Functional Outcomes of Displaced Midshaft Clavicular Fractures Treated with Precontoured Locked Plates: A Prospective Study

Functional Outcomes of Displaced Midshaft Clavicular Fractures Treated with Precontoured Locked Plates: A Prospective Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Functional Outcomes of Displaced Midshaft Clavicular Fractures Treated with Precontoured Locked Plates: A Prospective Study Abdullah Ali Al-Moaish, Jamal Abdulraheem Algabarty, Anwar Mughallas, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6185808/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose This study assessed the functional outcomes and complications of open reduction and internal fixation (ORIF) using pre-contoured superior clavicle locking plates for displaced midshaft clavicular fractures. Methods In a prospective two-center study at Al-Thawra Modern General Hospital and Kuwait University Hospital, Sana’a, Yemen, from January 2018 to September 2024, 65 patients (≥ 18 years) with closed, displaced midshaft clavicular fractures (displacement > 2 cm, shortening > 2 cm, comminution, or skin tenting) underwent ORIF. Functional outcomes were evaluated six months postoperatively using the University of California, Los Angeles (UCLA) shoulder rating score. Data were analyzed using SPSS version 26. Results The mean patient age was 32.09 years (83.1% male, n = 54). Road traffic accidents were the primary injury mechanism (66.2%, n = 43). At 6 months, the mean UCLA score was 32.46 ± 2.54, with 98.5% (n = 64) achieving good or excellent outcomes (UCLA score ≥ 27) and 1.5% (n = 1) fair/poor. Complications included hardware irritation (1.5%, n = 1), hardware failure (3.1%, n = 2), and superficial infections (1.5%, n = 1). All patients (100%) reported satisfaction with their outcomes. The UCLA scores varied significantly according to injury mechanism, side, and age, with older patients showing lower scores. Conclusion ORIF with pre-contoured locked plates yielded promising functional outcomes, high patient satisfaction, and low complication rates in this cohort. However, the observational design, lack of a control group, and 6-month follow-up limit broader conclusions. Larger controlled studies are needed to validate these findings and guide optimal management strategies for displaced midshaft clavicular fractures. Level of Evidence Level IV (OCEBM 2011). Orthopedic Surgery clavicle fracture precontoured locked plate functional outcomes surgical management complications patient satisfaction midshaft fracture ORIF Figures Figure 1 Figure 2 Introduction Clavicular fractures, comprising 5–10% of all fractures and 45% of shoulder girdle injuries, predominantly affect the midshaft (approximately 80% of cases)[ 1 – 3 ]. Historically managed nonoperatively with slings or figure-of-8 braces due to reported low nonunion rates, displaced midshaft fractures now show higher nonunion (22–44%), malunion, and dissatisfaction with conservative care[ 4 ]. This has spurred a shift toward surgical intervention, notably plate fixation. Precontoured locking plates enhance stability, enable early mobilization, and lower nonunion risk, with added benefits of procedural ease and reduced soft tissue irritation[ 5 ]. Although studies globally report strong outcomes with this approach[ 6 , 7 ], evidence from the Middle East, particularly Yemen, remains scarce, limiting region-specific insights. This study evaluated the functional outcomes and complications of pre-contoured superior clavicle locking plates for displaced midshaft clavicular fractures in a Yemeni cohort, focusing on patient satisfaction, range of motion, union time, and complication rates. Methods Study design This prospective observational study was conducted at the Department of Orthopedics, Al-Thawra Modern General Hospital, and Kuwait University Hospital, Sana’a, Yemen, from January 2018 to September 2024. The primary aim of this study was to assess the functional outcomes of displaced midshaft clavicular fractures treated with open reduction and internal fixation (ORIF) using pre-contoured superior clavicle locking plates. A standardized protocol governed patient selection, surgery, postoperative care, and follow-up to ensure consistency. Data were prospectively collected. Study population Eligible patients were adults (≥ 18 years) with closed, displaced midshaft clavicular fractures, defined as displacement > 2 cm, shortening > 2 cm, comminution, or skin tenting threatening viability. Exclusion criteria included open or pathological fractures, proximal or distal third clavicle involvement, head or neurovascular injuries, acromioclavicular dislocations, or prior nonunion. All the participants provided written informed consent. Sample size The sample size was calculated based on the University of California, Los Angeles (UCLA) Shoulder Score, which is the primary outcome. Prior studies reported postoperative means of 33–35 points with pre-contoured plates[ 8 , 9 ]. Assuming a 4-point difference (standard deviation 5), α = 0.05, and 90% power, a minimum of 33 patients were required. Allowing for dropouts, we targeted 36–40 patients; ultimately, 65 patients were enrolled, enhancing power and enabling subgroup analyses. Surgical technique Preoperative workup included standard blood tests and clavicular radiographs (anteroposterior, 20° cranial tilt). Under general anesthesia, the patients were positioned in a beach-chair setup with a scapular sandbag aiding reduction. Prophylactic antibiotics were administered before incision. A transverse incision below the fracture exposed the clavicle via superior retraction, thus avoiding wound overlap with the plate. Subcutaneous tissue and platysma were mobilized together, myofascial layers were incised, and soft tissues were elevated, preserving supraclavicular nerves unless exposure demanded sacrifice. Fracture reduction was performed using clamps or indirect techniques, as confirmed by fluoroscopy. A 3.5-mm titanium precontoured locking plate (Orthomed E, Egypt) was fixed anterosuperiorly with locking screws (≥ 3 cortices per fragment); lag screws addressed butterfly fragments as needed. The fascia was repaired over the plate, the skin was closed in layers, and the arm slung postoperatively. Postoperative care and follow-up Patients received analgesics, postoperative radiographs, and sling immobilization for 4 weeks with pendulum exercises. Follow-ups at 10 days (suture removal), 4, 8, 12, and 26 weeks included a rehabilitation protocol starting week 4 (active-assisted motion, progressing to full range by week 8). UCLA scores were assessed at 6 months; radiographic union was monitored descriptively by the treating surgeon, with delayed union defined as a lack of three-cortex bridging at 12 weeks. Outcome measures The primary outcome was functional recovery assessed using the UCLA Shoulder Score (max 35), evaluating pain (0–10), function (0–10), active forward flexion (0–5), strength (0–5), and satisfaction (0–5)[ 10 ]. Scores ≥ 27 indicated good/excellent outcomes, and < 27 fair/poor. Preoperative scores were not recorded; however, pre-injury shoulder function was queried to exclude prior pathology. The secondary outcomes included complication rates (hardware irritation, failure, infection, delayed union, and malunion). Statistical analysis Data were analyzed using SPSS version 26. Descriptive statistics summarized demographics, injury details, and outcomes (mean ± SD for continuous variables; frequencies/percentages for categorical variables). Given the modest sample and likely non-normal UCLA score distribution, nonparametric tests (Kruskal-Wallis, Mann-Whitney U) were used to assess subgroup differences, Chi-square tests were used to examine complication associations, and Spearman’s correlation was used to evaluate age-outcome links. Ethical considerations This study was conducted in accordance with the ethical standards of the Institutional Review Board (IRB) of Al-Thawra Modern General Hospital, Sana'a, Yemen, and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards . Ethical approval was obtained prior to commencement of the study (Reference Number: IRB-TMGH-2017-047). Written informed consent was obtained from all the participants. The participants were informed about the study's purpose, procedures, potential risks, and benefits, and their consent was documented. Results Demographic and injury characteristics Sixty-five patients with displaced midshaft clavicular fractures treated with precontoured locked plates were enrolled. The mean age was 32.09 years (range: 19–50 years), with 54 males (83.1%) and 11 females (16.9%). Road traffic accidents (RTAs) caused the most injuries (n=43, 66.2%), followed by falls (n=22, 33.8%). The right clavicle was affected in 43 (66.2%) patients and the left clavicle in 22 (33.8%). Table 