Conservative Management of Ipsilateral Clavicle and Scapula Fractures in Adults: A Retrospective Study

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This study aimed to examine the prevalence and impact of combined clavicle and scapula fractures on treatment and outcomes compared to isolated clavicle fractures. Methods A retrospective cohort analysis of patients treated in a three-year period with clavicle fractures and ipsilateral scapula fracture (range 18–85 years) were selected. In consideration of the demographic characteristics, a control group was selected with an isolated clavicle fracture, comparable in terms of radiographical features (fracture of the middle third). Functional outcomes were assessed using Constant-Murley and Disability of the Arm, Shoulder and Hand (DASH) scores, along with shoulder range of motion (ROM) measurements. Results With an accurate retrospective analysis, 201 patients were treated for clavicle fracture in our department, and 144 met the age criteria (101 males/43 females). Focusing on the inclusion criteria, patients with concomitant middle third of clavicle fracture associated with an omolateral non articular scapular fracture were selected, thereby a total of nine patients (6,25%), mean age 53 ± 20.1 years, represent our group of interest. Only three cases involved floating shoulder injuries. Conservative treatment implies the use of a sling or a figure-of-8 bendages for 6 weeks. Outcomes showed a mean Constant-Murley score of 89.22 and DASH score of 3.3, with limited ROM loss. Conclusions The association of clavicle and undisplaced or minimally displaced scapula fractures does not modify significantly the treatment and the outcomes; these fractures seem to scapula clavicle fracture conservative treatment clavicle and scapula clinical outcomes Figures Figure 1 1. Introduction The term 'floating shoulder' was first introduced by Ganz [ 1 ] who described a lesion of the ipsilateral fracture of the middle third of the clavicle and glenoid neck. Subsequently Goss [ 2 ] extended the concept of the floating shoulder to include any double disruption of the superior shoulder suspensory complex (SSSC). The SSSC represents a ring of soft tissue and bone whose his lack of continuity following injury, predisposes to a number of complications, including non-union, malunion, shoulder dysfunction, weakness and fatigue, which may eventually lead to early joint degeneration [ 3 ]. Isolated clavicle fractures represent quite common injuries with an incidence of ap-proximately 2.6- 4% in the adult population, accounting for 44% of shoulder girdle-related fractures. Fractures of the mid-shaft are the most frequent in the 69–75% of the cases[ 4 , 5 ]. Due to its mobility and the protection provided by the surrounding muscle masses, scapula fractures are uncommon, accounting for 3% to 5% of all shoulder fractures and merely 1% of fractures involving the entire human body [ 6 , 7 ]. About 25% of all scapula fractures are complicated by a clavicle fracture or acromion-clavicular dislocation. Conservative treatment of isolated clavicle fractures usually consists of immobilization with a figure-of-eight bandage or a sling for 4 to 6 weeks. In the evaluation of treatment strategies for an isolated clavicle fracture, it may be beneficial to consider a number of patient-related factors, including age, the necessity for return to sporting activities and the degree of fracture comminution. [ 8 ]. Non-unions represent the most frequent complication of conservative treatment, accounting for 7% to 15%, also resulting in a poorer long-term outcome than the contralateral uninvolved limb [ 8 , 9 ]. The treatment of floating shoulders is still controversial [ 10 , 11 , 12 ]. The results of conservative treatment are often analogous to those achieved through surgical intervention. Conservative treatment, as described by various authors in the literature, involves the use of figure of 8-bandage or alternatively the Velpau bandage or triangular sling for one month [ 13 ]. According to specific indications, conservative treatment of the clavicle fractures and associated ipsilateral scapular fracture is accepted in the literature and clinical practice in the management of floating shoulder [ 14 ]. In fact, nonoperative treatment could achieve satisfactory results probably equal or superior to those reported after operative treatment, without the risk of operative complications [ 15 ]. There is a paucity of literature examining the short- and long-term clinical outcomes of clavicle fractures associated with ipsilateral scapula fractures treated with a conservative approach [ 16 ]. Similarly, there is a dearth of studies investigating whether an associated scapula fracture can negatively impact the short- and long-term outcomes of clavicle fractures or whether the results are superimposable [ 17 , 18 , 19 ]. Our study aimed to investigate the prevalence of concomitant clavicle and ipsilateral scapula fractures and to determine whether conservative treatment yields comparable clinical outcomes to isolated clavicle fractures treated conservatively. 2. Materials and Methods 2.1 Participants selection In this retrospective study, we conducted a comprehensive review of the medical records of all patients who had been treated conservatively for an isolated clavicle fracture or a clavicle fracture and an associated omolateral scapula fracture at the Orthopaedics and Traumatology Unit of the University Hospital "Policlinico G. Rodolico-San Marco" in Catania over a three-year period, between January 2020 and December 2022. The patients included in the study were identified in accordance with the specific inclusion and exclusion criteria. The inclusion criteria were as follows: 1) clavicle fracture; 2) concomitant ipsilateral scapula fracture; 3) conservative treatment; 4) patients over 18 and under 85 years old; 5) minimum one-year follow-up. The exclusion criteria were: 1) age under 18 and over 85 years old; 2) surgical treatment; 3) follow-up of less than one year; 4) dementia and psychiatric pathologies; 5) refractures; 6) exposed fractures; 7) additional fractures of the upper limb. 8) Incomplete or absent data. A total of 201 patients treated at our hospital for clavicle fracture were initially identified during the period under analysis. In accordance to the aforementioned inclusion and exclusion criteria, as illustrated in Fig. 1 , the identification of the final study group, comprised nine patients with a concomitant ipsilateral fracture of the clavicle and scapula, representing 10.7% of the total sample. The remaining 75 patients (89%) with isolated clavicle fractures, who had been selected based on the aforementioned exclusion and inclusion criteria, constituted the control group. In order to facilitate a more accurate and clinically meaningful comparison of the results of our study group with those of patients with an isolated clavicle fracture, a control group was created using matching techniques. A one-to-one matching technique was employed to minimize selection bias and maximize the comparability of baseline characteristics between the two cohorts, thereby simulating a randomized trial design as closely as possible in a retrospective setting[ 20 ]. Specifically, the control group was designed to be as similar as possible to the study group in terms of key characteristics, including age (within a range of +/- 5 years), gender, involved limb laterality, and fracture pattern. By matching the study group with the control group, comprising 75 patients in total, a 1:1 matched control group of nine patients with a single clavicle fracture was obtained. All demographic and clinical data pertaining to the patients were collected during outpatient follow-ups and reviewed from medical records, discharge sheets and ambulatory reports. Radiographs and, when available, CT scans were also subjected to careful evaluation in order to ascertain the type of fracture and any concomitant injuries. 2.2 Conservative treatment All the patients admitted to our Unit and included in the study were assessed both clinically and radiographically in the emergency room at the time of the trauma, carefully evaluating the function of the entire upper limb to rule out any neurological or vascular lesions. They were instructed on how to wear the figure eight bandage or arm brace correctly and how to keep it in the correct position to avoid either excessive axillary compression or fracture displacement. Subsequently, they were followed-up weekly for re-wearing of the bandage, after one month for a radiographic check and then at three, six and nine months until one year after the injury. Radiographic evaluation was important to assess fracture healing but also to investigate possible complications such as malunion/nonunion and post-traumatic osteoarthritis. The figure-of-eight bandage was maintained until evidence of bone callus was observed on radiography or for a minimum of one month. Treatment with an eight-bandage involves mobilising the elbow to the extent tolerated, with no limits on range of motion. In contrast, treatment with a brace involves immobilisation for 15 days, during which time the arm must not move. This is followed by passive and active mobilization of the elbow to the extent tolerated. Thereafter, the patient was encouraged to commence progressive active and passive mobilisation of the affected scapular girdle with the assistance of a physiotherapist. Initially, maximum excursion in abduction, adduction and external and internal-external rotation was avoided. Once the fracture had healed, the patient was referred for a comprehensive physiotherapy program aimed at restoring full function of the upper limb, comprising muscle strengthening and active mobilisation exercises. 