Clavicle fractures in adults; current concepts

Frima, Herman; Heijl, Mark van; Michelitsch, Christian; Meijden, Olivier van der; Beeres, Frank J.P.; Houwert, Roderick M.; Sommer, Christoph

doi:10.1007/s00068-019-01122-4

Cited by 44 publications

(43 citation statements)

References 53 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In the United States, the incremental cost of clavicle fractures in patients of 65 to 69 years of age was $12,682 and in patients of 70 to 74 years of age was $12,744 [24]. Due to the complexity of lateral clavicle fractures, a variety of different treatment options are described and remain a topic of controversy [1–8]. The relationship between fracture pattern and coracoclavicular ligament integrity impacts lateral clavicle stability and substantially influences treatment.…”

Section: Discussionmentioning

confidence: 99%

“…In lateral clavicle fractures, the proximity of the joint portends difficulty healing and may compromise long-term outcomes. Both operative and nonoperative management options have been advocated and remain without consensus opinion [1–8]. Various classification systems have been established for the description of clavicle fractures [9–12] and, yet, only the Neer, the modified Neer, and a new classification system described by Cho et al have had their reliability assessed [13–15].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Inter- and intraobserver agreement of three classification systems for lateral clavicle fractures – reliability comparison between two specialist groups

et al. 2020

View full text Add to dashboard Cite

BackgroundAlthough of great value in the management of lateral clavicle fractures, substantial variation in their classification exists. We performed a retrospective study to address the inter- and intraobserver reliability of three different classification systems for lateral clavicle fractures.MethodsRadiographs of 20 lateral clavicle fractures that represented a full spectrum of adult fracture patterns were graded by five experienced radiologists and five experienced trauma surgeons according to the Orthopaedic Trauma Association (OTA), the Neer, and the Jäger/Breitner classification systems. This evaluation was performed at two different time points separated by 3 months. To measure the observer agreement, the Fleiss kappa coefficient (κ) was applied and assessed according to the grading of Landis and Koch.ResultsThe overall interobserver reliability showed a fair agreement in all three classification systems. For the OTA classification system, the interobserver agreement showed a mean kappa value of 0.338 ranging from 0.350 (radiologists) to 0.374 (trauma surgeons). Kappa values of the interobserver agreement for the Neer classification system ranged from 0.238 (trauma surgeons) to 0.276 (radiologists) with a mean κ of 0.278. The Jäger/Breitner classification system demonstrated a mean kappa value of 0.330 ranging from 0.306 (trauma surgeons) to 0.382 (radiologists).The overall intraobserver reliability was moderate for the OTA and the Jäger/Breitner classification systems, while the overall intraobserver reliability for the Neer classification system was fair.The kappa values of the intraobserver agreements showed, in all classification systems, a wide range with the OTA classification system ranging from 0.086 to 0.634, the Neer classification system ranging from 0.137 to 0.448, and a range from 0.154 to 0.625 of the Jäger/Breitner classification system.ConclusionsThe low inter- and intraobserver agreement levels exhibited in all three classification systems by both specialist groups suggest that the tested lateral clavicle fracture classification systems are unreliable and, therefore, of limited value. We should recognize there is considerable inconsistency in how physicians classify lateral clavicle fractures and therefore any conclusions based on these classifications should be recognized as being somewhat subjective.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Inter- and intraobserver agreement of three classification systems for lateral clavicle fractures – reliability comparison between two specialist groups

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Most midshaft clavicle fractures are displaced, as a result of the muscular action and the weight of the arm [ 6 , 8 ]. Treatment of displaced midshaft clavicle fractures is still controversial [ 10 , 11 , 12 , 13 , 14 , 15 ]. Traditionally, these fractures have been treated nonoperatively, even in cases of severe displacement or comminution, based on the high capacity of healing and remodeling of the clavicle [ 16 , 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