1 details these traits, and Figures 1–2 show the representative cases. Table 1: Demographic and Injury Characteristics Variable n % Age Group 18-30 years 37 56.9% 31-40 years 12 18.5% 41-50 years 16 24.6% Gender Male 54 83.1% Female 11 16.9% Mode of Injury RTA 43 66.2% Accidental Fall 22 33.8% Injured Side Right 43 66.2% Left 22 33.8% Abbreviations: n, number of patients; %, percentage; RTA, road traffic accident. Functional and radiographic outcomes At 6 months, the mean UCLA shoulder score was 32.46 ± 2.54, with 64 patients (98.5%) achieving good/excellent outcomes (UCLA ≥27) and one (1.5%) fair/poor (<27). Table 2 summarizes the scores, and Supplementary Table S1 breaks down the components. Radiographs confirmed union in all cases by 12 weeks (three-cortex bridging), with no delayed unions or malformations noted. Table 2: UCLA Shoulder Rating Score Outcomes Category Value n % Total UCLA Score (Mean ± SD) 32.46 ± 2.54 Outcome Categories Good/excellent (≥27) 64 98.5% Fair/poor (<27) 1 1.5% Abbreviations : UCLA, University of California, Los Angeles; SD, Standard Deviation. Patient satisfaction All 65 patients (100%) reported satisfaction with surgical outcomes, reflected in the UCLA Shoulder Rating Score satisfaction component (all scored 5, “Satisfied and better”; Supplementary Table S1). Postoperative complications Complications were rare and included hardware irritation (n=1, 1.5%), hardware failure (n=2, 3.1%), and superficial infection (n=1, 1.5%), totaling 6.2% affected. No delayed unions, malunions, or refractures occurred, and 61 patients (93.8%) were complication-free. Table 3 presents the outcomes. Table 3: Postoperative Complications Complication n % Hardware Irritation 1 1.5% Hardware Failure 2 3.1% Superficial Infection 1 1.5% No Complications 61 93.8% Subgroup and correlation analyses UCLA Scores and Patient Characteristics To assess differences in total UCLA scores across subgroups, we performed Kruskal-Wallis tests for age groups (more than two categories) and Mann-Whitney U tests for sex, injury mechanism, and injured side (two categories each). Spearman's rank-order correlation was used to examine the relationship between age (a continuous variable) and the total UCLA scores. The results are summarized in Table 4. Table 4: Comparison of Total UCLA Scores among Subgroups Variable Groups Compared Test Statistic p-value Age Group 18-30, 31-40, 41-50 H(2) = 16.525. < 0.001 Mechanism of Injury RTA vs. Fall U = 319.00 0.029 Gender Male vs. Female U = 248.00 0.380 Injured Side Right vs. Left U = 203.50 < 0.001 Note: Kruskal-Wallis tests were used for age group comparisons; Mann–Whitney U tests were used for comparisons between two groups. Abbreviations : H, Kruskal-Wallis test statistic; U, Mann-Whitney U test statistic; RTA, Road Traffic Accident. A statistically significant negative correlation was found between age and the total UCLA score (ρ = -0.317, p = 0.010), indicating that older patients tended to have lower UCLA scores. Significant differences in the total UCLA scores were also found based on the mechanism of injury (p = 0.029) and the injured side (p < 0.001). Patients with RTA injuries had higher UCLA scores than those with falls, and those with right-sided injuries had higher UCLA scores than those with left-sided injuries. No significant differences were observed according to sex. UCLA Component Scores and Age Kruskal-Wallis tests revealed significant differences across age groups for the pain score (p=0.001) and active forward flexion (p=0.013). Post-hoc tests indicated that the 41-50 age group had significantly better scores (less pain and better flexion) than the 18-30 age group. No significant differences were observed in terms of function, strength, or satisfaction. Complications and Patient Characteristics Chi-square tests of independence were performed to examine the relationship between categorical variables (age group, mechanism of injury, sex, injured side, and UCLA outcome category) and the occurrence of any complications. The results are summarized in Table 5. A statistically significant association was found between UCLA outcome category and complications (p < 0.001), with patients experiencing complications having worse outcomes, as expected. The Mann–Whitney U test revealed a statistically significant difference in the total UCLA scores between patients with and without complications (U = 11.000, p < 0.001). Patients with complications had significantly lower UCLA scores than those without complications. Although not statistically significant at p < 0.05, there were trends suggesting possible associations between age group (p=0.051, with a significant linear association p=0.046), mechanism of injury (p=0.073), and injured side (p=0.073) with complication rates. Table 5: Association between categorical variables and complications. Variable Complications Total Chi-Square/U p-value No, n (%) Yes, n(%) Age Group Χ 2 (2) = 5.946 0.051 18-30 years 36 (97.3%) 1 (2.7%) 37 31-40 years 12 (100%) 0 (0.0%) 12 41-50 years 13 (81.3%) 3 (18.8%) 16 Linear by Linear - - - Χ 2 (1) = 3.999 0.046 Mechanism of Injury Χ2(1) = 3.224 0.073 RTA 42 (97.7%) 1 (2.3%) 43 Fall 19 (86.4%) 3 (13.6%) 22 Gender Χ 2 (1) = 3.317 0.069 Male 52 (96.3%) 2 (3.7%) 54 Female 9 (81.8%) 2 (18.2%) 11 Injured Side Χ 2 (1) = 3.224 0.073 Right 42 (97.7%) 1 (2.3%) 43 Left 19 (86.4%) 3 (13.6%) 22 UCLA Outcome Χ 2 (1) = 15.488 < 0.001 Good/excellent (≥27) 61 (95.3%) 3 (4.7%) 64 Fair/poor (<27) 0 (0.0%) 1 (100%) 1 Total UCLA - - - U = 11.00 < 0.001 Note: Chi-square tests of independence were used to examine the association between categorical variables and the presence/absence of complications, reporting Pearson’s chi-square values unless otherwise noted . A Mann–Whitney U test was used to examine significant differences in total UCLA and Complications. Abbreviations : UCLA, University of California, Los Angeles; RTA, Road Traffic Accident; U, Mann-Whitney U test statistics. Discussion This prospective study evaluated precontoured locked plate fixation for displaced midshaft clavicular fractures in a Yemeni population and observed promising functional outcomes, high patient satisfaction, and a low complication rate. The mean UCLA shoulder rating score of 32.46 at 6 months (98.5% good/excellent results) aligns with previous reports of plate fixation efficacy. Ethiraj et al. (2016) and Itagi and Kalaskar (2020) documented similarly strong Constant-Murley scores (85.23–97.8)[11, 12], while Wijdicks et al. (2013) reported UCLA means above 30[13], reinforcing our findings. With 65 patients, this study adds robust region-specific evidence to the growing case of surgical intervention for displaced fractures. Subgroup analyses uncovered notable patterns, which merit deeper exploration. A significant negative correlation between age and UCLA scores (ρ = -0.317, p = 0.010) suggests that older patients (41–50 years) achieved slightly lower overall function yet paradoxically outperformed younger patients (18–30 years) in pain relief and forward flexion (p = 0.001, p = 0.013). Chue et al. (2018) noted comparable trends, attributing better pain outcomes in older adults to lower baseline demands or greater relative gains post-ORIF[14]. In our cohort, younger patients, often active males injured in RTAs, may face higher recovery expectations, driving subtle dissatisfaction despite healing. Alternatively, age-related differences in soft tissue resilience or rehabilitation adherence could play a role, although pre-injury function was not quantified in this study. These contradictions highlight the need for tailored outcome metrics across different age groups. Equally compelling differences in injury mechanism and laterality were observed. Patients with RTA injuries outscored those with falls (p = 0.029) and right-sided injuries surpassed left-sided injuries (p < 0.001). Sharma et al. (2021) linked high-energy trauma (e.g., RTAs) to better ORIF outcomes, possibly due to stricter postoperative care[15], but falls in our study varied in severity, muddying this explanation. Instead, RTA fractures might involve distinct comminution patterns, stabilized effectively by locked plates, versus falls, which could skew toward simpler breaks with unrecognized soft tissue impacts. Laterality findings are equally provocative; if most patients are right-handed (data unavailable), dominant-side injuries might spur greater rehabilitation effort, yielding higher symmetry indices, as seen in Riemann et al. (2023)[16]. Left-sided repairs, potentially on non-dominant arms, might result in less patient-driven recovery focus or slight surgical adjustments (e.g., plate contouring challenges on the left clavicle curve). These hypotheses, while speculative, align with the reported variability in shoulder recovery dynamics [7, 17, 18] and elevate our findings