2.3 Patients evaluation In order to assess their clinical-functional outcome three validated score systems questionnaires were used: the Disabilities of the Arm, Shoulder and Hand Score (DASH), the Constant score and the UCLA shoulder score [ 21 ]. We administered Italian translated and validated versions [ 21 , 22 , 23 ]. In addition, strength and range of motions (ROM) were assessed and recorded separately. Shoulder ranges of movement were evaluated in the different planes (elevation, ab-duction, external rotation and internal rotation) and measured with the aid of a goniometer. Regarding strength measurement, it is suggested to use a digital dynamometer attached distal on the forearm and to measure with the arm in 90 degrees of elevation in the plane of the scapula (20–30 degrees in front of the coronal plane), elbow straight and palm of the hand facing the floor (pronation) [ 25 ]. 2.4 Statistical analysis We used Microsoft Excel 365 for Windows (Microsoft, Redmond, WA, USA) to statis-tically analyse and process the collected data. Patient characteristics were reported as mean values (with standard deviation) or numbers (with percentages). The normality of data distribution was assessed using the Shapiro-Wilk test. Student’s t test was used to find any significant differences in the continuous variables such as age and functional outcomes between the two groups under investigation, if the distribution was normal the independent samples t-test was used to define the two-sided probability of statistical significance and Welch's test (t-test with correction for unequal variances) where the P-value of the F test was less than 0.05. 3. Results 3.1. Patients characteristics The study group was composed of 5 males (56%) and 4 females (44%) and the average patients age was of 53.3 ± 20.1 years. In 5 patients (56%) was involved the right side, whereas in 4 (44%) the left one. Regarding the fractured portion of the clavicle, in 2 (22%) patients was involved the lateral third of the clavicle, in 6 (67%) the middle third and in 1 (11%) the medial third. in 1 patient (11%) clavicle fracture was displaced and in 2 (22%) there were more than 2 fragments. With regard to scapula fractures, 3 (33,3%) patients had fractures involving articular portion of the bone or which could be defined as a floating shoulder pattern. The whole control group made up of all patient with isolated clavicle fractures was represented by 49 males (65%) and 26 females (35%) with an average age of 51.5 ± 18.5 years. According to the side involved, 39 patients (52%) suffered from a fracture of the right clavicle and 36 (48%) of the left one. In 22 patient (36%) the fracture affected the lateral portion of the clavicle, in 46 (61%) the middle third and in 2 (3%) the medial third. In 26 (36%) there was a displaced fracture pattern and in 6 (8%) a multifragmentary one. Table 1 Patient demographics Clavicle fracture group Total Patients N (%) Male N (%) Female N (%) Age Mean ± 1 SD 75 (89%) 49 (65%) 26 (35%) 51.55 ± 18.5 Clavicle and scapula fracture group 9 (11%) 5 (56%) 4 (44%) 53.33 ± 20.1 p value 0.56 0.79 Overall population 84 54 (64%) 30 (36%) 51.74 ± 18.7 Table 2 Comparison of the involved limb side in the two groups Involved limb side Right N (%) Left N (%) Clavicle fracture group 39 (52%) 36 (48%) Clavicle and scapula fracture group 5 (56%) 4 (44%) p value 0.84 Overall population 44 (52%) 40 (48%) Table 3 Comparison of the involved part of the clavicle between the two groups Involved part of the clavicle Lateral third N (%) Middle third N (%) Medial third N (%) Clavicle fracture group 27 (36%) 46 (61%) 2 (3%) Clavicle and scapula fracture group 2 (22%) 6 (67%) 1 (11%) p value 0.35 Overall population 29 (34%) 52 (62%) 3 (4%) Table 4 Comparison of fracture pattern between the two groups Fracture pattern Displaced fracture N (%) Multifragmentary fracture N (%) Clavicle fracture group 27 (36%) 6 (8%) Clavicle and scapula fracture group 1 (11%) 2 (22%) p value 0.13 0.18 Overall population 28 (33%) 8 (9%) The statistical comparison showed no significant differences in the distribution of the two samples analysed above. Indeed, both in terms of gender ( p = 0.56), age ( p = 0.79), side involved ( p = 0.84), clavicle portion fractured ( p = 0.35) and fracture pattern (displacement p = 0.13, and multifragmentry p = 0.17) the differences found did not reach statistical significance ( p > 0.05). For obvious reasons, the distribution features of the matched control group were exactly the same as the study group. 3.2. Outcome measure scores In the study group with concomitant and ipsilateral fracture of clavicle and scapula, the mean Constant Score was 91 ± 4.5 with a range of 82–96, the mean UCLA score was 91.33 ± 4.69 with a range of 83–99, and the mean DASH score was 4.65 ± 2.08 with a range of 2.5-9. Among the matched control group, the mean Constant Score was 92.56 ± 5.96 with a range of 80–100, the mean UCLA score was 92.96 ± 4.68 with a range of 85.7–100 and that of the DASH score was 4.14 ± 1.21 with a range of 3–6. Table 5 Comparison of patient clinical outcome Constant score UCLA score DASH score Mean ± 1 SD Range Mean ± 1 SD Range Mean ± 1 SD Range Clavicle fracture group 92.56 ± 5.96 80–100 92.96 ± 4.68 85.7–100 4.65 ± 2.08 2.5-9 Clavicle and scapula fracture group 91 ± 4.5 82–96 91.33 ± 4.69 83–99 4.14 ± 1.21 3–6 p value 0.54 0.47 0.54 Overall population 91.8 ± 5.23 80–100 92.15 ± 4.7 83–100 4.4 ± 1.64 2.5-9 Comparing the results of these questionnaires, the experimental group showed slightly worse values than the control group represented. This means that the mean value of the Constant Score was lower (91 ± 4.5 < 92.56 ± 5.96), the mean value of the UCLA score was also slightly lower (91.33 ± 4.69 < 92.96 ± 4.68), and the mean value of the DASH score was little higher (4.14 ± 1.21 0.05, respectively p = 0.54 for the DASH, p = 0.54 for the Constant score and p = 0.47 the UCLA score. 3 .3 Range of motion and strength Focusing on the evaluation of the range of motion, in the experimental group the mean value of anterior flexion was 161.67° ± 5.92° with a range of 150°-170°, slightly lower than in the control group where this value was 164.22° ± 6.53° with a range of 152°-170°, however there was no statistically significant difference between the two cohorts ( p = 0.40). The same applies to abduction, where the mean value was 155.56° ± 15.69° with a range of 168°-130° in the group of patients with ipsilateral concomitant fracture of the clavicle and scapula, slightly lower but not statistically significant compared to the control group where this result was 159.67° ± 14.76° with a range of 172°-136° ( p = 0.58). Table 6 Comparison of ROM in anterior flexion and abduction Anterior flexion Abduction Mean ± 1 SD Range Mean ± 1 SD Range Clavicle fracture group 164.22°±6.53° 150°-170° 159.67°±14.76° 172°-136° Clavicle and scapula fracture group 161.67°±5.92° 152°-170° 155.56°±15.69° 168 − 130° p value 0.54 0.58 Overall population 162.94°±6.22° 150°-170° 157.61°±15.22° 130°-172° In the study group, the mean value of internal rotation was 40.56° ± 3.91° with a range of 35°-45°, whereas the external rotation was 78.89° ± 10.24° with a range of 65°-90°. In the control group, the mean degree of internal rotation was 42.56° ± 2.96° with a range of 38°-45°, while that of external rotation was 82.22° ± 7.55° with a range of 70°-90°. Table 7 Comparison of ROM in internal and external rotation Internal rotation External rotation Mean ± 1 SD Range Mean ± 1 SD Range Clavicle fracture group 42.56°±2.96° 38°-45° 82.22°±7.55° 70°-90° Clavicle and scapula fracture group 40.56°±3.91° 35°-45° 78.89°±10.24° 65–90° p value 0.24 0.44 Overall population 41.56°±3.43° 35°-45° 80.55°±8.9° 65°-90° Even by comparing the ROM of internal and external rotation between the two cohorts, we can see slightly lower values in the experimental group (40.56° ± 3.91°<42.56° ± 2.96°; 78.89° ± 10.24°<82.22° ± 7.55°), although statistically significant results were not found (respectively p = 0.24 and p = 0.44). With regard to the strength, the patients with concomitant and ipsilateral fracture of the scapula and clavicle had an average of 20.56 ± 4.43 kg with a range of 13-26.5 kg, slightly lower than the control group of clavicle