Defining patient acceptable symptom state thresholds one year after ORIF for midshaft clavicle fractures

Background: Midshaft clavicle fractures affect young, active patients with high functional demands. Open reduction and internal fixation (ORIF) achieve reliable union, but it is unclear whether outcomes meet patient-defined standards. This study aimed to (1) establish Patient Acceptable Symptom State (PASS) thresholds for the American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE), and Visual Analog Scale (VAS) one year after fixation, (2) determine the proportion of patients meeting these thresholds, and (3) assess each metric's ability to discriminate satisfaction. Methods: We retrospectively analyzed prospectively collected data from 166 patients who underwent ORIF between 2017 and 2021 with ≥1-year follow-up. Patients completed ASES, SANE, VAS, and a validated satisfaction anchor. PASS thresholds were derived via ROC analysis and the Youden index. Discrimination was assessed using area under the curve (AUC). Results: At one year, 87.3% reported satisfaction. PASS thresholds were ASES ≥100, SANE ≥90, and VAS ≤0. Despite high average scores (ASES 96.2; SANE 85.1; VAS 0.7), only 63.9%, 56.7%, and 59.4% met PASS, respectively. ASES (AUC 0.678) and VAS (0.679) showed modest discrimination, while SANE performed poorly (0.569). Conclusion: Most patients are satisfied after ORIF, but many fail to meet PROM-based PASS, highlighting the need to align surgical success with patient-defined benchmarks.