beyond mere observation, warranting targeted biomechanical and behavioral studies. Complications, although rare (6.2%), correlated strongly with poorer UCLA outcomes (p < 0.001), an expected finding consistent with hardware-related setbacks. Compared to the literature rates (e.g., 5–15% for irritation or failure)[5, 6, 8, 11, 19, 20], our results suggest that technical proficiency and patient selection minimized risks, reinforcing ORIF’s safety profile of ORIF in this setting. Limitations This study has several limitations that limit its conclusions. Foremost, the absence of a control group—whether nonoperative management or alternative fixation (e.g., intramedullary nailing)—precludes definitive claims about the superiority of precontoured locked plate fixation despite its promising outcomes. The 6-month follow-up captures early recovery but misses critical long-term outcomes, such as hardware removal rates, refracture, or chronic dysfunction, undermining durability assessments. Geographic confinement to two Sana’a, Yemen centers restricts generalizability, as resource availability and patient profiles may differ elsewhere. Pre-injury UCLA scores were not recorded, which hindered the direct measurement of functional gains. Non-blinded assessors may have biased UCLA scoring, particularly physician-assessed components (flexion and strength), while the 100% satisfaction rate suggests potential reporting bias or that an insufficiently granular metric—alternative tool (e.g., DASH) might reveal variability. These constraints underscore the preliminary nature of our findings and urge cautious interpretation. Larger multicenter studies with longer follow-up and control groups are needed to confirm these results and assess long-term efficacy. Exploring subgroup differences (e.g., age, mechanism, and laterality) with biomechanical and patient-reported data could refine treatment strategies. Conclusion This prospective study of 65 Yemeni patients with displaced midshaft clavicular fractures treated via ORIF with pre-contoured locked plates revealed promising early outcomes: a mean UCLA score of 32.46 at 6 months (98.5% good/excellent), radiographic union by 12 weeks, universal patient satisfaction (100%), and a 6.2% complication rate. These findings suggest that this approach is a feasible option in our cohort, particularly when early mobilization is prioritized. However, the observational design—lacking a control group (e.g., non-operative or nailing)—and 6-month follow-up constrain claims of superiority or long-term benefit, compounded by potential assessor bias and an unbalanced satisfaction metric. Larger controlled trials with extended follow-up are crucial to confirm these results, assess durability, and guide the management of such fractures. Declarations Ethics Approval and Consent to Participate This study was conducted in accordance with the ethical standards of the Institutional Review Board (IRB) of Al-Thawra Modern General Hospital, Sana'a, Yemen, and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards . Ethical approval was obtained prior to commencement of the study (Reference Number: IRB-TMGH-2017-047). Written informed consent was obtained from all the participants. The participants were informed about the study's purpose, procedures, potential risks, and benefits, and their consent was documented. Consent to Publish All participants provided written consent for publication of their anonymized data, including images, after reviewing a summary of the study contents. Availability of Data and Materials Datasets are available from the corresponding author upon reasonable request. Competing Interests The authors declare no conflicts of interest. Funding This research received no specific funding. Authors' Contributions AAA: Conceptualization, study design, surgical procedures, manuscript drafting. JAJ: Supervision, study design, data interpretation, critical revision. AM: Data collection, patient recruitment, manuscript review. AMA: Data collection, patient management, surgical assistance. MH: Data collection, patient follow-up, manuscript review. MS: Surgical procedures, patient management. MA: Data collection, patient management, surgical assistance. AHA: Surgical procedures, patient management, data collection. HMJ: Data analysis, interpretation, manuscript revision, corresponding author. All authors approved the final manuscript. Acknowledgments Not applicable. References Robinson CM (1998) Fractures of the clavicle in the adult: Epidemiology and Classification. J Bone Joint Surg 80:. https://doi.org/10.1302/0301-620x.80b3.8079 Zlowodzki M, Zelle BA, Cole PA, et al (2005) Treatment of Acute Midshaft Clavicle Fractures: Systematic Review of 2144 Fractures. J Orthop Trauma 19:504–507. https://doi.org/10.1097/01.bot.0000172287.44278.ef Nowak J, Holgersson M, Larsson S (2004) Can we predict long-term sequelae after fractures of the clavicle based on initial findings? A prospective study with nine to ten years of follow-up. J Shoulder Elbow Surg 13:479–486. https://doi.org/10.1016/j.jse.2004.01.026 Lazarides S, Zafiropoulos G (2006) Conservative treatment of fractures at the middle third of the clavicle: The relevance of shortening and clinical outcome. J Shoulder Elbow Surg 15:191–194. https://doi.org/10.1016/j.jse.2005.08.007 Kingsly P, Sathish M, Ismail NDM (2019) Comparative analysis of functional outcome of anatomical precontoured locking plate versus reconstruction plate in the management of displaced midshaft clavicular fractures. Journal of Orthopaedic Surgery 27:. https://doi.org/10.1177/2309499018820351 Lee SK, Lee JW, Song DG, Choy WS (2013) Precontoured Locking Plate Fixation for Displaced Lateral Clavicle Fractures. Orthopedics 36:801–807. https://doi.org/10.3928/01477447-20130523-28 McKee RC, Whelan DB, Schemitsch EH, McKee MD (2012) Operative Versus Nonoperative Care of Displaced Midshaft Clavicular Fractures: A Meta-Analysis of Randomized Clinical Trials. Journal of Bone and Joint Surgery 94:675–684. https://doi.org/10.2106/JBJS.J.01364 Malavolta EA, Yamamoto GJ, Bussius DT, et al (2022) Establishing minimal clinically important difference for the UCLA and ASES scores after rotator cuff repair. Orthopaedics & Traumatology: Surgery & Research 108:102894. https://doi.org/10.1016/j.otsr.2021.102894 Virtanen KJ, Remes V, Pajarinen J, et al (2012) Sling Compared with Plate Osteosynthesis for Treatment of Displaced Midshaft Clavicular Fractures. Journal of Bone and Joint Surgery 94:1546–1553. https://doi.org/10.2106/JBJS.J.01999 Amstutz HC, Sew Hoy AL, Clarke IC (1981) UCLA anatomic total shoulder arthroplasty. Clin Orthop Relat Res 155:7–20 Ethiraj DrP, Prathap DrP, HS DrA, JS DrN (2016) Functional outcome in surgical management of midshaft clavicle fractures fixed with precontoured plate in adults. International Journal of Orthopaedics Sciences 2:458–462. https://doi.org/10.22271/ortho.2016.v2.i4g.70 Itagi P, Kalaskar A (2020) Functional outcome of midshaft clavicle fractures treated with a pre-contoured locking plate: A prospective study. Indian Journal of Orthopaedics Surgery 4:87–90. https://doi.org/10.18231/2395-1362.2018.0019 Wijdicks F-J, Houwert M, Millett P, et al (2013) Systematic review of complications after intramedullary fixation for displaced midshaft clavicle fractures. Canadian Journal of Surgery 56:58–64. https://doi.org/10.1503/cjs.029511 Chu J-Y, Yeh K-T, Lee R-P, et al (2018) Open reduction and internal fixation with plating is beneficial in the early recovery stage for displaced midshaft clavicular fractures in patients aged 30–65 years old. Tzu Chi Med J 30:242. https://doi.org/10.4103/tcmj.tcmj_25_18 Sharma V, Modi A, Armstrong A, et al (2021) The Management of Distal Clavicle Fractures - A Survey of UK Shoulder and Elbow Surgeons. Cureus 13:e17305. https://doi.org/10.7759/cureus.17305 Riemann BL, Davies GJ (2023) Limb Dominance Effects on Seated Single-Arm Shot-Put Limb Symmetry Indices Following Shoulder Rehabilitation. J Sport Rehabil 32:215–219. https://doi.org/10.1123/jsr.2022-0225 Woltz S, Sengab A, Krijnen P, Schipper IB (2017) Does clavicular shortening after nonoperative treatment of midshaft fractures affect shoulder function? A systematic review. Arch Orthop Trauma Surg 137:1047–1053. https://doi.org/10.1007/s00402-017-2734-7 Herzog MM, Whitesell RC, Mac LM, et al (2017) Functional outcomes following non-operative versus operative treatment of clavicle fractures in adolescents. J Child Orthop 11:310–317. https://doi.org/10.1302/1863-2548.11.160267 Coupe BD, Wimhurst JA, Indar R, et al (2005) A new approach for plate fixation of midshaft clavicular fractures. Injury 36:1166–1171. https://doi.org/10.1016/j.injury.2005.03.007 McKee MD, Kreder HJ, Mandel S, et al (2007) Nonoperative Treatment Compared with Plate Fixation of Displaced Midshaft Clavicular Fractures. J