fracture patients, where the average reached value was 21.78 ± 5.49 kg with a range of 9.5–29 kg: these differences were not statistically significant ( p = 0.60). Table 8 Comparison of the strength values Strength Mean ± 1 SD Range Clavicle fracture group 21.78 ± 5.49 Kg 9.5–29 Kg Clavicle and scapula fracture group 20.56 ± 4.43 Kg 13-26.5 Kg p value 0.61 Overall population 21.17 ± 4.96 Kg 9.5–29 Kg 4. Discussion Scapula fractures account for less than 1% of all adult fractures and are associated with ipsilateral clavicle fracture in 25–30% of cases. The need for surgical treatment is still debated in the literature. Various authors claim that the results of conservative treatment can be satisfactory. In dislocated fractures, the most notable finding could be considered glenoid decomposition. Surgical fixation of the clavicle fracture alone in the floating shoulder have been reported in the literature with good short- and medium-term results[ 3 , 25 , 26 ], although not without complications in a small percentage of cases. Synthesis of the clavicle, auspicial between 1 and 10 days from the traumatic accident, may also lead to earlier mobilisation and initiation of physical therapy [ 3 ]. A systematic review of recent literature shows that there is still no consensus on clavicle or combined, clavicle and scapula, fixation in floating shoulder [ 13 ]. Labler et al[ 28 ] recommended scapular fixation if the fracture is displaced more than 25 mm or if the glenopolar angle (GPA) is reduced to < 30°. In fact, Dombrowsky et al [ 13 ], highlighted how some authors noted worse outcomes in patients with a preoperative GPA < 30°. Conservative treatment is also controversial.[ 8 , 10 , 12 ] Our findings indicate that conservative treatment may be a good option both for isolated clavicle fractures and those associated with the ipsilateral scapula. This suggests that the indications for conservative management used for isolated clavicle fractures—based on displacement and comminution—can be effectively extended to combined injuries. A clavicle fracture eligible for non-operative management in isolation does not automatically require fixation solely due to a concomitant scapula fracture. Furthermore, conservative treatment has the potential to improve range of motion, minimise complications and reduce treatment timing. Edwards et al. in their retrospective study analysed the results of conservative treatment. For cases with less than 5 mm of displacement, conservative treatment appears to have equivalent results to surgical treatment without the associated risks [ 29 ]. In the treatment of isolated clavicle fractures, satisfactory and comparable results were found for conservative and surgical treatment. In active and younger patients, surgical treatment may be advisable because of the short rehabilitation period, a faster return to sports activities and in consideration of the high non-union rate after conservative treatment [ 9 ]. Many factors, including fracture displacement, surgeon preference, patient age, patient activity requirements, degree of rehabilitation exercise, etc., have a potential influence on treatment strategies for floating shoulder injuries. [ 29 , 30 ]. Shao et al.[ 14 ] reported comparable outcomes for concomitant treatment of scapula and ipsilateral clavicle fractures and isolated treatment of clavicle fractures. According to literature, they report a better long-term outcome in older patients treated with clavicle and scapula fixation, in contrast to younger patients, whose results are superimposable. A return to sporting activity is not accurately analysed in the literature, as far as we are aware. Similarly, there is no single rehabilitation protocol. Reisch et al. attempted to summarise the objectives to be pursued during the rehabilitation course [ 31 ]. Despite the satisfactory outcomes of conservative treatment reported in the literature, albeit with limited sample sizes per study, we aim to provide further evidence of the treatment's effectiveness, thereby expanding knowledge on this topic. This study presents some limitation. Firstly, the sample size is small and could benefit from a control group in which the same fracture is treated surgically on both the scapula and the clavicle. Furthermore, an a priori power calculation was not performed because, due to the retrospective design of this research, the sample size was determined by the number of eligible patients available in our database, rather than by a pre-determined statistical analysis. However, the sample size is consistent with the current literature given the low incidence of clavicle fractures associated with ipsilateral scapula fractures. The study is limited by the length of follow-up. Although a one-year follow-up allows for the assessment of fracture union and final functional scores, it precludes a detailed timeline of return to daily activities and work, as well as long-term sequelae. Finally, given its retrospective nature and the impossibility of evaluating the physiotherapy protocol for each patient, the present study does not focus on rehabilitation, which is a key aspect of treatment. Similarly, the literature contains limited information on rehabilitation treatment. The literature lacks sufficient analysis of the outcome in patients with high functional demands or top-class sportspeople. These topics could serve as significant points of discussion and provide opportunities for future research. 5. Conclusions In our study patients with ipsilateral clavicle and scapula fractures treated conservatively showed no significant differences in clinical functional outcomes compared with patients with isolated clavicle fractures. As seen in the literature, good results can be obtained by conservative treatment of ipsilateral clavicle and scapula fractures and the findings from our retrospective study confirm this. The burden of the scapula fracture in concomitant clavicle fractures treated non-operatively appears not to be clinically relevant. Certainly, an important moment is to understand which is the best treatment for each patient. Even in the literature, it is not possible to determine which treatment is always the best and whether there are real differences between them, primarily because of the different characteristics of each patient, the different types of fracture and also the small number of patients in most of the studies mentioned. More studies with a larger number of patients, longer follow-up and higher methodological standards, such as prospective, randomized controlled trials, regarding the conservative treatment of ipsilateral clavicle and scapula fractures are needed. Declarations Informed Consent Statement: Informed consent was obtained from all subjects involved in the study. Conflicts of Interest: The authors declare no conflict of interest. Funding: This research received no external funding Author Contribution Author Contributions: Conceptualization, L.L., M.M. and M.D.C.; methodology, M.D.C. and M.M.; software, G.S.; validation, V.P., G.T. and L.C.; formal analysis, G.R.; investigation, G.S., M.D.C. and M.M; resources, A.V.; data curation, A.V., G.R., and F.B.; writing—original draft preparation, F.M.C.P, M.D.C, M.M. and L.L.; writing—review and editing, L.C. and V.P.; visualization, F.B. and A.V.; supervision, V.P. and G.T.; project administration, G.S. 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PMID: 12631494 Carosi M, Galeoto G, Gennaro SD, Berardi A, Valente D, Servadio A (2020) Transcultural reliability and validity of an Italian language version of the Constant–Murley Score. J Orthop Trauma Rehabilitation 27(2):186–191. 10.1177/2210491720945327 Marchese C, Cristalli G, Pichi B, Manciocco V, Mercante G, Pellini R, Marchesi P, Sperduti I, Ruscito P, Spriano G (2012) Italian cross-cultural adaptation and validation of three different scales for the evaluation of shoulder pain and dys-function after neck dissection: University of California - Los Angeles (UCLA) Shoulder Scale, Shoulder Pain and Dis-ability Index (SPADI) and Simple Shoulder Test (SST). Acta Otorhinolaryngol Ital 32(1):12–17 PMID: 22500061; PMCID: PMC3324966 Ziegler P, Kühle L, Stöckle U et al (2019) Evaluation of the Constant score: which is the method to assess the objective strength? BMC Musculoskelet Disord 20:403. https://doi.org/10.1186/s12891-019-2795-6 Oh CW, Jeon IH, Kyung HS, Park BC, Kim PT, Ihn JC (2002) The treatment of double disruption of the superior shoulder suspensory complex. Int Orthop 26:145–149. 10.1007/s00264-001-0325-1 Herscovici D, Fiennes A, Allgower M, Ruedi T (1992) The floating shoulder:Ipsilateral clavicle and scapular neck fractures. J Bone Joint Surg Br 74:362–364. 10.1302/0301-620X.74B3.1587877 Labler LMD, Platz AMD, Weishaupt DMD, Trentz OMD Clinical and Functional Results after Floating Shoulder Injuries. The Journal of Trauma: Injury, Infection, and Critical Care 57(3):p 595–602, September 2004. | 10.1097/01.TA.0000105883.79994.AB Edwards SG, Whittle AP, Wood GW 2 (2000) nd. Nonoperative treatment of ipsilateral fractures of the scapula and clavicle. J Bone Joint Surg Am. ;82(6):774 – 80. 