Development of the Utrecht Score for clavicle fractures: a short and complete clavicle score with patient-reported and objective measures

  • Martijn Hulsmans
  • Steven Ferree
  • Marijn Houwert
  • Marcel Dijkgraaf
  • Egbert Jan Verleisdonk
  • Mark van Heijl
Original Article



The purpose of this study was to develop a clavicle-specific questionnaire with patient-reported and objective measures.


The present study used data of DASH and Constant scores from a previously performed randomized-controlled trial comparing plate and intramedullary pin fixation of clavicle fractures. Exploratory factor analysis was used to identify the most relevant items and the underlying structure of the questionnaires. To optimize the applicability to patients with a clavicle fracture, the selected items were reformulated. If relevant themes were underexposed, an additional question was added.


Based on the scree plot of eigenvalues and the parallel analysis, a seven-factor model with good factorability was constructed. Using exploratory factor analysis, 13 patient-reported and 2 objective measurements were identified. The internal consistency of the selected questions was excellent. An additional question was added to cover complaints relating to direct pressure on the clavicle and implants.


The Utrecht Score for clavicle fractures is a compact yet complete tool that was developed to assess functional outcome specifically in patients with a clavicle fracture, consisting of patient-reported and objective measures. After external validation, the USC can be used for research purposes or clinical follow-up during rehabilitation in patients with a clavicle fracture.


Clavicle Questionnaire Patient-reported Functional outcome 


Compliance with ethical standards

Conflict of interest

M. Hulsmans, S. Ferree, R Houwert, M Dijkgraaf, E.J. Verleisdonk, and M. van Heijl declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Martijn Hulsmans
    • 1
  • Steven Ferree
    • 1
  • Marijn Houwert
    • 2
  • Marcel Dijkgraaf
    • 3
  • Egbert Jan Verleisdonk
    • 1
  • Mark van Heijl
    • 1
  1. 1.Department of SurgeryDiakonessenhuis UtrechtUtrechtThe Netherlands
  2. 2.Utrecht Traumacenter, UtrechtUtrechtThe Netherlands
  3. 3.Clinical Research UnitAcademic Medical Center AmsterdamAmsterdamThe Netherlands

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