Bone Joint Surg 89:1–10. https://doi.org/10.2106/JBJS.F.00020 Additional Declarations The authors declare no competing interests. Supplementary Files SupplementaryTableS1UCLAComponents.docx Supplementary_Table_S1_UCLA_Components Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6185808","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":426061256,"identity":"01860e76-ba14-4fa3-b071-4f3066e2ac1b","order_by":0,"name":"Abdullah Ali Al-Moaish","email":"data:image/png;base64,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","orcid":"https://orcid.org/0009-0008-7267-238X","institution":"Department of Orthopedic Surgery, Al-Thawra Modern General Hospital, Sana’a, Yemen; Department of Surgery, Faculty of Medicine and Health Sciences, Sana’a University, Sana’a, Yemen.","correspondingAuthor":true,"prefix":"","firstName":"Abdullah","middleName":"Ali","lastName":"Al-Moaish","suffix":""},{"id":426061257,"identity":"70ac819b-da50-4ad0-b3dd-9c8ecfa6eacf","order_by":1,"name":"Jamal Abdulraheem Algabarty","email":"","orcid":"","institution":"Department of Orthopedic Surgery, Al-Thawra Modern General Hospital, Sana’a, Yemen","correspondingAuthor":false,"prefix":"","firstName":"Jamal","middleName":"Abdulraheem","lastName":"Algabarty","suffix":""},{"id":426061258,"identity":"ba428627-0ba1-4f1b-929d-58e3f1cffe7b","order_by":2,"name":"Anwar Mughallas","email":"","orcid":"","institution":"Department of Orthopedic Surgery, Al-Thawra Modern General Hospital, Sana’a, Yemen; Department of Surgery, Faculty of Medicine and Health Sciences, Sana’a University, Sana’a, Yemen.","correspondingAuthor":false,"prefix":"","firstName":"Anwar","middleName":"","lastName":"Mughallas","suffix":""},{"id":426061259,"identity":"b0effbd3-19ac-47ad-8f15-027b9de994ec","order_by":3,"name":"Ali Mustafa Alhamzi","email":"","orcid":"","institution":"Department of Orthopedic Surgery, Kuwait University Hospital, Sana'a, Yemen.; Department of Surgery, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen","correspondingAuthor":false,"prefix":"","firstName":"Ali","middleName":"Mustafa","lastName":"Alhamzi","suffix":""},{"id":426061260,"identity":"28733301-1b1c-4674-b752-08b1bcfa239c","order_by":4,"name":"Mohammed Hutaif","email":"","orcid":"","institution":"Department of Orthopedic Surgery, Al-Thawra Modern General Hospital, Sana’a, Yemen; Department of Surgery, Faculty of Medicine and Health Sciences, Sana’a University, Sana’a, Yemen.","correspondingAuthor":false,"prefix":"","firstName":"Mohammed","middleName":"","lastName":"Hutaif","suffix":""},{"id":426061261,"identity":"44aaa22a-075b-4fd9-9086-ce08529f4b6f","order_by":5,"name":"Mosleh Soliaman","email":"","orcid":"","institution":"Department of Orthopedic Surgery, Kuwait University Hospital, Sana'a, Yemen","correspondingAuthor":false,"prefix":"","firstName":"Mosleh","middleName":"","lastName":"Soliaman","suffix":""},{"id":426061262,"identity":"c7d22cf2-09bb-45b3-bf51-90e7de78e058","order_by":6,"name":"Abdukareem Hussain Almahdi","email":"","orcid":"","institution":"Department of Orthopedic Surgery, Al-Thawra Modern General Hospital, Sana’a, Yemen; Department of Surgery, Faculty of Medicine and Health Sciences, Sana’a University, Sana’a, Yemen.","correspondingAuthor":false,"prefix":"","firstName":"Abdukareem","middleName":"Hussain","lastName":"Almahdi","suffix":""},{"id":426061263,"identity":"c30e0562-321e-4c18-81c9-01e76c362b92","order_by":7,"name":"Mohammed Abdulmoghni","email":"","orcid":"","institution":"Department of Orthopedic Surgery, Al-Thawra Modern General Hospital, Sana’a, Yemen; Department of Surgery, Faculty of Medicine and Health Sciences, Sana’a University, Sana’a, Yemen.","correspondingAuthor":false,"prefix":"","firstName":"Mohammed","middleName":"","lastName":"Abdulmoghni","suffix":""},{"id":426061264,"identity":"303119ae-77be-4eff-a35e-8d83b7baa586","order_by":8,"name":"Haitham Mohammed Jowah","email":"","orcid":"https://orcid.org/0009-0008-3815-3017","institution":"Department of Surgery, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen","correspondingAuthor":false,"prefix":"","firstName":"Haitham","middleName":"Mohammed","lastName":"Jowah","suffix":""}],"badges":[],"createdAt":"2025-03-08 20:26:04","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-6185808/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6185808/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":78349751,"identity":"7f7e1684-2539-495c-9336-87731707c68b","added_by":"auto","created_at":"2025-03-12 10:23:06","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1211107,"visible":true,"origin":"","legend":"\u003cp\u003ePreoperative and Postoperative Radiographs of a 30-Year-Old Male with a Displaced Midshaft Clavicular Fracture\u003cbr\u003e\n \u003cem\u003e(a)\u003c/em\u003e Preoperative anteroposterior radiograph showing a displaced, slightly comminuted midshaft fracture of the right clavicle in a 30-year-old male patient.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(b)\u003c/em\u003e Postoperative anteroposterior radiograph of the same patient following open reduction and internal fixation (ORIF) with a pre-contoured superior locking plate (Orthomed E, 7-hole, titanium). Note the anatomical reduction of the fracture and the use of locking screws that engage at least four cortices on either side of the fracture.\u003c/p\u003e","description":"","filename":"Figureone.png","url":"https://assets-eu.researchsquare.com/files/rs-6185808/v1/cc96706b250dd53538e6096a.png"},{"id":78349753,"identity":"add05e63-bc59-4c60-a32d-fd9c02d23a84","added_by":"auto","created_at":"2025-03-12 10:23:06","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":3660942,"visible":true,"origin":"","legend":"\u003cp\u003ePreoperative and Postoperative Radiographs of a 26-Year-Old Female with a Severely Comminuted Midshaft Clavicular Fracture\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(a)\u003c/em\u003e Preoperative anteroposterior radiograph showing a displaced, severely comminuted midshaft fracture of the right clavicle in a 26-year-old female patient.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(b)\u003c/em\u003e Postoperative anteroposterior radiograph of the same patient following open reduction and internal fixation (ORIF) with a pre-contoured superior locking plate (Orthomed E, 8-hole, titanium). Note the anatomical reduction of the fracture and the use of locking screws that engage at least four cortices on either side of the fracture. Two lag screws were used to stabilize the butterfly fragments.\u003c/p\u003e","description":"","filename":"Figuretwo.png","url":"https://assets-eu.researchsquare.com/files/rs-6185808/v1/16cd9c48ee9ab950beec9927.png"},{"id":78351680,"identity":"e03e3d0e-cc6e-4229-8b57-dfb284442b6f","added_by":"auto","created_at":"2025-03-12 10:39:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":8795301,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6185808/v1/245859be-eb7a-4ae5-95e3-2799cab78d9e.pdf"},{"id":78349748,"identity":"4e71a55b-8d1c-414d-9c83-cd5bedd89bf6","added_by":"auto","created_at":"2025-03-12 10:23:05","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":16896,"visible":true,"origin":"","legend":"\u003cp\u003eSupplementary_Table_S1_UCLA_Components\u003c/p\u003e","description":"","filename":"SupplementaryTableS1UCLAComponents.docx","url":"https://assets-eu.researchsquare.com/files/rs-6185808/v1/5464ed96d2501603202bb2f0.docx"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eFunctional Outcomes of Displaced Midshaft Clavicular Fractures Treated with Precontoured Locked Plates: A Prospective Study\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eClavicular fractures, comprising 5\u0026ndash;10% of all fractures and 45% of shoulder girdle injuries, predominantly affect the midshaft (approximately 80% of cases)[\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Historically managed nonoperatively with slings or figure-of-8 braces due to reported low nonunion rates, displaced midshaft fractures now show higher nonunion (22\u0026ndash;44%), malunion, and dissatisfaction with conservative care[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. This has spurred a shift toward surgical intervention, notably plate fixation. Precontoured locking plates enhance stability, enable early mobilization, and lower nonunion risk, with added benefits of procedural ease and reduced soft tissue irritation[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Although studies globally report strong outcomes with this approach[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], evidence from the Middle East, particularly Yemen, remains scarce, limiting region-specific insights.\u003c/p\u003e \u003cp\u003eThis study evaluated the functional outcomes and complications of pre-contoured superior clavicle locking plates for displaced midshaft clavicular fractures in a Yemeni cohort, focusing on patient satisfaction, range of motion, union time, and complication rates.