10.2106/00004623-200006000-00003 . PMID: 10859096 Sameer R, Oak B, Klein NN, Verma B, Kerzner LM, Fortier, Neha S, Chava MM, Reinold, Asheesh Bedi, Rehabilitation and Return to Play of the Athlete after an Upper Extremity Injury, Arthroscopy, Sports Medicine, and, Rehabilitation (2022) Volume 4, Issue 1, Pages e163-e173, ISSN 2666-061X. https://doi.org/10.1016/j.asmr.2021.09.033 Reisch B, Fischer J (2012) Rehabilitation of a patient with 'floating shoulder' and associated fractures: a case report. Physiother Theory Pract 28(7):542–551. 10.3109/09593985.2011.654178 Epub 2012 Jan 30. PMID: 22288656.) Additional Declarations No competing interests reported. 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. 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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-9024223","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":607621403,"identity":"150d3457-ae20-4a9b-88e5-65594dd61dcb","order_by":0,"name":"Ludovico Lucenti","email":"","orcid":"","institution":"University of Palermo","correspondingAuthor":false,"prefix":"","firstName":"Ludovico","middleName":"","lastName":"Lucenti","suffix":""},{"id":607621405,"identity":"c7318af0-3870-49ef-b9a7-59912071752e","order_by":1,"name":"Mirko Castiglione","email":"","orcid":"","institution":"University of Catania","correspondingAuthor":false,"prefix":"","firstName":"Mirko","middleName":"","lastName":"Castiglione","suffix":""},{"id":607621408,"identity":"f8b3cedc-6122-4063-a9f2-411fae0f9a35","order_by":2,"name":"Maria Musumeci","email":"","orcid":"","institution":"University of Catania","correspondingAuthor":false,"prefix":"","firstName":"Maria","middleName":"","lastName":"Musumeci","suffix":""},{"id":607621409,"identity":"0b2df281-49ab-44be-bf14-274cbaca2edb","order_by":3,"name":"Andrea Vescio","email":"","orcid":"","institution":"Link Campus University","correspondingAuthor":false,"prefix":"","firstName":"Andrea","middleName":"","lastName":"Vescio","suffix":""},{"id":607621411,"identity":"8befd94a-b379-4207-8e9d-ad148d01dfc8","order_by":4,"name":"Giuseppe 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Catania","correspondingAuthor":false,"prefix":"","firstName":"Giulia","middleName":"","lastName":"Sciacca","suffix":""},{"id":607621414,"identity":"bff39eb4-e3eb-479a-9f55-4e075047136a","order_by":6,"name":"Gianluca Testa","email":"","orcid":"","institution":"University of Catania","correspondingAuthor":false,"prefix":"","firstName":"Gianluca","middleName":"","lastName":"Testa","suffix":""},{"id":607621419,"identity":"d5026609-337a-405b-8dd6-8e7110b5b930","order_by":7,"name":"Francesco Bosco","email":"","orcid":"","institution":"University of Palermo","correspondingAuthor":false,"prefix":"","firstName":"Francesco","middleName":"","lastName":"Bosco","suffix":""},{"id":607621421,"identity":"8b04f839-e0fc-49c4-aaa5-a3d1b0613b30","order_by":8,"name":"Lawrence Camarda","email":"","orcid":"","institution":"University of Palermo","correspondingAuthor":false,"prefix":"","firstName":"Lawrence","middleName":"","lastName":"Camarda","suffix":""},{"id":607621422,"identity":"1a22c84d-46d2-497c-987c-afe3d16d6db5","order_by":9,"name":"Flora Maria Chiara Panvini","email":"","orcid":"","institution":"University of Catania","correspondingAuthor":false,"prefix":"","firstName":"Flora","middleName":"Maria Chiara","lastName":"Panvini","suffix":""},{"id":607621424,"identity":"463f4797-5c09-480d-8f84-dd5db3948f4c","order_by":10,"name":"Vito Pavone","email":"","orcid":"","institution":"University of Catania","correspondingAuthor":false,"prefix":"","firstName":"Vito","middleName":"","lastName":"Pavone","suffix":""}],"badges":[],"createdAt":"2026-03-03 23:53:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9024223/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9024223/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":105035696,"identity":"38618896-ad34-4da0-bbf6-ca326bae974b","added_by":"auto","created_at":"2026-03-20 07:26:28","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":282096,"visible":true,"origin":"","legend":"\u003cp\u003ePatients’ selection flow-chart\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9024223/v1/517457cc2df6c7af91f51fdb.jpeg"},{"id":105036863,"identity":"19fcb596-425d-4d88-b01f-50ceaf3d3908","added_by":"auto","created_at":"2026-03-20 07:36:26","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1142057,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9024223/v1/9c4f44bb-1a88-48a2-905c-048359162b36.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Conservative Management of Ipsilateral Clavicle and Scapula Fractures in Adults: A Retrospective Study","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eThe term 'floating shoulder' was first introduced by Ganz [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] who described a lesion of the ipsilateral fracture of the middle third of the clavicle and glenoid neck. Subsequently Goss [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] extended the concept of the floating shoulder to include any double disruption of the superior shoulder suspensory complex (SSSC). The SSSC represents a ring of soft tissue and bone whose his lack of continuity following injury, predisposes to a number of complications, including non-union, malunion, shoulder dysfunction, weakness and fatigue, which may eventually lead to early joint degeneration [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIsolated clavicle fractures represent quite common injuries with an incidence of ap-proximately 2.6- 4% in the adult population, accounting for 44% of shoulder girdle-related fractures. Fractures of the mid-shaft are the most frequent in the 69\u0026ndash;75% of the cases[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Due to its mobility and the protection provided by the surrounding muscle masses, scapula fractures are uncommon, accounting for 3% to 5% of all shoulder fractures and merely 1% of fractures involving the entire human body [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. About 25% of all scapula fractures are complicated by a clavicle fracture or acromion-clavicular dislocation.\u003c/p\u003e \u003cp\u003eConservative treatment of isolated clavicle fractures usually consists of immobilization with a figure-of-eight bandage or a sling for 4 to 6 weeks.\u003c/p\u003e \u003cp\u003eIn the evaluation of treatment strategies for an isolated clavicle fracture, it may be beneficial to consider a number of patient-related factors, including age, the necessity for return to sporting activities and the degree of fracture comminution. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Non-unions represent the most frequent complication of conservative treatment, accounting for 7% to 15%, also resulting in a poorer long-term outcome than the contralateral uninvolved limb [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe treatment of floating shoulders is still controversial [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The results of conservative treatment are often analogous to those achieved through surgical intervention. Conservative treatment, as described by various authors in the literature, involves the use of figure of 8-bandage or alternatively the Velpau bandage or triangular sling for one month [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAccording to specific indications, conservative treatment of the clavicle fractures and associated ipsilateral scapular fracture is accepted in the literature and clinical practice in the management of floating shoulder [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. In fact, nonoperative treatment could achieve satisfactory results probably equal or superior to those reported after operative treatment, without the risk of operative complications [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThere is a paucity of literature examining the short- and long-term clinical outcomes of clavicle fractures associated with ipsilateral scapula fractures treated with a conservative approach [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Similarly, there is a dearth of studies investigating whether an associated scapula fracture can negatively impact the short- and long-term outcomes of clavicle fractures or whether the results are superimposable [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOur study aimed to investigate the prevalence of concomitant clavicle and ipsilateral scapula fractures and to determine whether conservative treatment yields comparable clinical outcomes to isolated clavicle fractures treated conservatively.\u003c/p\u003e"},{"header":"2. Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Participants selection\u003c/h2\u003e \u003cp\u003e In this retrospective study, we conducted a comprehensive review of the medical records of all patients who had been treated conservatively for an isolated clavicle fracture or a clavicle fracture and an associated omolateral scapula fracture at the Orthopaedics and Traumatology Unit of the University Hospital \"Policlinico G. Rodolico-San Marco\" in Catania over a three-year period, between January 2020 and December 2022.