{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T02:23:47Z","timestamp":1781922227477,"version":"3.54.5"},"reference-count":38,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2021,2,17]],"date-time":"2021-02-17T00:00:00Z","timestamp":1613520000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Shoulder &amp; Elbow"],"published-print":{"date-parts":[[2022,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The primary aim of this study was to compare the long-term functional outcome of midshaft clavicle fracture fixation for delayed (\u22653 month) and non-union (\u22656 month) compared to a matched cohort of patients that achieved union with non-operative management. The secondary aim was to assess cost-effectiveness of fixation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A consecutive series of patients over 10-years were retrospectively reviewed using the QuickDASH, Oxford Shoulder Score and EuroQol five-dimension summary index (EQ-5D). These patients were compared to a matched cohort that achieved union after non-operative management using propensity score matching.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Sixty patients (follow-up 79%,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200960\/76) at 4.1 years post-operative (1.1\u201310.0 years) had a QuickDASH of 16.5 (95% CI 11.6\u201321.5), Oxford Shoulder Score 41.5 (39.0\u201344.1) and EQ-5D 0.7621 (0.6822\u20130.8421). One in five patients were dissatisfied with their final outcome (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200913\/60). Functional outcome was inferior following fixation when compared to patients that united with non-operative management (QuickDASH 16.5 vs. 5.5,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001 and EQ-5D 0.7621 vs. 0.9073,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001). However, significant improvements were found when compared to pre-operative scores (QuickDASH\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001 and EQ-5D\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). The cost per QALY for fixation was \u00a35624.62 for the study cohort.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Clavicle fixation for delayed and non-union is a cost-effective intervention but outcomes are worse compared to patients that unite with non-operative management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/1758573221990367","type":"journal-article","created":{"date-parts":[[2021,2,21]],"date-time":"2021-02-21T08:43:06Z","timestamp":1613896986000},"page":"360-367","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":4,"title":["Plate fixation of midshaft clavicle fractures for delayed union and non-union is a cost-effective intervention but functional deficits persist at long-term follow-up"],"prefix":"10.1177","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2949-6236","authenticated-orcid":false,"given":"Ben","family":"Fox","sequence":"first","affiliation":[{"name":"Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas David","family":"Clement","sequence":"additional","affiliation":[{"name":"Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah J","family":"MacDonald","sequence":"additional","affiliation":[{"name":"Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Robinson","sequence":"additional","affiliation":[{"name":"Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3640-8254","authenticated-orcid":false,"given":"Jamie A","family":"Nicholson","sequence":"additional","affiliation":[{"name":"Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2021,2,17]]},"reference":[{"key":"e_1_3_2_2_2","first-page":"CD007429","article-title":"Surgical versus conservative interventions for treating fractures of the middle third of the clavicle","volume":"10","author":"Lenza M","year":"2019","unstructured":"Lenza M, Buchbinder R, Johnston RV, et al. 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