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eThis prospective observational study was conducted at the Department of Orthopedics, Al-Thawra Modern General Hospital, and Kuwait University Hospital, Sana\u0026rsquo;a, Yemen, from January 2018 to September 2024. The primary aim of this study was to assess the functional outcomes of displaced midshaft clavicular fractures treated with open reduction and internal fixation (ORIF) using pre-contoured superior clavicle locking plates. A standardized protocol governed patient selection, surgery, postoperative care, and follow-up to ensure consistency. Data were prospectively collected.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy population\u003c/h3\u003e\n\u003cp\u003eEligible patients were adults (\u0026ge;\u0026thinsp;18 years) with closed, displaced midshaft clavicular fractures, defined as displacement\u0026thinsp;\u0026gt;\u0026thinsp;2 cm, shortening\u0026thinsp;\u0026gt;\u0026thinsp;2 cm, comminution, or skin tenting threatening viability. Exclusion criteria included open or pathological fractures, proximal or distal third clavicle involvement, head or neurovascular injuries, acromioclavicular dislocations, or prior nonunion. All the participants provided written informed consent.\u003c/p\u003e\n\u003ch3\u003eSample size\u003c/h3\u003e\n\u003cp\u003eThe sample size was calculated based on the University of California, Los Angeles (UCLA) Shoulder Score, which is the primary outcome. Prior studies reported postoperative means of 33\u0026ndash;35 points with pre-contoured plates[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Assuming a 4-point difference (standard deviation 5), α\u0026thinsp;=\u0026thinsp;0.05, and 90% power, a minimum of 33 patients were required. Allowing for dropouts, we targeted 36\u0026ndash;40 patients; ultimately, 65 patients were enrolled, enhancing power and enabling subgroup analyses.\u003c/p\u003e\n\u003ch3\u003eSurgical technique\u003c/h3\u003e\n\u003cp\u003ePreoperative workup included standard blood tests and clavicular radiographs (anteroposterior, 20\u0026deg; cranial tilt). Under general anesthesia, the patients were positioned in a beach-chair setup with a scapular sandbag aiding reduction. Prophylactic antibiotics were administered before incision. A transverse incision below the fracture exposed the clavicle via superior retraction, thus avoiding wound overlap with the plate. Subcutaneous tissue and platysma were mobilized together, myofascial layers were incised, and soft tissues were elevated, preserving supraclavicular nerves unless exposure demanded sacrifice. Fracture reduction was performed using clamps or indirect techniques, as confirmed by fluoroscopy. A 3.5-mm titanium precontoured locking plate (Orthomed E, Egypt) was fixed anterosuperiorly with locking screws (\u0026ge;\u0026thinsp;3 cortices per fragment); lag screws addressed butterfly fragments as needed. The fascia was repaired over the plate, the skin was closed in layers, and the arm slung postoperatively.\u003c/p\u003e\n\u003ch3\u003ePostoperative care and follow-up\u003c/h3\u003e\n\u003cp\u003ePatients received analgesics, postoperative radiographs, and sling immobilization for 4 weeks with pendulum exercises. Follow-ups at 10 days (suture removal), 4, 8, 12, and 26 weeks included a rehabilitation protocol starting week 4 (active-assisted motion, progressing to full range by week 8). UCLA scores were assessed at 6 months; radiographic union was monitored descriptively by the treating surgeon, with delayed union defined as a lack of three-cortex bridging at 12 weeks.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eOutcome measures\u003c/h2\u003e \u003cp\u003eThe primary outcome was functional recovery assessed using the UCLA Shoulder Score (max 35), evaluating pain (0\u0026ndash;10), function (0\u0026ndash;10), active forward flexion (0\u0026ndash;5), strength (0\u0026ndash;5), and satisfaction (0\u0026ndash;5)[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Scores\u0026thinsp;\u0026ge;\u0026thinsp;27 indicated good/excellent outcomes, and \u0026lt;\u0026thinsp;27 fair/poor. Preoperative scores were not recorded; however, pre-injury shoulder function was queried to exclude prior pathology. The secondary outcomes included complication rates (hardware irritation, failure, infection, delayed union, and malunion).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eData were analyzed using SPSS version 26. Descriptive statistics summarized demographics, injury details, and outcomes (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD for continuous variables; frequencies/percentages for categorical variables). Given the modest sample and likely non-normal UCLA score distribution, nonparametric tests (Kruskal-Wallis, Mann-Whitney U) were used to assess subgroup differences, Chi-square tests were used to examine complication associations, and Spearman\u0026rsquo;s correlation was used to evaluate age-outcome links.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEthical considerations\u003c/h3\u003e\n\u003cp\u003eThis study was conducted in accordance with the ethical standards of the Institutional Review Board (IRB) of Al-Thawra Modern General Hospital, Sana'a, Yemen, \u003cem\u003eand with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards\u003c/em\u003e. Ethical approval was obtained prior to commencement of the study (Reference Number: IRB-TMGH-2017-047). Written informed consent was obtained from all the participants. The participants were informed about the study's purpose, procedures, potential risks, and benefits, and their consent was documented.\u003c/p\u003e"},{"header":"Results","content":"\u003ch2\u003eDemographic and injury characteristics\u003c/h2\u003e\n\u003cp\u003eSixty-five patients with displaced midshaft clavicular fractures treated with precontoured locked plates were enrolled. The mean age was 32.09 years (range: 19\u0026ndash;50 years), with 54 males (83.1%) and 11 females (16.9%). Road traffic accidents (RTAs) caused the most injuries (n=43, 66.2%), followed by falls (n=22, 33.8%). The right clavicle was affected in 43 (66.2%) patients and the left clavicle in 22 (33.8%). Table 1 details these traits, and Figures 1\u0026ndash;2 show the representative cases.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1: Demographic and Injury Characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge Group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e18-30 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e56.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e31-40 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e18.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e41-50 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e83.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e16.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMode of Injury\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eRTA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e66.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAccidental Fall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e33.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eInjured Side\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eRight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e66.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLeft\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e33.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAbbreviations:\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e\u0026nbsp;n, number of patients; %, percentage; RTA, road traffic accident.\u003c/em\u003e\u003c/p\u003e\n\u003ch2\u003eFunctional and radiographic outcomes\u003c/h2\u003e\n\u003cp\u003eAt 6 months, the mean UCLA shoulder score was 32.46 \u0026plusmn; 2.54, with 64 patients (98.5%) achieving good/excellent outcomes (UCLA \u0026ge;27) and one (1.5%) fair/poor (\u0026lt;27). Table 2 summarizes the scores, and Supplementary Table S1 breaks down the components. Radiographs confirmed union in all cases by 12 weeks (three-cortex bridging), with no delayed unions or malformations noted.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: UCLA Shoulder Rating Score Outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eValue\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTotal UCLA Score (Mean \u0026plusmn; SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e32.46 \u0026plusmn; 2.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOutcome Categories\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eGood/excellent (\u0026ge;27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e98.