\u003c/p\u003e \u003cp\u003eThe patients included in the study were identified in accordance with the specific inclusion and exclusion criteria. The inclusion criteria were as follows: 1) clavicle fracture; 2) concomitant ipsilateral scapula fracture; 3) conservative treatment; 4) patients over 18 and under 85 years old; 5) minimum one-year follow-up.\u003c/p\u003e \u003cp\u003eThe exclusion criteria were: 1) age under 18 and over 85 years old; 2) surgical treatment; 3) follow-up of less than one year; 4) dementia and psychiatric pathologies; 5) refractures; 6) exposed fractures; 7) additional fractures of the upper limb. 8) Incomplete or absent data.\u003c/p\u003e \u003cp\u003eA total of 201 patients treated at our hospital for clavicle fracture were initially identified during the period under analysis. In accordance to the aforementioned inclusion and exclusion criteria, as illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, the identification of the final study group, comprised nine patients with a concomitant ipsilateral fracture of the clavicle and scapula, representing 10.7% of the total sample. The remaining 75 patients (89%) with isolated clavicle fractures, who had been selected based on the aforementioned exclusion and inclusion criteria, constituted the control group.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eIn order to facilitate a more accurate and clinically meaningful comparison of the results of our study group with those of patients with an isolated clavicle fracture, a control group was created using matching techniques. A one-to-one matching technique was employed to minimize selection bias and maximize the comparability of baseline characteristics between the two cohorts, thereby simulating a randomized trial design as closely as possible in a retrospective setting[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Specifically, the control group was designed to be as similar as possible to the study group in terms of key characteristics, including age (within a range of +/- 5 years), gender, involved limb laterality, and fracture pattern.\u003c/p\u003e \u003cp\u003eBy matching the study group with the control group, comprising 75 patients in total, a 1:1 matched control group of nine patients with a single clavicle fracture was obtained.\u003c/p\u003e \u003cp\u003eAll demographic and clinical data pertaining to the patients were collected during outpatient follow-ups and reviewed from medical records, discharge sheets and ambulatory reports. Radiographs and, when available, CT scans were also subjected to careful evaluation in order to ascertain the type of fracture and any concomitant injuries.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Conservative treatment\u003c/h2\u003e \u003cp\u003eAll the patients admitted to our Unit and included in the study were assessed both clinically and radiographically in the emergency room at the time of the trauma, carefully evaluating the function of the entire upper limb to rule out any neurological or vascular lesions. They were instructed on how to wear the figure eight bandage or arm brace correctly and how to keep it in the correct position to avoid either excessive axillary compression or fracture displacement. Subsequently, they were followed-up weekly for re-wearing of the bandage, after one month for a radiographic check and then at three, six and nine months until one year after the injury.\u003c/p\u003e \u003cp\u003eRadiographic evaluation was important to assess fracture healing but also to investigate possible complications such as malunion/nonunion and post-traumatic osteoarthritis.\u003c/p\u003e \u003cp\u003eThe figure-of-eight bandage was maintained until evidence of bone callus was observed on radiography or for a minimum of one month.\u003c/p\u003e \u003cp\u003eTreatment with an eight-bandage involves mobilising the elbow to the extent tolerated, with no limits on range of motion. In contrast, treatment with a brace involves immobilisation for 15 days, during which time the arm must not move. This is followed by passive and active mobilization of the elbow to the extent tolerated.\u003c/p\u003e \u003cp\u003eThereafter, the patient was encouraged to commence progressive active and passive mobilisation of the affected scapular girdle with the assistance of a physiotherapist. Initially, maximum excursion in abduction, adduction and external and internal-external rotation was avoided. Once the fracture had healed, the patient was referred for a comprehensive physiotherapy program aimed at restoring full function of the upper limb, comprising muscle strengthening and active mobilisation exercises.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Patients evaluation\u003c/h2\u003e \u003cp\u003eIn order to assess their clinical-functional outcome three validated score systems questionnaires were used: the Disabilities of the Arm, Shoulder and Hand Score (DASH), the Constant score and the UCLA shoulder score [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. We administered Italian translated and validated versions [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn addition, strength and range of motions (ROM) were assessed and recorded separately.\u003c/p\u003e \u003cp\u003eShoulder ranges of movement were evaluated in the different planes (elevation, ab-duction, external rotation and internal rotation) and measured with the aid of a goniometer. Regarding strength measurement, it is suggested to use a digital dynamometer attached distal on the forearm and to measure with the arm in 90 degrees of elevation in the plane of the scapula (20\u0026ndash;30 degrees in front of the coronal plane), elbow straight and palm of the hand facing the floor (pronation) [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Statistical analysis\u003c/h2\u003e \u003cp\u003eWe used Microsoft Excel 365 for Windows (Microsoft, Redmond, WA, USA) to statis-tically analyse and process the collected data.\u003c/p\u003e \u003cp\u003ePatient characteristics were reported as mean values (with standard deviation) or numbers (with percentages). The normality of data distribution was assessed using the Shapiro-Wilk test. Student\u0026rsquo;s t test was used to find any significant differences in the continuous variables such as age and functional outcomes between the two groups under investigation, if the distribution was normal the independent samples t-test was used to define the two-sided probability of statistical significance and Welch's test (t-test with correction for unequal variances) where the P-value of the F test was less than 0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e3.1. Patients characteristics\u003c/h2\u003e \u003cp\u003eThe study group was composed of 5 males (56%) and 4 females (44%) and the average patients age was of 53.3\u0026thinsp;\u0026plusmn;\u0026thinsp;20.1 years. In 5 patients (56%) was involved the right side, whereas in 4 (44%) the left one. Regarding the fractured portion of the clavicle, in 2 (22%) patients was involved the lateral third of the clavicle, in 6 (67%) the middle third and in 1 (11%) the medial third. in 1 patient (11%) clavicle fracture was displaced and in 2 (22%) there were more than 2 fragments. With regard to scapula fractures, 3 (33,3%) patients had fractures involving articular portion of the bone or which could be defined as a floating shoulder pattern.\u003c/p\u003e \u003cp\u003eThe whole control group made up of all patient with isolated clavicle fractures was represented by 49 males (65%) and 26 females (35%) with an average age of 51.5\u0026thinsp;\u0026plusmn;\u0026thinsp;18.5 years. According to the side involved, 39 patients (52%) suffered from a fracture of the right clavicle and 36 (48%) of the left one. In 22 patient (36%) the fracture affected the lateral portion of the clavicle, in 46 (61%) the middle third and in 2 (3%) the medial third. In 26 (36%) there was a displaced fracture pattern and in 6 (8%) a multifragmentary one.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatient demographics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eClavicle fracture group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal Patients N (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMale N (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFemale N (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAge Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;1 SD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e75 (89%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49 (65%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26 (35%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e51.55\u0026thinsp;\u0026plusmn;\u0026thinsp;18.5\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClavicle and scapula fracture group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (56%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (44%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e53.33\u0026thinsp;\u0026plusmn;\u0026thinsp;20.