A retrospective study of the association between shortening of the clavicle after fracture and the clinical outcome in 136 patients

Rasmussen, Jeppe Vejlgaard; Jensen, Steen Lund; Petersen, Jens B.; Falstie-Jensen, Thomas; Lausten, Gunnar Schwarz; Olsen, Birgit Anette

doi:10.1016/j.injury.2010.11.061

Cited by 74 publications

(69 citation statements)

References 14 publications

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“…12 Hence the trend has shifted towards operative treatment. 6,7 Now the clavicular plate is widely used to fix the displaced clavicle fracture. 70% cases has dominant side involvement.…”

Section: Discussionmentioning

confidence: 99%

Observational study to compare the outcome of non-operative and operative management of displaced fracture clavicle: A retrospective study

2020

IJOS

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Introduction: For centuries fracture of clavicle has been treated conservatively non-union of clavicle fracture is rare, Mal-union was considered to be of radiographic importance only. The scenario has changed and there has been a shift towards operative treatment on union, cosmesis, early recovery grounds. Both the methods is compared taking into account the union, cosmesis, early recovery, functional outcome and satisfaction of the patient. Materials and Methods: Total 70 patients of displaced fracture of clavicle (AO B1 & B2) were divided into two groups that is non-operative and operative. The informed consent was taken. The patient were explained about both modalities & procedure, cost, outcome and complications of each modality. After the decision of the patient he was allotted to Group I (conservative) & Group II (operative) the study was carried out till 35 patients were included in each group. The follow-up of both group's patients were done at 6 weeks, 3 months, 6 months using patients subjective evaluation, DASH score, range of motion, radiological assessment and complication if any. Observation and Result: Of all 70 patients the age varied between 20-66 years with mean age was 34.5 years. In the conservative group 23(65.7%) and in operative group 26 (74.2%) had dominant side involvement. In non-operative group there were 3(8.75%) cases of non-union, 15 (42.8%) mal-union, 5 (14.2%) muscle wasting, and 4 (11.4%) pressure symptoms in upper limb 2 (5.71%) stiffness of shoulder, 8 (22.85%) pain after union. Of 15 cases of mal-union only 7 (20%). 5 (14.28%) patients complaint of hardware prominence and irritation. Total 4 (11.42%) patients needed implant removal (2 due to infection and 2 due to hardware problem). 6 (17.14%) patients complaint of postoperative infraclavicular hypoesthesia. The DASH score was superior in Group II over I at 6 weeks and at 3 months. Overall in non-operative patients 22 (62.85%) were satisfied (17.14%) were not satisfied in operative group 28(80%) were satisfied while 7 (20%) were unsatisfied. The average follow-up period was 9.5 months (6-18 months). Conclusion: Though operative treatment is better in terms of early mobilization, union, absence of mal-union, cosmetically well accepted, it has its own complication which should also be taken into consideration while choosing between the two modalities. Seeing at satisfaction level in patient related to functional outcome the conservative treatment plays a vital role in poor patients.

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“…12 Hence the trend has shifted towards operative treatment. 6,7 Now the clavicular plate is widely used to fix the displaced clavicle fracture. 70% cases has dominant side involvement.…”

Section: Discussionmentioning

confidence: 99%

Observational study to compare the outcome of non-operative and operative management of displaced fracture clavicle: A retrospective study

2020

IJOS

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“…An increasing number of studies have reported that such shortening deformity is associated with greater disability of the shoulder [10][11][12][13], whereas other studies have reported no such association [2,14,15].…”

Section: Introductionmentioning

confidence: 99%

Impact of Clavicular Shortening after Midclavicular Fracture: A Retrospective Series