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFair/poor (\u0026lt;27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAbbreviations\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e: UCLA, University of California, Los Angeles; SD, Standard Deviation.\u003c/em\u003e\u003c/p\u003e\n\u003ch2\u003ePatient satisfaction\u003c/h2\u003e\n\u003cp\u003eAll 65 patients (100%) reported satisfaction with surgical outcomes, reflected in the UCLA Shoulder Rating Score satisfaction component (all scored 5, \u0026ldquo;Satisfied and better\u0026rdquo;; Supplementary Table S1).\u003c/p\u003e\n\u003ch2\u003ePostoperative complications\u003c/h2\u003e\n\u003cp\u003eComplications were rare and included hardware irritation (n=1, 1.5%), hardware failure (n=2, 3.1%), and superficial infection (n=1, 1.5%), totaling 6.2% affected. No delayed unions, malunions, or refractures occurred, and 61 patients (93.8%) were complication-free. Table 3 presents the outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3: Postoperative Complications\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eComplication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHardware Irritation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHardware Failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSuperficial Infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo Complications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e93.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch2\u003eSubgroup and correlation analyses\u003c/h2\u003e\n\u003ch3\u003eUCLA Scores and Patient Characteristics\u003c/h3\u003e\n\u003cp\u003eTo assess differences in total UCLA scores across subgroups, we performed Kruskal-Wallis tests for age groups (more than two categories) and Mann-Whitney U tests for sex, injury mechanism, and injured side (two categories each). Spearman\u0026apos;s rank-order correlation was used to examine the relationship between age (a continuous variable) and the total UCLA scores. The results are summarized in Table 4.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4: Comparison of Total UCLA Scores among Subgroups\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroups Compared\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTest Statistic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAge Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e18-30, 31-40, 41-50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eH(2) = 16.525.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMechanism of Injury\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eRTA vs. Fall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eU = 319.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.029\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMale vs. Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eU = 248.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.380\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eInjured Side\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eRight vs. Left\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eU = 203.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eNote: Kruskal-Wallis tests were used for age group comparisons; Mann\u0026ndash;Whitney U tests were used for comparisons between two groups.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAbbreviations\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e: H, \u0026nbsp;Kruskal-Wallis test statistic; U, Mann-Whitney U test statistic; RTA, Road Traffic Accident.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA statistically significant negative correlation was found between age and the total UCLA score (\u0026rho; = -0.317, p = 0.010), indicating that older patients tended to have lower UCLA scores. Significant differences in the total UCLA scores were also found based on the mechanism of injury (p = 0.029) and the injured side (p \u0026lt; 0.001). Patients with RTA injuries had higher UCLA scores than those with falls, and those with right-sided injuries had higher UCLA scores than those with left-sided injuries. No significant differences were observed according to sex.\u003c/p\u003e\n\u003ch3\u003eUCLA Component Scores and Age\u0026nbsp;\u003c/h3\u003e\n\u003cp\u003eKruskal-Wallis tests revealed significant differences across age groups for the pain score (p=0.001) and active forward flexion (p=0.013). Post-hoc tests indicated that the 41-50 age group had significantly better scores (less pain and better flexion) than the 18-30 age group. No significant differences were observed in terms of function, strength, or satisfaction.\u003c/p\u003e\n\u003ch3\u003eComplications and Patient Characteristics\u0026nbsp;\u003c/h3\u003e\n\u003cp\u003eChi-square tests of independence were performed to examine the relationship between categorical variables (age group, mechanism of injury, sex, injured side, and UCLA outcome category) and the occurrence of any complications. The results are summarized in Table 5. A statistically significant association was found between UCLA outcome category and complications (p \u0026lt; 0.001), with patients experiencing complications having worse outcomes, as expected. The Mann\u0026ndash;Whitney U test revealed a statistically significant difference in the total UCLA scores between patients with and without complications (U = 11.000, p \u0026lt; 0.001). Patients with complications had significantly lower UCLA scores than those without complications. Although not statistically significant at p \u0026lt; 0.05, there were trends suggesting possible associations between age group (p=0.051, with a significant linear association p=0.046), mechanism of injury (p=0.073), and injured side (p=0.073) with complication rates.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5: Association between categorical variables and complications.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eComplications\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eChi-Square/U\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo,\u003c/strong\u003e n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes,\u0026nbsp;\u003c/strong\u003en(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge Group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u0026Chi;\u003csup\u003e2\u003c/sup\u003e(2) = 5.946\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e0.051\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e18-30 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e36 (97.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1 (2.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e31-40 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e41-50 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13 (81.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3 (18.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLinear by Linear\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026Chi;\u003csup\u003e2\u003c/sup\u003e(1) = 3.999\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.046\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMechanism of Injury\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u0026Chi;2(1) = 3.224\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e0.073\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eRTA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e42 (97.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1 (2.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e19 (86.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3 (13.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u0026Chi;\u003csup\u003e2\u003c/sup\u003e(1) = 3.317\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e0.069\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e52 (96.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2 (3.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9 (81.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2 (18.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eInjured Side\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u0026Chi;\u003csup\u003e2\u003c/sup\u003e(1) = 3.224\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e0.073\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eRight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e42 (97.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1 (2.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLeft\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e19 (86.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3 (13.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eUCLA Outcome\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u0026Chi;\u003csup\u003e2\u003c/sup\u003e(1) = 15.488\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eGood/excellent (\u0026ge;27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e61 (95.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3 (4.