Are diaphyseal clavicular fractures still treated traditionally in a non-surgical way?

Abstract

ObjectiveTo evaluate the decision of orthopedics surgeons regarding which cases they would indicate surgery or non-surgical treatment.Methods20 images of radiographs with fracture in the middle third of the collar bone (AO/OTA 15-B) in anteroposterior view were analyzed, and divided into four groups: group 1 – fracture type AO/OTA 15-B1 without displacement; group 2 – fracture type AO/OTA 15-B1 with displacement; group 3 – fracture type AO/OTA 15-B2; group 4 – fracture type AO/OTA 15-B3. The evaluator was requested to indicate the choice of treatment, surgical or non-surgical.ResultsThere was no strong correlation between the amount of surgical indications and the working experience or age of the medical evaluator. It was observed that the average of surgical indications in the total sample was 52%. When indications were studied in different areas of Brazil, there was no significant difference among them. No pattern for the Brazilian regions studied was observed in the case analysis. Even within a group (cases of the same complexity), no specific pattern of surgical indication was observed.ConclusionNo association between surgical indication and the length of professional experience was found. The Southern and Southeastern regions were those that most recommended surgeries in groups 2, 3, and 4. In no region the same level of surgical indication for cases of the same complexity rate was kept.

Comparative Analysis of Surgical Treatment of Unstable Fractures of the Clavicle

“…При этом значительная часть используемых в настоящее время методик оперативного лечения переломов ключицы позволяет достичь быстрого восстановления структурно-функциональных сте-реотипов пациента в большинстве случаев. Однако отмечается определенная доля осложнений и не-удовлетворительных исходов, обусловленных раз-личными причинами: характер перелома, диапазон полезных свойств различных технологий остеосин-теза, оптимальность реабилитационных мероприя-тий [7,8,9].…”

Epidemiological, Characteristics and Complication of Clavicular Fractures among Patients in Baghdad

“…Males are affected approximately twice as often as females (67.9% vs 32.1%) [6]; these injuries may also have a seasonal correlation, with one epidemiologic analysis noting an increase during the summer [6,7]. In adults, more than two-thirds of these injuries occur at the diaphysis of the clavicle, and these injuries are more likely to be displaced as compared with medial and lateral third fractures [8,9]. Lateral-third fractures are less common, accounting for approximately 25% of all clavicle fractures, and are less likely to be displaced than those occurring in the midshaft [10,11].…”

Tratamento cirúrgico da fratura multifragmentada da diáfise da clavícula pela técnica minimamente invasiva: Descrição e resultados preliminares

“…[6][7][8][9] Most Brazilian orthopedists indicate osteosynthesis for deviated and/or comminuted shaft fractures. 10 The most widely used osteosynthesis method for deviated clavicular shaft fractures is open reduction and internal fixation (ORIF) with plate and screws. 5,9 However, since comminuted fractures require an extensive access to the fracture site, this approach may be associated with high rates of complications, including hypertrophic, painful scars, 4 infection, 11 pseudoarthrosis, 12 implant failure and refracture after implant removal.…”

“…[6][7][8][9] Em nosso meio, a maioria dos ortopedistas indica osteossíntese para fraturas diafisárias desviadas e/ou multifragmentadas. 10 O método mais utilizado de osteossíntese das fraturas diafisárias desviadas da clavícula é a redução aberta e fixação interna com placa e parafusos. 5,9 Porém, nas fraturas multifragmentadas, esta opção, por necessitar de extenso acesso ao foco de fratura, pode associar-se a altos índices de complicações como cicatrizes hipertróficas e dolorosas, 4 infecção, 11 pseudoartrose, 12 falha do implante e refratura após a retirada do implante.…”