Clinical Impact of Malunion After All-Arthroscopic Coracoclavicular Stabilization for Displaced and Unstable Lateral Clavicle Fractures

Degeorge, Benjamin; Ravoyard, Salomé; Lazerges, Cyril; Toffoli, Adriano; Chammas, Michel; Coulet, Bertrand

doi:10.1097/bot.0000000000002330

Cited by 1 publication

(3 citation statements)

References 35 publications

(66 reference statements)

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“…However, our study adds to these findings, because in their study only 30 out of 122 (25%) patients were available for follow-up analysis compared to 353 out of 619 (response rate 57%) patients with mean follow-up of 7.4 (SD 2.9) years in our study [22]. Different operative techniques have been described for the stabilization of displaced lateral clavicle fractures, each with their pros and cons [23][24][25][26][27][28][29]. A recent systematic review, comparing different operative treatment strategies in patients with displaced lateral clavicle fractures, found that plate fixation was associated with the highest postoperative function scores and lowest risk of complications, followed by coracoclavicular fixation [8].…”

Section: Patient-reported Outcomesmentioning

confidence: 74%

“…Different operative techniques have been described for the stabilization of displaced lateral clavicle fractures, each with their pros and cons [ 23 – 29 ]. A recent systematic review, comparing different operative treatment strategies in patients with displaced lateral clavicle fractures, found that plate fixation was associated with the highest postoperative function scores and lowest risk of complications, followed by coracoclavicular fixation [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…They found that, besides high rates of implant removal after hook plate fixation, none of the treatment modalities was superior. However, comparison with a control group of nonoperatively treated patients was lacking in most case series or small cohorts that report on surgical techniques [24][25][26][27][28][29]. Robinson et al reported that nonoperative management in 101 patients with a displaced lateral clavicle fracture resulted in good functional outcome and quality of life after a mean follow-up of 6.2 years [6].…”

Section: Patient-reported Outcomesmentioning

confidence: 99%

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What are the long-term patient-reported and clinical outcomes after lateral clavicle fractures? A cross-sectional study of 619 patients

Linde

Helden

Woltz

et al. 2022

Eur J Trauma Emerg Surg

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Background Lateral clavicle fractures account for 17% of all clavicle fractures and large studies comparing nonoperative and operative treatment are lacking. Therefore, patients cannot be properly informed about different treatment options and prognosis. We assessed long-term patient-reported and clinical outcomes in patients with lateral clavicle fractures. Methods A multicenter cross-sectional study was performed in patients treated for lateral clavicle fractures between 2007 and 2016. Primary outcome included patient-reported outcome measures (PROMs) (DASH, EQ-5D, return to work, sports, cosmetics and satisfaction). Questionnaires were sent to 619 eligible patients, of which 353 (57%) responded after a mean follow-up of 7.4 ± 2.8 years. Secondary outcome included adverse events and secondary interventions. Outcomes after nonoperative vs. operative treatment (stratified by nondisplaced vs. displaced fractures) were compared using Student t tests and linear regression analysis. Results Nondisplaced lateral clavicle fractures were treated nonoperatively and resulted in excellent PROMs. Six patients (3%) developed a nonunion. For displaced lateral clavicle fractures, no differences were found between nonoperative and operative treatment with regard to DASH score (7.8 ± 12.5 vs 5.4 ± 8.6), EQ-5D (0.91 ± 0.13 vs 0.91 ± 0.09), pain (0.9 ± 1.7 vs. 0.8 ± 1.6), patient satisfaction (90.1 ± 25.5 vs. 86.3 ± 20.4), return to work (96.4% vs. 100%) and sports (61.4% vs. 62.3%). The absolute risk of nonunion in patients with a displaced fracture was higher after nonoperative than operative treatment (20.2% vs. 2.9%; p = 0.002), with six patients needing treatment to avoid one nonunion. Conclusions Nondisplaced lateral clavicle fractures should be treated nonoperatively and result in good functional outcomes and high union rates. For displaced fractures, neither nonoperative nor operative treatment seems superior. Patients opting for nonoperative treatment should be informed that nonunion occurs in 20% of patients, but only half of these need additional operative treatment. Patients who opt for surgery should be told that nonunion occurs in only 3%; however, most patients (56%) will require secondary intervention for elective implant removal. Regardless of the type of treatment, no differences in functional outcome and PROMs should be expected at long-term follow-up.

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