Dash score of clavicle
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DASH score clavicle fracture outcome scoring
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Here is a comprehensive overview of the DASH score as it relates to clavicle fractures, drawn from Rockwood and Green's Fractures in Adults (10th ed., 2025):
DASH Score and Clavicle Fractures
What is the DASH Score?
The Disabilities of the Arm, Shoulder and Hand (DASH) is a patient-reported outcome measure (PROM) used to quantify the impact of upper limb impairment on function. It consists of 30 disability/symptom items, each scored 1-5. At least 27 of the 30 items must be completed. The formula is:
DASH score = [(sum of responses / n) - 1] × 25
- Score range: 0-100
- Higher score = greater disability
- Lower score = better function
Role in Outcome Assessment After Clavicle Fractures
The DASH is one of the standard outcome tools used alongside the Constant shoulder score, SF-36, and UCLA shoulder score in clavicle fracture research. It captures the patient's perspective on limb function and disability.
Key limitation - "ceiling effect": The typical clavicle fracture patient is young with excellent baseline function. After recovery, DASH scores tend to cluster in the upper (near-normal) regions of the scale, making it less sensitive for picking up minor residual symptoms. This is a recognized limitation in this population.
Time to maximal recovery: DASH and Constant scores do not change appreciably after 1 year from injury, making 1-year follow-up a reasonable endpoint for clinical studies (Schemitsch et al.).
DASH Score as a Predictor of Nonunion
This is a clinically important use of the DASH score:
- A DASH score ≥ 35 at 6 weeks after injury (indicating greater disability) is an early predictor of symptomatic nonunion in displaced midshaft clavicle fractures (Clement et al., Bone Joint J 2016).
- Smoking + DASH ≥ 35 at 6 weeks together dramatically increase nonunion risk:
- No risk factors: ~2% risk of symptomatic nonunion
- Both risk factors present: ~44% risk of nonunion
| Risk Factor | Nonunion Risk |
|---|---|
| No risk factors | ~2% |
| Smoking alone | Increased ~3x |
| DASH ≥35 at 6 weeks alone | Increased ~3x |
| Both smoking + DASH ≥35 | ~44% |
DASH Score: Operative vs. Nonoperative Treatment
- Meta-analyses show that surgical (plate) fixation favors better DASH scores compared to conservative management, particularly at intermediate (6-12 months) and late (≥24 months) follow-up.
- However, the difference rarely exceeds the minimal clinically important difference (MCID) of 10 points for DASH.
- After plate fixation vs. sling: better early function is seen at 6 weeks, but most trials show similar long-term DASH scores.
Typical reported DASH scores:
- Surgical group: ~7.3 (near-normal function)
- Conservative group: ~11.1 (still good, but slightly worse)
MCID for DASH in Clavicle Fractures
The minimal clinically important difference (MCID) for the DASH is 10 points. Changes smaller than this threshold, while statistically significant, may not be clinically meaningful.
Summary Table
| Parameter | Value |
|---|---|
| Score range | 0-100 (higher = worse) |
| Minimum items needed | 27 of 30 |
| MCID | 10 points |
| Plateau after injury | ~1 year |
| Nonunion risk threshold | DASH ≥ 35 at 6 weeks |
| Limitation in clavicle Fx | Ceiling effect in young patients |
- Rockwood and Green's Fractures in Adults (10th ed., 2025), pp. 1202, 1219, 1221
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