1. Nottingham Clavicle Score
2. Clavicle Shaft Fractures
3. Titanium Elastic Nailing
4. Orthopedic Outcome Measures
5. Clavicle Injury Treatment


A recently published article in the “Journal of Clinical Orthopaedics and Trauma” sheds light on the efficacy of the Nottingham Clavicle Score (NCS) in assessing the functional outcomes of surgically treated clavicle shaft fractures. The study, conducted by a team under Vishwanathan Karthik K and Shantanu S Jain from the Department of Orthopaedics at Pramukhswami Medical College, India, focuses on the validity and responsiveness of the NCS in patients who underwent titanium elastic nailing procedure. The findings of this study are instrumental in establishing the credibility of NCS as a tool for evaluating patient outcomes following clavicle fracture surgeries.


Clavicle fractures are a common occurrence, and treatment often varies between conservative management and surgical intervention. When opting for surgery, doctors may use different methods such as plating or intramedullary fixation like titanium elastic nailing. It’s crucial to assess outcomes through reliable and validated scoring systems, which is where the Nottingham Clavicle Score comes into play. It is important for patients and clinicians to utilize a system that accurately reflects the recovery and functionality after treatment. Prior to this study, the NCS’s adequacy in the context of surgically treated clavicle shaft fractures had not been thoroughly investigated.


DOI: 10.1016/j.jcot.2018.06.004

The study was a prospective analysis conducted on patients with clavicle shaft fractures who were consecutively operated on using titanium elastic nails from November 2013 to August 2016. The Nottingham Clavicle Score, a patient-reported outcome measure, was administered at two and six months postoperatively. The study aimed to validate the construct of the score by testing pre-specified hypotheses about expected outcomes. Furthermore, it assessed responsiveness through standardized response mean (SRM) and effect size (ES) while also checking for floor and ceiling effects to evaluate internal validity.


According to the study, 36 patients were included, and the NCS at the two follow-up intervals showed a significant improvement (69.6 ± 9.6 at two months; 87.2 ± 7.1 at six months). No significant difference was found in the NCS of patients whether they underwent open or closed reduction or among different types of clavicle fractures (15B1 and 15B2), thus supporting the NCS’s construct validity. Additionally, the Nottingham Clavicle Score exhibited excellent responsiveness with an ES of 1.8 and SRM of 2.6. The score showed no issues of floor or ceiling effects at either of the two postoperative time points.


The study’s results demonstrate that the Nottingham Clavicle Score has commendable construct validity, internal validity, and responsiveness for evaluation in clavicle shaft fractures treated with titanium elastic nailing. This validation indicates that the NCS can be a reliable tool in both clinical practice and research settings for assessing patient outcomes post-surgery. The importance of such a targeted outcome measure cannot be overstated as it provides a nuanced view of the specific impacts of clavicle-related treatments.


The research put forth by the Pramukhswami Medical College’s Department of Orthopaedics is an invaluable contribution to orthopedic care and outcome measurement, enhancing our understanding of clavicle fracture management’s success. With a reliable scoring system like the Nottingham Clavicle Score, medical professionals can quantify patient recovery with greater accuracy, resulting in improved patient care and informed clinical decision-making.


1. Karthik K, V., Jain, S. S., & Patel, A. A. (2019). Validity and responsiveness of the Nottingham Clavicle Score in clavicle shaft fractures treated with titanium elastic nailing. Journal of Clinical Orthopaedics and Trauma, 10(3), 497–502. doi:10.1016/j.jcot.2018.06.004

2. Charles, E., Kumar, V., & Blacknall, J. (2017). A validation of the Nottingham Clavicle score: a Clavicle, acromioclavicular joint, and sternoclavicular joint-specific patient-reported outcome measure. Journal of Shoulder and Elbow Surgery, 26(10), 1732–1739. doi:10.1016/j.jse.2017.03.005

3. Vascellari, A., Schiavetti, S., & Rebuzzi, E. et al. (2015). Translation, cross-cultural adaptation, and validation of the Italian version of the Nottingham Clavicle Score (NCS). Archives of Orthopaedic and Trauma Surgery, 135(11), 1561–1566. doi:10.1007/s00402-015-2312-5

4. Kumar, V. et al. (2014). Modified Weaver-Dunn procedure versus the use of a synthetic ligament for acromioclavicular joint reconstruction. Journal of Orthopaedic Surgery (Hong Kong), 22(2), 199–203. doi:10.1177/230949901402200211

5. Sciascia, A. D., Morris, B. J., & Edwards, T. B. (2017). Responsiveness and internal validity of common patient-reported outcome measures following total shoulder arthroplasty. Orthopedics, 40(3), 513–519. doi:10.3928/01477447-20170412-02