Jubel¹,

Schiffer²,

Andermahr³

et al. 2017

Open J Trauma

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Background: Clavicular shortening often occurs after midclavicular fractures and its impact on functional outcomes has thus far been evaluated solely by radiographic and surgeon-based measures, with divergent fi ndings.The goal of this study was to evaluate shoulder function and disability after midclavicular fractures in relation to shortening and compare it with that of healthy individuals and individuals with nonunion.Methods: Seventy-one adult patients (38±14 years) with midclavicular fractures that had been treated nonoperatively were reviewed retrospectively after a mean follow up of 28±15 months. The primary outcome variables were Disabilities of the Arm, Shoulder, and Hand, Constant-Murley, and Cologne clavicle scores. Range of motion was calculated as the difference in degrees between the injured and uninjured sides. Control cohorts of 35 healthy adults and 28 persons with nonunion were assembled.Results: Average shortening was 1.2±0.75 cm. Patients with clavicular shortening of >2 cm (Group 3) had signifi cantly more pain, greater loss of mobility and lower Constant-Murley scores than patients with shortening < 1 cm (Group 1) and healthy controls. Shortening deformity of more than 2 cm associated with Disabilities of the Arm, Shoulder, and Hand, Constant-Murley, and Cologne clavicle equivalent to those of subjects with nonunion. Shortening deformity of more than 2 cm is functionally equivalent to nonunion. Conclusions:Shortening deformities after clavicular fractures in adults greatly impact functional outcomes. Patients perceive a shortening deformity of ≥ 2cm as conferring signifi cant disability. These fi ndings suggest that the goal of therapy for diaphyseal clavicular fractures should be restoration of anatomical length of the clavicle.

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“…Nonsurgical treatment of clavicle fractures with a figure-of-eight bandage or sling have been used for decades with excellent results and low complication rates [8][9][10]. However, some recent studies have questioned these results, especially in cases of displacement and clavicular shortening [11,12].…”

Section: Introductionmentioning

confidence: 99%

Correlation of the degree of clavicle shortening after non-surgical treatment of midshaft fractures with upper limb function

Figueiredo¹

2014

http://isrctn.org/>

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Background: Despite the use of non-surgical methods to treat for the majority of midshaft fractures of the clavicle, it is remains controversial whether shortening of this bone following non-surgical treatment of a middle third fracture affects upper limb function. Methods: We conducted a cohort study by sequentially recruiting 59 patients with a fracture of the middle third of the clavicle. All patients were treated nonsurgically with a figure-of-eight bandage until clinical and radiological findings indicated healing of the fracture. Functional outcome was assessed using the Disability of Arm, Hand and Shoulder (DASH) score revalidated for the Portuguese language, other outcomes assessed included: pain measured by visual analogue scale (VAS); radiographies to measure the degree of shortening, fracture consolidation and fracture malunion. Information were also collected regarding the mechanism of injury, patient's daily activities level and epidemiological features of the patient cohort. The results of our findings are expressed as the comparison of the functional outcome with the degree of shortening. Results: Patients were assessed six weeks and one year after injury. In the first evaluation, the mean DASH score was 28.84 and pain measured by VAS was 2.57. In the second evaluation (one year after injury) the mean DASH score was 8.18 and pain was 0.84. The mean clavicle shortening was 0.92 cm, ranging from 0 to 3 cm (SD = 0.64). There were no correlation between the degree of shortening and DASH score after six weeks and one year (p = 0.073 and 0.706, respectively). When only patients with of shortening greater than 2 cm were assessed for correlation, the result did not change. Conclusion: We conclude that clavicle shortening after nonsurgical treatment with a figure-of-eight bandage does not affect limb function, even when shortening exceeds 2 cm.

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A retrospective study of the association between shortening of the clavicle after fracture and the clinical outcome in 136 patients

Cited by 74 publications

References 14 publications

Observational study to compare the outcome of non-operative and operative management of displaced fracture clavicle: A retrospective study

Observational study to compare the outcome of non-operative and operative management of displaced fracture clavicle: A retrospective study

Impact of Clavicular Shortening after Midclavicular Fracture: A Retrospective Series

Correlation of the degree of clavicle shortening after non-surgical treatment of midshaft fractures with upper limb function

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