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall population\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54 (64%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30 (36%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e51.74\u0026thinsp;\u0026plusmn;\u0026thinsp;18.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of the involved limb side in the two groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eInvolved limb side\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClavicle fracture group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39 (52%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (48%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClavicle and scapula fracture group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (56%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (44%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall population\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44 (52%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40 (48%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of the involved part of the clavicle between the two groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eInvolved part of the clavicle\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLateral third\u003c/p\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMiddle third\u003c/p\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMedial third\u003c/p\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClavicle fracture group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27 (36%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46 (61%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClavicle and scapula fracture group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (67%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (11%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall population\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29 (34%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52 (62%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of fracture pattern between the two groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFracture pattern\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDisplaced fracture\u003c/p\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMultifragmentary fracture\u003c/p\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClavicle fracture group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27 (36%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClavicle and scapula fracture group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (22%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall population\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28 (33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe statistical comparison showed no significant differences in the distribution of the two samples analysed above. Indeed, both in terms of gender (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.56), age (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.79), side involved (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.84), clavicle portion fractured (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.35) and fracture pattern (displacement \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.13, and multifragmentry \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.17) the differences found did not reach statistical significance (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eFor obvious reasons, the distribution features of the matched control group were exactly the same as the study group.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.2. Outcome measure scores\u003c/h2\u003e \u003cp\u003eIn the study group with concomitant and ipsilateral fracture of clavicle and scapula, the mean Constant Score was 91\u0026thinsp;\u0026plusmn;\u0026thinsp;4.5 with a range of 82\u0026ndash;96, the mean UCLA score was 91.33\u0026thinsp;\u0026plusmn;\u0026thinsp;4.69 with a range of 83\u0026ndash;99, and the mean DASH score was 4.65\u0026thinsp;\u0026plusmn;\u0026thinsp;2.08 with a range of 2.5-9.\u003c/p\u003e \u003cp\u003eAmong the matched control group, the mean Constant Score was 92.56\u0026thinsp;\u0026plusmn;\u0026thinsp;5.96 with a range of 80\u0026ndash;100, the mean UCLA score was 92.96\u0026thinsp;\u0026plusmn;\u0026thinsp;4.68 with a range of 85.7\u0026ndash;100 and that of the DASH score was 4.14\u0026thinsp;\u0026plusmn;\u0026thinsp;1.21 with a range of 3\u0026ndash;6.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of patient clinical outcome\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eConstant score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUCLA score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDASH score\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;1 SD Range\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;1 SD Range\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;1 SD Range\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClavicle fracture group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e92.56\u0026thinsp;\u0026plusmn;\u0026thinsp;5.96 80\u0026ndash;100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e92.96\u0026thinsp;\u0026plusmn;\u0026thinsp;4.68 85.7\u0026ndash;100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.65\u0026thinsp;\u0026plusmn;\u0026thinsp;2.08 2.5-9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClavicle and scapula fracture group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91\u0026thinsp;\u0026plusmn;\u0026thinsp;4.5 82\u0026ndash;96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e91.33\u0026thinsp;\u0026plusmn;\u0026thinsp;4.69 83\u0026ndash;99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.14\u0026thinsp;\u0026plusmn;\u0026thinsp;1.21 3\u0026ndash;6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.54\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall population\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91.8\u0026thinsp;\u0026plusmn;\u0026thinsp;5.23 80\u0026ndash;100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e92.15\u0026thinsp;\u0026plusmn;\u0026thinsp;4.7 83\u0026ndash;100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.64 2.5-9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eComparing the results of these questionnaires, the experimental group showed slightly worse values than the control group represented. This means that the mean value of the Constant Score was lower (91\u0026thinsp;\u0026plusmn;\u0026thinsp;4.5\u0026thinsp;\u0026lt;\u0026thinsp;92.56\u0026thinsp;\u0026plusmn;\u0026thinsp;5.96), the mean value of the UCLA score was also slightly lower (91.33\u0026thinsp;\u0026plusmn;\u0026thinsp;4.69\u0026thinsp;\u0026lt;\u0026thinsp;92.96\u0026thinsp;\u0026plusmn;\u0026thinsp;4.68), and the mean value of the DASH score was little higher (4.14\u0026thinsp;\u0026plusmn;\u0026thinsp;1.21\u0026thinsp;\u0026lt;\u0026thinsp;4.65\u0026thinsp;\u0026plusmn;\u0026thinsp;2.08).\u003c/p\u003e \u003cp\u003eHowever, none of these differences were statistically significant, in fact for all the scores evaluated the \u003cem\u003ep\u003c/em\u003e-value was \u0026gt;\u0026thinsp;0.05, respectively \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.54 for the DASH, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.54 for the Constant score and \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.47 the UCLA score.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3\u003cem\u003e.3 Range of motion and strength\u003c/em\u003e\u003c/h2\u003e \u003cp\u003eFocusing on the evaluation of the range of motion, in the experimental group the mean value of anterior flexion was 161.67\u0026deg; \u0026plusmn; 5.92\u0026deg; with a range of 150\u0026deg;-170\u0026deg;, slightly lower than in the control group where this value was 164.22\u0026deg; \u0026plusmn; 6.53\u0026deg; with a range of 152\u0026deg;-170\u0026deg;, however there was no statistically significant difference between the two cohorts (\u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.40).\u003c/p\u003e \u003cp\u003eThe same applies to abduction, where the mean value was 155.56\u0026deg; \u0026plusmn; 15.69\u0026deg; with a range of 168\u0026deg;-130\u0026deg; in the group of patients with ipsilateral concomitant fracture of the clavicle and scapula, slightly lower but not statistically significant compared to the control group where this result was 159.67\u0026deg; \u0026plusmn; 14.76\u0026deg; with a range of 172\u0026deg;-136\u0026deg; (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.58).