{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T14:12:21Z","timestamp":1768399941607,"version":"3.49.0"},"reference-count":18,"publisher":"British Editorial Society of Bone & Joint Surgery","issue":"1","license":[{"start":{"date-parts":[[2016,1,1]],"date-time":"2016-01-01T00:00:00Z","timestamp":1451606400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/online.boneandjoint.org.uk\/TDM"}],"content-domain":{"domain":["online.boneandjoint.org.uk"],"crossmark-restriction":true},"short-container-title":["The Bone &amp; Joint Journal"],"published-print":{"date-parts":[[2016,1]]},"abstract":"<jats:sec><jats:title>Aims<\/jats:title><jats:p>This study identifies early risk factors for symptomatic nonunion of displaced midshaft fractures of the clavicle that aid identification of an at risk group who may benefit from surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We performed a retrospective study of 88 patients aged between 16 and 60 years that were managed non-operatively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The rate of symptomatic nonunion requiring surgery was 14% (n = 13). Smoking (odds ratio (OR) 40.76, 95% confidence intervals (CI) 1.38 to 120.30) and the six week Disabilities of the Arm Shoulder and Hand (DASH) score (OR 1.11, 95% CI 1.01 to 1.22, for each point increase) were independent predictors of nonunion. A six week DASH score of 35 or more was identified as a threshold value to predict nonunion using receiver operating characteristic curve analysis. Smoking and the threshold value in the DASH and were additive risk factors for nonunion, when neither were present the risk of nonunion was 2%, if one or the other were present the nonunion rate was between 17% to 20%, and if both were present the rate increased to 44%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Patients with either of these risk factors, which include approximately half of all patients sustaining displaced midshaft fractures of the clavicle, are at an increased risk of developing a symptomatic non-union. Take home message: Smoking and failure of functional return at six weeks are significant predictors of nonunion of the midshaft of the clavicle. Such patients warrant further investigation as to whether they would benefit from early surgical fixation in order to avoid the morbidity of a nonunion. Cite this article: Bone Joint J 2016;98-B:125\u201330.<\/jats:p><\/jats:sec>","DOI":"10.1302\/0301-620x.98b1.36260","type":"journal-article","created":{"date-parts":[[2016,1,5]],"date-time":"2016-01-05T14:10:49Z","timestamp":1452003049000},"page":"125-130","update-policy":"https:\/\/doi.org\/10.1302\/crossmark-policy","source":"Crossref","is-referenced-by-count":43,"title":["Smoking status and the Disabilities of the Arm Shoulder and Hand score are early predictors of symptomatic nonunion of displaced midshaft fractures of the clavicle"],"prefix":"10.1302","volume":"98-B","author":[{"given":"N. D.","family":"Clement","sequence":"first","affiliation":[{"name":"Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh EH16 4SA, UK."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E. B.","family":"Goudie","sequence":"additional","affiliation":[{"name":"Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh EH16 4SA, UK."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A. J.","family":"Brooksbank","sequence":"additional","affiliation":[{"name":"Glasgow Royal Infirmary, 84 Castle Street, Glasgow G4 0SF, UK."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T. J. S.","family":"Chesser","sequence":"additional","affiliation":[{"name":"Southmead Hospital, Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB, UK."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C. M.","family":"Robinson","sequence":"additional","affiliation":[{"name":"Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh EH16 4SA, UK."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"42","reference":[{"key":"r1","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2006.04.130"},{"key":"r2","doi-asserted-by":"publisher","DOI":"10.1016\/0020-1383(75)90006-6"},{"key":"r3","doi-asserted-by":"publisher","DOI":"10.1097\/00005131-199811000-00008"},{"key":"r4","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.K.01275"},{"key":"r5","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.F.00020"},{"key":"r6","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-200407000-00002"},{"key":"r7","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0b013e3181d8290e"},{"key":"r8","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.79B4.0790537"},{"key":"r9","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.L.00307"},{"key":"r10","first-page":"341","volume":"38","author":"Judd DB","year":"2009","journal-title":"Am J Orthop (Belle Mead NJ)"},{"key":"r11","first-page":"CD009363","volume":"6","author":"Lenza M","year":"2013","journal-title":"Cochrane Database Syst Rev"},{"key":"r12","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-013-1871-z"},{"key":"r13","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0274(199606)29:6<602::AID-AJIM4>3.0.CO;2-L"},{"key":"r14","doi-asserted-by":"publisher","DOI":"10.1016\/S0304-3959(01)00349-9"},{"key":"r15","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-014-2450-7"},{"key":"r16","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2013.06.025"},{"key":"r17","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1097\/00003086-198701000-00023","volume":"214","author":"Constant CR","year":"1987","journal-title":"Clin Orthop Relat Res"},{"key":"r18","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.J.01999"}],"container-title":["The Bone &amp; Joint Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/online.boneandjoint.org.uk\/doi\/pdf\/10.1302\/0301-620X.98B1.36260","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/online.boneandjoint.org.uk\/doi\/full-xml\/10.1302\/0301-620X.98B1.36260","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/online.boneandjoint.org.uk\/doi\/pdf\/10.1302\/0301-620X.98B1.36260","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,5,31]],"date-time":"2022-05-31T22:40:45Z","timestamp":1654036845000},"score":1,"resource":{"primary":{"URL":"https:\/\/online.boneandjoint.org.uk\/doi\/10.1302\/0301-620X.98B1.36260"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,1]]},"references-count":18,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2016,1]]}},"alternative-id":["10.1302\/0301-620X.98B1.36260"],"URL":"https:\/\/doi.org\/10.1302\/0301-620x.98b1.36260","relation":{},"ISSN":["2049-4394","2049-4408"],"issn-type":[{"value":"2049-4394","type":"print"},{"value":"2049-4408","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,1]]},"assertion":[{"value":"2015-04-01","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2015-08-07","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2016-01-01","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}