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFair/poor (\u0026lt;27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal UCLA\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eU = 11.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eNote: Chi-square tests of independence were used to examine the association between categorical variables and the presence/absence of complications, reporting Pearson\u0026rsquo;s chi-square values unless otherwise noted . A Mann\u0026ndash;Whitney U test was used to examine significant differences in total UCLA and Complications.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAbbreviations\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e:\u003c/em\u003e\u003cem\u003e\u0026nbsp;UCLA, University of California, Los Angeles; RTA, Road Traffic Accident; U, \u0026nbsp;Mann-Whitney U test statistics.\u003c/em\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis prospective study evaluated precontoured locked plate fixation for displaced midshaft clavicular fractures in a Yemeni population and observed promising functional outcomes, high patient satisfaction, and a low complication rate. The mean UCLA shoulder rating score of 32.46 at 6 months (98.5% good/excellent results) aligns with previous reports of plate fixation efficacy. Ethiraj et al. (2016) and Itagi and Kalaskar (2020) documented similarly strong Constant-Murley scores (85.23\u0026ndash;97.8)[11, 12], while Wijdicks et al. (2013) reported UCLA means above 30[13], reinforcing our findings. With 65 patients, this study adds robust region-specific evidence to the growing case of surgical intervention for displaced fractures.\u003c/p\u003e\n\u003cp\u003eSubgroup analyses uncovered notable patterns, which merit deeper exploration. A significant negative correlation between age and UCLA scores (\u0026rho; = -0.317, p = 0.010) suggests that older patients (41\u0026ndash;50 years) achieved slightly lower overall function yet paradoxically outperformed younger patients (18\u0026ndash;30 years) in pain relief and forward flexion (p = 0.001, p = 0.013). Chue et al. (2018) noted comparable trends, attributing better pain outcomes in older adults to lower baseline demands or greater relative gains post-ORIF[14]. In our cohort, younger patients, often active males injured in RTAs, may face higher recovery expectations, driving subtle dissatisfaction despite healing. Alternatively, age-related differences in soft tissue resilience or rehabilitation adherence could play a role, although pre-injury function was not quantified in this study. These contradictions highlight the need for tailored outcome metrics across different age groups.\u003c/p\u003e\n\u003cp\u003eEqually compelling differences in injury mechanism and laterality were observed. Patients with RTA injuries outscored those with falls (p = 0.029) and right-sided injuries surpassed left-sided injuries (p \u0026lt; 0.001). Sharma et al. (2021) linked high-energy trauma (e.g., RTAs) to better ORIF outcomes, possibly due to stricter postoperative care[15], but falls in our study varied in severity, muddying this explanation. Instead, RTA fractures might involve distinct comminution patterns, stabilized effectively by locked plates, versus falls, which could skew toward simpler breaks with unrecognized soft tissue impacts. Laterality findings are equally provocative; if most patients are right-handed (data unavailable), dominant-side injuries might spur greater rehabilitation effort, yielding higher symmetry indices, as seen in Riemann et al. (2023)[16]. Left-sided repairs, potentially on non-dominant arms, might result in less patient-driven recovery focus or slight surgical adjustments (e.g., plate contouring challenges on the left clavicle curve). These hypotheses, while speculative, align with the reported variability in shoulder recovery dynamics [7, 17, 18] and elevate our findings beyond mere observation, warranting targeted biomechanical and behavioral studies.\u003c/p\u003e\n\u003cp\u003eComplications, although rare (6.2%), correlated strongly with poorer UCLA outcomes (p \u0026lt; 0.001), an expected finding consistent with hardware-related setbacks. Compared to the literature rates (e.g., 5\u0026ndash;15% for irritation or failure)[5, 6, 8, 11, 19, 20], our results suggest that technical proficiency and patient selection minimized risks, reinforcing ORIF\u0026rsquo;s safety profile of ORIF in this setting.\u003c/p\u003e\n\u003ch2\u003eLimitations\u003c/h2\u003e\n\u003cp\u003eThis study has several limitations that limit its conclusions. Foremost, the absence of a control group\u0026mdash;whether nonoperative management or alternative fixation (e.g., intramedullary nailing)\u0026mdash;precludes definitive claims about the superiority of precontoured locked plate fixation despite its promising outcomes. The 6-month follow-up captures early recovery but misses critical long-term outcomes, such as hardware removal rates, refracture, or chronic dysfunction, undermining durability assessments. Geographic confinement to two Sana\u0026rsquo;a, Yemen centers restricts generalizability, as resource availability and patient profiles may differ elsewhere. Pre-injury UCLA scores were not recorded, which hindered the direct measurement of functional gains. Non-blinded assessors may have biased UCLA scoring, particularly physician-assessed components (flexion and strength), while the 100% satisfaction rate suggests potential reporting bias or that an insufficiently granular metric\u0026mdash;alternative tool (e.g., DASH) might reveal variability. These constraints underscore the preliminary nature of our findings and urge cautious interpretation.\u003c/p\u003e\n\u003cp\u003eLarger multicenter studies with longer follow-up and control groups are needed to confirm these results and assess long-term efficacy. Exploring subgroup differences (e.g., age, mechanism, and laterality) with biomechanical and patient-reported data could refine treatment strategies.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis prospective study of 65 Yemeni patients with displaced midshaft clavicular fractures treated via ORIF with pre-contoured locked plates revealed promising early outcomes: a mean UCLA score of 32.46 at 6 months (98.5% good/excellent), radiographic union by 12 weeks, universal patient satisfaction (100%), and a 6.2% complication rate. These findings suggest that this approach is a feasible option in our cohort, particularly when early mobilization is prioritized. However, the observational design—lacking a control group (e.g., non-operative or nailing)—and 6-month follow-up constrain claims of superiority or long-term benefit, compounded by potential assessor bias and an unbalanced satisfaction metric. Larger controlled trials with extended follow-up are crucial to confirm these results, assess durability, and guide the management of such fractures.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics Approval and Consent to Participate\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the ethical standards of the Institutional Review Board (IRB) of Al-Thawra Modern General Hospital, Sana\u0026apos;a, Yemen, \u003cem\u003eand with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards\u003c/em\u003e. Ethical approval was obtained prior to commencement of the study (Reference Number: IRB-TMGH-2017-047). Written informed consent was obtained from all the participants. The participants were informed about the study\u0026apos;s purpose, procedures, potential risks, and benefits, and their consent was documented. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent to Publish\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants provided written consent for publication of their anonymized data, including images, after reviewing a summary of the study contents.