Midshaft Clavicle Fractures Treated Nonoperatively Using Figure-of-Eight Bandage: Are Fracture Type, Shortening, and Displacement Radiographic Predictors of Failure?

et al. 2020

View full text Add to dashboard Cite

As there are no clear and unique radiographic predictors of healing disturbances for acute midshaft clavicle fractures, their treatment is still controversial. The aim of the study was to evaluate in midshaft clavicle fractures treated nonoperatively if fracture type (FT), shortening, and displacement, assessed before and after figure-of-eight bandage (F8-B) application, could be considered prognostic factors of delayed union and nonunion. One hundred twenty-two adult patients presenting a closed displaced midshaft clavicle fracture, managed nonoperatively with an F8-B, were enrolled. FT, initial shortening (IS), and initial displacement (ID) were radiographically evaluated at diagnosis, and both residual shortening (RS) and displacement (RD) were measured after F8-B application. The patients were followed up 1, 3, 6, and 12 months post-injury. Multivariate statistical analysis was performed. RD should be considered as radiological predictor of sequelae. Further, an RD equal to 104% of clavicle width was identified as an optimal cut-off point to distinguish between healed and unhealed fractures, and 140% between delayed union and nonunion. Our data pointed out the effectiveness of the F8-B in reducing fracture fragments and restoring clavicular length. In midshaft clavicle fractures of adults, fracture comminution and clavicular shortening did not influence bone healing. On the contrary, RD has been shown as the most likely predictor of both delayed union and nonunion.

show abstract

“…Research has shown that a non-operative treatment of an isolated, non-displaced, medial clavicle produced limited pain and excellent functional outcomes [2]. Displaced medial fracture require operative treatment [15].…”

Section: Discussionmentioning

confidence: 99%

Bipolar clavicular fractures and treatment options

Ruiter

Gardenbroek

Bos

et al. 2019

Eur J Trauma Emerg Surg

Self Cite

View full text Add to dashboard Cite

Introduction Fractures of the clavicle are common injuries, accounting 2.6-4% of all fractures in adults. Of these fractures, 21-28% are lateral clavicle fractures and 2-3% are medial clavicle fractures. Bipolar clavicle fractures are defined as a lateral and medial fracture and are uncommon. There is no consensus on the treatment of these fractures. The aim of this study is to provide a treatment on bipolar clavicle fractures based on the current literature. Methods The electronic databases PubMed, the Cochrane library and EMBASE were searched up on September 25th, 2017. Two reviewers (KR and TG) independently screened titles and abstracts for their relevance. Studies designed to evaluate the outcomes of conservative and/or operative treatment of segmental bipolar clavicle fractures in adults (> 16 years) were included. Editorials and commentaries were excluded, as well as synthetic, cadaveric and animal studies. Primary outcomes considered were pain reduction and shoulder function. Secondary outcomes considered are complications. Results Ten studies reporting results from ten patients were included for the review. In most patients, if treated operatively, surgical treatment with the use of double plating was performed. Only in elderly patients conservative treatment was adopted. All included patients were pain free and had a full range of motion after 3-6 months. Only two case reports provided a DASH score, while in eight studies no functional outcome score was measured. Conclusion A missed bipolar fracture can complicate the clinical progress. Surgical management of these fractures may be necessary; however, the treatment of choice depends on the age of the patient, daily activities and comorbidity.

show abstract

Clavicle fractures in adults; current concepts

Cited by 44 publications

References 53 publications

Inter- and intraobserver agreement of three classification systems for lateral clavicle fractures – reliability comparison between two specialist groups

Inter- and intraobserver agreement of three classification systems for lateral clavicle fractures – reliability comparison between two specialist groups

Midshaft Clavicle Fractures Treated Nonoperatively Using Figure-of-Eight Bandage: Are Fracture Type, Shortening, and Displacement Radiographic Predictors of Failure?

Bipolar clavicular fractures and treatment options

Contact Info

Product

Resources

About