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of ROM in anterior flexion and abduction\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026minus;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026minus;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eAnterior flexion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eAbduction\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;1 SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRange\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;1 SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRange\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClavicle fracture group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e164.22\u0026deg;\u0026plusmn;6.53\u0026deg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e150\u0026deg;-170\u0026deg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e159.67\u0026deg;\u0026plusmn;14.76\u0026deg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e172\u0026deg;-136\u0026deg;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClavicle and scapula fracture group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e161.67\u0026deg;\u0026plusmn;5.92\u0026deg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e152\u0026deg;-170\u0026deg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e155.56\u0026deg;\u0026plusmn;15.69\u0026deg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e168\u0026thinsp;\u0026minus;\u0026thinsp;130\u0026deg;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall population\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e162.94\u0026deg;\u0026plusmn;6.22\u0026deg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e150\u0026deg;-170\u0026deg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e157.61\u0026deg;\u0026plusmn;15.22\u0026deg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c5\"\u003e \u003cp\u003e130\u0026deg;-172\u0026deg;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn the study group, the mean value of internal rotation was 40.56\u0026deg; \u0026plusmn; 3.91\u0026deg; with a range of 35\u0026deg;-45\u0026deg;, whereas the external rotation was 78.89\u0026deg; \u0026plusmn; 10.24\u0026deg; with a range of 65\u0026deg;-90\u0026deg;.\u003c/p\u003e \u003cp\u003eIn the control group, the mean degree of internal rotation was 42.56\u0026deg; \u0026plusmn; 2.96\u0026deg; with a range of 38\u0026deg;-45\u0026deg;, while that of external rotation was 82.22\u0026deg; \u0026plusmn; 7.55\u0026deg; with a range of 70\u0026deg;-90\u0026deg;.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of ROM in internal and external rotation\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026minus;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026minus;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eInternal rotation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eExternal rotation\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;1 SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRange\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;1 SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRange\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClavicle fracture group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42.56\u0026deg;\u0026plusmn;2.96\u0026deg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e38\u0026deg;-45\u0026deg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e82.22\u0026deg;\u0026plusmn;7.55\u0026deg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e70\u0026deg;-90\u0026deg;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClavicle and scapula fracture group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40.56\u0026deg;\u0026plusmn;3.91\u0026deg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e35\u0026deg;-45\u0026deg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e78.89\u0026deg;\u0026plusmn;10.24\u0026deg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e65\u0026ndash;90\u0026deg;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall population\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41.56\u0026deg;\u0026plusmn;3.43\u0026deg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e35\u0026deg;-45\u0026deg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e80.55\u0026deg;\u0026plusmn;8.9\u0026deg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c5\"\u003e \u003cp\u003e65\u0026deg;-90\u0026deg;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eEven by comparing the ROM of internal and external rotation between the two cohorts, we can see slightly lower values in the experimental group (40.56\u0026deg; \u0026plusmn; 3.91\u0026deg;\u0026lt;42.56\u0026deg; \u0026plusmn; 2.96\u0026deg;; 78.89\u0026deg; \u0026plusmn; 10.24\u0026deg;\u0026lt;82.22\u0026deg; \u0026plusmn; 7.55\u0026deg;), although statistically significant results were not found (respectively \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.24 and \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.44).\u003c/p\u003e \u003cp\u003eWith regard to the strength, the patients with concomitant and ipsilateral fracture of the scapula and clavicle had an average of 20.56\u0026thinsp;\u0026plusmn;\u0026thinsp;4.43 kg with a range of 13-26.5 kg, slightly lower than the control group of clavicle fracture patients, where the average reached value was 21.78\u0026thinsp;\u0026plusmn;\u0026thinsp;5.49 kg with a range of 9.5\u0026ndash;29 kg: these differences were not statistically significant (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.60).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab8\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 8\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of the strength values\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eStrength\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;1 SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRange\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClavicle fracture group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21.78\u0026thinsp;\u0026plusmn;\u0026thinsp;5.49 Kg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.5\u0026ndash;29 Kg\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClavicle and scapula fracture group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20.56\u0026thinsp;\u0026plusmn;\u0026thinsp;4.43 Kg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13-26.5 Kg\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall population\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21.17\u0026thinsp;\u0026plusmn;\u0026thinsp;4.96 Kg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.5\u0026ndash;29 Kg\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eScapula fractures account for less than 1% of all adult fractures and are associated with ipsilateral clavicle fracture in 25\u0026ndash;30% of cases. The need for surgical treatment is still debated in the literature. Various authors claim that the results of conservative treatment can be satisfactory. In dislocated fractures, the most notable finding could be considered glenoid decomposition. Surgical fixation of the clavicle fracture alone in the floating shoulder have been reported in the literature with good short- and medium-term results[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], although not without complications in a small percentage of cases. Synthesis of the clavicle, auspicial between 1 and 10 days from the traumatic accident, may also lead to earlier mobilisation and initiation of physical therapy [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. A systematic review of recent literature shows that there is still no consensus on clavicle or combined, clavicle and scapula, fixation in floating shoulder [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Labler et al[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] recommended scapular fixation if the fracture is displaced more than 25 mm or if the glenopolar angle (GPA) is reduced to \u0026lt;\u0026thinsp;30\u0026deg;. In fact, Dombrowsky et al [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], highlighted how some authors noted worse outcomes in patients with a preoperative GPA\u0026thinsp;\u0026lt;\u0026thinsp;30\u0026deg;. Conservative treatment is also controversial.[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] Our findings indicate that conservative treatment may be a good option both for isolated clavicle fractures and those associated with the ipsilateral scapula. This suggests that the indications for conservative management used for isolated clavicle fractures\u0026mdash;based on displacement and comminution\u0026mdash;can be effectively extended to combined injuries. A clavicle fracture eligible for non-operative management in isolation does not automatically require fixation solely due to a concomitant scapula fracture. Furthermore, conservative treatment has the potential to improve range of motion, minimise complications and reduce treatment timing. Edwards et al. in their retrospective study analysed the results of conservative treatment. For cases with less than 5 mm of displacement, conservative treatment appears to have equivalent results to surgical treatment without the associated risks [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. In the treatment of isolated clavicle fractures, satisfactory and comparable results were found for conservative and surgical treatment. In active and younger patients, surgical treatment may be advisable because of the short rehabilitation period, a faster return to sports activities and in consideration of the high non-union rate after conservative treatment [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Many factors, including fracture displacement, surgeon preference, patient age, patient activity requirements, degree of rehabilitation exercise, etc., have a potential influence on treatment strategies for floating shoulder injuries. [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Shao et al.