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAvailability of Data and Materials\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDatasets are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting Interests\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors\u0026apos; Contributions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAAA: Conceptualization, study design, surgical procedures, manuscript drafting. JAJ: Supervision, study design, data interpretation, critical revision. AM: Data collection, patient recruitment, manuscript review. AMA: Data collection, patient management, surgical assistance. MH: Data collection, patient follow-up, manuscript review. MS: Surgical procedures, patient management. MA: Data collection, patient management, surgical assistance. AHA: Surgical procedures, patient management, data collection. HMJ: Data analysis, interpretation, manuscript revision, corresponding author. All authors approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgments\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eRobinson CM (1998) Fractures of the clavicle in the adult: Epidemiology and Classification. J Bone Joint Surg 80:. https://doi.org/10.1302/0301-620x.80b3.8079\u003c/li\u003e\n \u003cli\u003eZlowodzki M, Zelle BA, Cole PA, et al (2005) Treatment of Acute Midshaft Clavicle Fractures: Systematic Review of 2144 Fractures. J Orthop Trauma 19:504\u0026ndash;507. https://doi.org/10.1097/01.bot.0000172287.44278.ef\u003c/li\u003e\n \u003cli\u003eNowak J, Holgersson M, Larsson S (2004) Can we predict long-term sequelae after fractures of the clavicle based on initial findings? A prospective study with nine to ten years of follow-up. J Shoulder Elbow Surg 13:479\u0026ndash;486. https://doi.org/10.1016/j.jse.2004.01.026\u003c/li\u003e\n \u003cli\u003eLazarides S, Zafiropoulos G (2006) Conservative treatment of fractures at the middle third of the clavicle: The relevance of shortening and clinical outcome. J Shoulder Elbow Surg 15:191\u0026ndash;194. https://doi.org/10.1016/j.jse.2005.08.007\u003c/li\u003e\n \u003cli\u003eKingsly P, Sathish M, Ismail NDM (2019) Comparative analysis of functional outcome of anatomical precontoured locking plate versus reconstruction plate in the management of displaced midshaft clavicular fractures. Journal of Orthopaedic Surgery 27:. https://doi.org/10.1177/2309499018820351\u003c/li\u003e\n \u003cli\u003eLee SK, Lee JW, Song DG, Choy WS (2013) Precontoured Locking Plate Fixation for Displaced Lateral Clavicle Fractures. Orthopedics 36:801\u0026ndash;807. https://doi.org/10.3928/01477447-20130523-28\u003c/li\u003e\n \u003cli\u003eMcKee RC, Whelan DB, Schemitsch EH, McKee MD (2012) Operative Versus Nonoperative Care of Displaced Midshaft Clavicular Fractures: A Meta-Analysis of Randomized Clinical Trials. Journal of Bone and Joint Surgery 94:675\u0026ndash;684. https://doi.org/10.2106/JBJS.J.01364\u003c/li\u003e\n \u003cli\u003eMalavolta EA, Yamamoto GJ, Bussius DT, et al (2022) Establishing minimal clinically important difference for the UCLA and ASES scores after rotator cuff repair. Orthopaedics \u0026amp; Traumatology: Surgery \u0026amp; Research 108:102894. https://doi.org/10.1016/j.otsr.2021.102894\u003c/li\u003e\n \u003cli\u003eVirtanen KJ, Remes V, Pajarinen J, et al (2012) Sling Compared with Plate Osteosynthesis for Treatment of Displaced Midshaft Clavicular Fractures. Journal of Bone and Joint Surgery 94:1546\u0026ndash;1553. https://doi.org/10.2106/JBJS.J.01999\u003c/li\u003e\n \u003cli\u003eAmstutz HC, Sew Hoy AL, Clarke IC (1981) UCLA anatomic total shoulder arthroplasty. Clin Orthop Relat Res 155:7\u0026ndash;20\u003c/li\u003e\n \u003cli\u003eEthiraj DrP, Prathap DrP, HS DrA, JS DrN (2016) Functional outcome in surgical management of midshaft clavicle fractures fixed with precontoured plate in adults. International Journal of Orthopaedics Sciences 2:458\u0026ndash;462. https://doi.org/10.22271/ortho.2016.v2.i4g.70\u003c/li\u003e\n \u003cli\u003eItagi P, Kalaskar A (2020) Functional outcome of midshaft clavicle fractures treated with a pre-contoured locking plate: A prospective study. Indian Journal of Orthopaedics Surgery 4:87\u0026ndash;90. https://doi.org/10.18231/2395-1362.2018.0019\u003c/li\u003e\n \u003cli\u003eWijdicks F-J, Houwert M, Millett P, et al (2013) Systematic review of complications after intramedullary fixation for displaced midshaft clavicle fractures. Canadian Journal of Surgery 56:58\u0026ndash;64. https://doi.org/10.1503/cjs.029511\u003c/li\u003e\n \u003cli\u003eChu J-Y, Yeh K-T, Lee R-P, et al (2018) Open reduction and internal fixation with plating is beneficial in the early recovery stage for displaced midshaft clavicular fractures in patients aged 30\u0026ndash;65 years old. Tzu Chi Med J 30:242. https://doi.org/10.4103/tcmj.tcmj_25_18\u003c/li\u003e\n \u003cli\u003eSharma V, Modi A, Armstrong A, et al (2021) The Management of Distal Clavicle Fractures - A Survey of UK Shoulder and Elbow Surgeons. Cureus 13:e17305. https://doi.org/10.7759/cureus.17305\u003c/li\u003e\n \u003cli\u003eRiemann BL, Davies GJ (2023) Limb Dominance Effects on Seated Single-Arm Shot-Put Limb Symmetry Indices Following Shoulder Rehabilitation. J Sport Rehabil 32:215\u0026ndash;219. https://doi.org/10.1123/jsr.2022-0225\u003c/li\u003e\n \u003cli\u003eWoltz S, Sengab A, Krijnen P, Schipper IB (2017) Does clavicular shortening after nonoperative treatment of midshaft fractures affect shoulder function? A systematic review. Arch Orthop Trauma Surg 137:1047\u0026ndash;1053. https://doi.org/10.1007/s00402-017-2734-7\u003c/li\u003e\n \u003cli\u003eHerzog MM, Whitesell RC, Mac LM, et al (2017) Functional outcomes following non-operative \u003cem\u003eversus\u003c/em\u003e operative treatment of clavicle fractures in adolescents. J Child Orthop 11:310\u0026ndash;317. https://doi.org/10.1302/1863-2548.11.160267\u003c/li\u003e\n \u003cli\u003eCoupe BD, Wimhurst JA, Indar R, et al (2005) A new approach for plate fixation of midshaft clavicular fractures. Injury 36:1166\u0026ndash;1171. https://doi.org/10.1016/j.injury.2005.03.007\u003c/li\u003e\n \u003cli\u003eMcKee MD, Kreder HJ, Mandel S, et al (2007) Nonoperative Treatment Compared with Plate Fixation of Displaced Midshaft Clavicular Fractures. J Bone Joint Surg 89:1\u0026ndash;10. https://doi.org/10.2106/JBJS.F.00020\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Al-Thawra Modern General Hospital, Sana'a, Yemen","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"clavicle fracture, precontoured locked plate, functional outcomes, surgical management, complications, patient satisfaction, midshaft fracture, ORIF","lastPublishedDoi":"10.21203/rs.3.rs-6185808/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6185808/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eThis study assessed the functional outcomes and complications of open reduction and internal fixation (ORIF) using pre-contoured superior clavicle locking plates for displaced midshaft clavicular fractures.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eIn a prospective two-center study at Al-Thawra Modern General Hospital and Kuwait University Hospital, Sana\u0026rsquo;a, Yemen, from January 2018 to September 2024, 65 patients (\u0026ge;\u0026thinsp;18 years) with closed, displaced midshaft clavicular fractures (displacement\u0026thinsp;\u0026gt;\u0026thinsp;2 cm, shortening\u0026thinsp;\u0026gt;\u0026thinsp;2 cm, comminution, or skin tenting) underwent ORIF. Functional outcomes were evaluated six months postoperatively using the University of California, Los Angeles (UCLA) shoulder rating score. Data were analyzed using SPSS version 26.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe mean patient age was 32.09 years (83.1% male, n\u0026thinsp;=\u0026thinsp;54). Road traffic accidents were the primary injury mechanism (66.2%, n\u0026thinsp;=\u0026thinsp;43). At 6 months, the mean UCLA score was 32.46\u0026thinsp;\u0026plusmn;\u0026thinsp;2.54, with 98.5% (n\u0026thinsp;=\u0026thinsp;64) achieving good or excellent outcomes (UCLA score\u0026thinsp;\u0026ge;\u0026thinsp;27) and 1.5% (n\u0026thinsp;=\u0026thinsp;1) fair/poor. Complications included hardware irritation (1.5%, n\u0026thinsp;=\u0026thinsp;1), hardware failure (3.1%, n\u0026thinsp;=\u0026thinsp;2), and superficial infections (1.5%, n\u0026thinsp;=\u0026thinsp;1). All patients (100%) reported satisfaction with their outcomes. The UCLA scores varied significantly according to injury mechanism, side, and age, with older patients showing lower scores.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eORIF with pre-contoured locked plates yielded promising functional outcomes, high patient satisfaction, and low complication rates in this cohort. However, the observational design, lack of a control group, and 6-month follow-up limit broader conclusions. Larger controlled studies are needed to validate these findings and guide optimal management strategies for displaced midshaft clavicular fractures.\u003c/p\u003e\u003ch2\u003eLevel of Evidence\u003c/h2\u003e \u003cp\u003eLevel IV (OCEBM 2011).\u003c/p\u003e","manuscriptTitle":"Functional Outcomes of Displaced Midshaft Clavicular Fractures Treated with Precontoured Locked Plates: A Prospective Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-12 10:23:00","doi":"10.21203/rs.3.rs-6185808/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"05b1dc45-21cd-4e82-9c5d-7a0ba1efc3b1","owner":[],"postedDate":"March 12th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":45404925,"name":"Orthopedic Surgery"}],"tags":[],"updatedAt":"2025-03-12T10:23:01+00:00","versionOfRecord":[],"versionCreatedAt":"2025-03-12 10:23:00","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6185808","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6185808","identity":"rs-6185808","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}