Date of Award

Summer 8-28-2019

Document Type

Open Access Thesis

Degree Name

MS in Physician Assistant Studies (PA)


Physician Assistant Studies

First Advisor

Steven Gilles, MS, PA-C


Background: Clavicle fractures and scapula fractures represent up to 4% and 1% of all fractures, respectively.1-4,9-11 Historically, both fracture types have been treated conservatively with acceptable outcomes. The surgical correction of these fractures is currently being investigated as a viable alternative to conservative management.

Method: A systematic search of PubMed was performed to identify articles comparing open reduction and internal fixation (ORIF) with conservative treatment for both clavicular and scapular fractures. Specific outcomes of interest were shoulder function, pain, strength, range of motion, and risk of nonunion.

Results: ORIF of midshaft clavicular fractures results in increased shoulder function within six weeks following treatment and a decreased risk of nonunion. After one year, there was no longer a difference in shoulder function between groups. There was no difference in pain between treatment groups. Both ORIF and conservative treatment of extraarticular scapular fractures yield comparable results in shoulder function, range of motion, and strength following treatment.

Conclusions: Both conservative and operative treatment of midshaft clavicular fractures yield acceptable, long-term outcomes in shoulder function and pain, although conservative treatment has a higher risk of nonunion. More randomized clinical trials are needed to address the high heterogeneity between studies, which is limiting the strength of the current evidence. The lack of randomized clinical trials comparing operative and conservative treatment of extraarticular scapular fractures does not allow for specific conclusions to be made regarding superiority of treatment; only that both treatment options produce acceptable results. Therefore, additional studies are warranted.


SC 11.PAS.2019.Davis.C