[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] reported comparable outcomes for concomitant treatment of scapula and ipsilateral clavicle fractures and isolated treatment of clavicle fractures. According to literature, they report a better long-term outcome in older patients treated with clavicle and scapula fixation, in contrast to younger patients, whose results are superimposable. A return to sporting activity is not accurately analysed in the literature, as far as we are aware. Similarly, there is no single rehabilitation protocol. Reisch et al. attempted to summarise the objectives to be pursued during the rehabilitation course [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Despite the satisfactory outcomes of conservative treatment reported in the literature, albeit with limited sample sizes per study, we aim to provide further evidence of the treatment's effectiveness, thereby expanding knowledge on this topic. This study presents some limitation. Firstly, the sample size is small and could benefit from a control group in which the same fracture is treated surgically on both the scapula and the clavicle. Furthermore, an \u003cem\u003ea priori\u003c/em\u003e power calculation was not performed because, due to the retrospective design of this research, the sample size was determined by the number of eligible patients available in our database, rather than by a pre-determined statistical analysis. However, the sample size is consistent with the current literature given the low incidence of clavicle fractures associated with ipsilateral scapula fractures. The study is limited by the length of follow-up. Although a one-year follow-up allows for the assessment of fracture union and final functional scores, it precludes a detailed timeline of return to daily activities and work, as well as long-term sequelae. Finally, given its retrospective nature and the impossibility of evaluating the physiotherapy protocol for each patient, the present study does not focus on rehabilitation, which is a key aspect of treatment. Similarly, the literature contains limited information on rehabilitation treatment.\u003c/p\u003e \u003cp\u003eThe literature lacks sufficient analysis of the outcome in patients with high functional demands or top-class sportspeople. These topics could serve as significant points of discussion and provide opportunities for future research.\u003c/p\u003e"},{"header":"5. Conclusions","content":"\u003cp\u003eIn our study patients with ipsilateral clavicle and scapula fractures treated conservatively showed no significant differences in clinical functional outcomes compared with patients with isolated clavicle fractures. As seen in the literature, good results can be obtained by conservative treatment of ipsilateral clavicle and scapula fractures and the findings from our retrospective study confirm this. The burden of the scapula fracture in concomitant clavicle fractures treated non-operatively appears not to be clinically relevant. Certainly, an important moment is to understand which is the best treatment for each patient. Even in the literature, it is not possible to determine which treatment is always the best and whether there are real differences between them, primarily because of the different characteristics of each patient, the different types of fracture and also the small number of patients in most of the studies mentioned. More studies with a larger number of patients, longer follow-up and higher methodological standards, such as prospective, randomized controlled trials, regarding the conservative treatment of ipsilateral clavicle and scapula fractures are needed.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eInformed Consent\u003c/h2\u003e\n\u003cp\u003eStatement: Informed consent was obtained from all subjects involved in the study.\u003c/p\u003e\n\u003ch2\u003eConflicts of Interest:\u003c/h2\u003e\n\u003cp\u003eThe authors declare no conflict of interest.\u003c/p\u003e\n\u003ch2\u003eFunding:\u003c/h2\u003e\n\u003cp\u003eThis research received no external funding\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eAuthor Contributions: Conceptualization, L.L., M.M. and M.D.C.; methodology, M.D.C. and M.M.; software, G.S.; validation, V.P., G.T. and L.C.; formal analysis, G.R.; investigation, G.S., M.D.C. and M.M; resources, A.V.; data curation, A.V., G.R., and F.B.; writing\u0026mdash;original draft preparation, F.M.C.P, M.D.C, M.M. and L.L.; writing\u0026mdash;review and editing, L.C. and V.P.; visualization, F.B. and A.V.; supervision, V.P. and G.T.; project administration, G.S. All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003eData is contained within the article.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGanz R, Noesberger B (1975) Die Behandlung der Scapula-Frakturen [Treatment of scapular fractures]. Hefte Unfallheilkd. ;(126):59\u0026ndash;62. German. PMID: 1234274.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGoss TP (1993) Double disruptions of the superior shoulder suspensory complex. J Orthop Trauma. ;7(2):99\u0026ndash;106. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/00005131-199304000-00001\u003c/span\u003e\u003cspan address=\"10.1097/00005131-199304000-00001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. 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PMID: 22288656.)\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","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":"scapula, clavicle, fracture, conservative treatment, clavicle and scapula, clinical outcomes","lastPublishedDoi":"10.21203/rs.3.rs-9024223/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9024223/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eConcomitant clavicle and scapula fractures are rare. This study aimed to examine the prevalence and impact of combined clavicle and scapula fractures on treatment and outcomes compared to isolated clavicle fractures.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA retrospective cohort analysis of patients treated in a three-year period with clavicle fractures and ipsilateral scapula fracture (range 18\u0026ndash;85 years) were selected. In consideration of the demographic characteristics, a control group was selected with an isolated clavicle fracture, comparable in terms of radiographical features (fracture of the middle third). Functional outcomes were assessed using Constant-Murley and Disability of the Arm, Shoulder and Hand (DASH) scores, along with shoulder range of motion (ROM) measurements.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eWith an accurate retrospective analysis, 201 patients were treated for clavicle fracture in our department, and 144 met the age criteria (101 males/43 females). Focusing on the inclusion criteria, patients with concomitant middle third of clavicle fracture associated with an omolateral non articular scapular fracture were selected, thereby a total of nine patients (6,25%), mean age 53\u0026thinsp;\u0026plusmn;\u0026thinsp;20.1 years, represent our group of interest. Only three cases involved floating shoulder injuries. Conservative treatment implies the use of a sling or a figure-of-8 bendages for 6 weeks. Outcomes showed a mean Constant-Murley score of 89.22 and DASH score of 3.3, with limited ROM loss.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe association of clavicle and undisplaced or minimally displaced scapula fractures does not modify significantly the treatment and the outcomes; these fractures seem to\u003c/p\u003e","manuscriptTitle":"Conservative Management of Ipsilateral Clavicle and Scapula Fractures in Adults: A Retrospective Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-19 16:32:18","doi":"10.21203/rs.3.rs-9024223/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":"d76f61c4-b23b-4a7b-91ba-24527419e20d","owner":[],"postedDate":"March 19th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-19T16:32:19+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-19 16:32:18","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9024223","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9024223","identity":"rs-9024223","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}