Yılmaz Ergişi1, Erdi Özdemir2, Mesut Tıkman1, Selçuk Korkmazer1, Halil Kekeç1, Nadir Yalçın1

1Department of Orthopedics and Traumatology, Karabük University Faculty of Medicine, Karabük, Türkiye
2Department of Orthopaedics & Rehabilitation, Penn State College of Medicine, Hershey, United States

Keywords: Clavicle fracture, clavicle length, clavicle shortening, conservative treatment, surgical treatment.


Objectives: The aim of the study was to investigate whether clavicular symmetry was a valid assumption and to assess the factors that could predict clavicular asymmetry.

Patients and methods: Between January 2021 and April 2021, a total of 100 consecutive patients (61 males, 39 females; mean age: 63.6±15.5 years; range, 27 to 94 years) whose both clavicles were adequately seen on chest computed tomography (CT) were retrospectively analyzed. Clavicular lengths were measured on three-dimensional (3D) reconstruction of chest CTs by two independent orthopedic surgeons on two separate occasions. The longest distance passing the straight line between the most lateral part of the clavicle at the acromioclavicular joint and the most medial point of the clavicle on the sternoclavicular joint was given as the clavicle length after adjusting tilt of convertible 3D CTs. Clavicular length difference was calculated by subtracting the short clavicle’s length from the long clavicle’s length. Patients’ age and sex were noted. The calculated clavicular length differences were assigned into three groups: ≤5 mm, >5 mm and ≤10 mm, and >10 mm.

Results: The mean right and left clavicle lengths were 13.9±1.3 cm and 14.1±1.2 cm, respectively (p<0.001). A total of 29 patients (29%) had >5 mm clavicle asymmetry and six patients (6%) had more than 10 mm clavicular length difference. Age, sex, and clavicular length were not associated with the clavicular length difference.

Conclusion: Our study results showed that 29% of the patients had >5 mm clavicular length asymmetry. The clavicular symmetry may not be a valid assumption in the decision making for the surgical treatment of mid-shaft clavicle fractures; thus, this assumption may lead to maltreatment. More factors that can predict clavicle asymmetry should be investigated in future studies.

Citation:Ergişi Y, Özdemir E, Tıkman M, Korkmazer S, Kekeç H, Yalçın N. Revisiting the surgical indication of mid-shaft clavicle fractures: Clavicle asymmetry. Jt Dis Relat Surg 2023;34(1):63-68. doi: 10.52312/jdrs.2023.937.

Ethics Committee Approval

The study protocol was approved by the Karabük University Non-Interventional Clinical Research Ethics Committee (date: 01.10.2021, no: E.67419). The study was conducted in accordance with the principles of the Declaration of Helsinki.

Author Contributions

Idea/concept, design, control/ supervision, data processing, literature review, writing of the article, critical review: Y.E.; Idea/concept, design, control/ supervision, data processing and analysis, literature review, writing of the article, critical review: E.Ö.; Idea/concept, data collection, literature review, writing of the article: M.T., H.K.; Idea/concept, design, literature review, writing of the article, critical review: S.K.; Idea/concept, design, control/supervision, writing of the article, critical review: N.Y.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.