial wound infections, and 1 partial wound dehiscence. No refractures were observed. There was no significant association between fracture pattern (AO classification) or vertical displacement and functional outcomes (p = .578; p = .137). However, postoperative lengthening showed a significant correlation with QuickDASH scores (p = .019). Patient characteristics (BMI, age, gender, sports participation, or occupation) were not significantly associated with functional outcomes, complications, or hardware removal (p > .05). Conclusion: Although preoperative fracture displacement and hardware removal were not linked to poorer functional outcomes, up to 30% of patients reported discomfort post-surgery. Despite this, their perceived quality of life remained high. These findings provide valuable insights into long-term outcomes for patients treated with pre-contoured plates, underscoring the need for ongoing follow-up in this population. Level of evidence Level III, Retrospective Cohort Design, Treatment Study.