Intrinsic and extrinsic risk factors for nonunion after nonoperative treatment of midshaft clavicle fractures

Liu, W.; Xiao, Jianghong; Ji, Feng; Xie, Yongpeng; Hao, Yonggang

doi:10.1016/j.otsr.2014.11.018

Cited by 46 publications

(31 citation statements)

References 24 publications

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“…These were considered collectively but also as subgroups based on the injury or the treatment. The subgroups for the delayed and/or non-union in smokers and non-smokers were long bone fracture, [5][6][7][8][9][10][11][12][13][14][15][16][17][18] spinal fusions, [19][20][21][22][23][24] osteotomy, [25][26][27][28][29] arthrodesis [30][31][32][33][34][35][36][37] and established non-union. 23 [38][39][40][41][42] The mean difference in the time to union between smokers and non-smokers was also subjected to meta-analysis.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Do smokers have greater risk of delayed and non-union after fracture, osteotomy and arthrodesis? A systematic review with meta-analysis

et al. 2016

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ObjectivesSystematic review and meta-analysis of published observational cohort studies. To quantify the increased risk smokers have of experiencing a delayed and/or non-union in fractures, spinal fusion, osteotomy, arthrodesis or established non-unions.SettingMedical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica database (EMBASE), Allied and Complementary Medicine Database (AMED) and Web of Science Core Collection from 1966 to 2015.Study eligibility criteria, participants and interventionsObservational cohort studies that reported adult smokers and non-smokers with delayed and/or non-union or time to union of the fracture, spinal fusion, osteotomy, arthrodesis or established non-union were eligible.Data extraction and outcome measures2 authors screen titles, abstracts and full papers. Data were extracted by 1 author and checked independently by a second. The relative risk ratios of smoking versus non-smoking and the mean difference in time to union patients developing a delayed and/or non-union were calculated.ResultsThe search identified 3013 articles; of which, 40 studies were included. The meta-analysis of 7516 procedures revealed that smoking is linked to an increased risk of delayed and/or non-union. When considered collectively, smokers have 2.2 (1.9 to 2.6) times the risk of experiencing delayed and/or non-union. In all the subgroups, the increased risk was always ≥1.6 times that of non-smokers. In the patients where union did occur, it was a longer process in the smokers. The data from 923 procedures were included and revealed an increase in time to union of 27.7 days (14.2 to 41.3).ConclusionsSmokers have twice the risk of experiencing a non-union after fracture, spinal fusion, osteotomy, arthrodesis or treatment of non-union. Time to union following fracture, osteotomy, arthrodesis or treatment of an established non-union is longer in smokers. Smokers should be encouraged to abstain from smoking to improve the outcome of these orthopaedic treatments.

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Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Do smokers have greater risk of delayed and non-union after fracture, osteotomy and arthrodesis? A systematic review with meta-analysis

et al. 2016

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“…Regarding the type of fracture line, there was a predominance of the comminuted type (52.9%). Robinson et al 20 also found a higher incidence of this type of fracture (68%), and the high percentage of TAs may explain this situation, since in these cases there is a relationship with the high energy of the trauma, according to Stegeman et al 23 In another study, 24 this characteristic was identified as a risk factor for pseudarthrosis, and was even associated with worse functional scores. In the present study, however, there was no significant difference in the comparison between the types of fracture line and the functional scores.…”

Section: Discussionmentioning

confidence: 95%

Avaliação clínica do tratamento cirúrgico das fraturas do terço médio da clavícula em um hospital do sul de Santa Catarina

et al. 2019

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Palavras-chave► clavícula/cirurgia ► resultado do tratamento ► fraturas ósseas ResumoObjetivo Avaliar o resultado do tratamento cirúrgico de fraturas do terço médio da clavícula. Métodos Estudo transversal retrospectivo, em que foram avaliados 36 pacientes que sofreram fratura do terço médio da clavícula, que foram tratados cirurgicamente no período de janeiro de 2012 a fevereiro de 2017. Eles foram avaliados quanto aos tipos de fratura, idade, tabagismo, material de síntese, e escores de Constant-Murley e Modified-University of California at Los Angeles Shoulder Rating Scale (UCLA-M). Resultados As médias dos escores de Constant-Murley e UCLA-M foram de 91,59 e 31,29, respectivamente. A idade média foi de 37,62 anos, e apresentou relação estatística com o tipo de síntese (p < 0,05), mas o material de síntese não apresentou significância com a melhora de pontuação dos escores funcionais. Conclusão O tratamento cirúrgico ocasiona bons resultados funcionais após a fratura diafisária de clavícula, independente do traço da fratura, com baixa taxa de pseudoartrose. AbstractObjective To evaluate the results of the surgical treatment of fractures of the middle third of the clavicle. Methods A retrospective cross-sectional study, in which 36 patients who suffered fractures of the middle third of the clavicle and who were surgically treated from

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“…The vast majority of these fractures involve the middle third, and the majority are ubiquitously treated conservatively, using sling immobilization and serial radiological check-ups [2,3]. The reported incidence of nonunion in the paediatric population is extremely rare, in contrast to that known of the adult population, where the rate is from 8% to 14% [4]. A systematic review undertaken by Hughes et al reported 21 paediatric cases of nonunion, the majority of which occurred after a displaced right-sided fracture and with typical presentation occurring at a distance of one year [5].…”

Section: Introductionmentioning

confidence: 99%

Posttraumatic Pseudoarthrosis of a Clavicle Fracture in an 11-Year-Old Girl: A Case Report and Analysis

Odorizzi¹,

FitzGerald²,

Gonzalez³

et al. 2020

Case Reports in Orthopedics

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Clavicular fractures are some of the most common bone injuries in the paediatric population, yet the rates of nonunion are very low under 18 years. To the best of our knowledge, posttraumatic nonunion of the clavicle in a paediatric population is rarely reported. We report the case of an 11-year-old girl who presented with a nondislocated fracture of the midshaft to the proximal third of the right clavicle. Initial conservative treatment by sling immobilization demonstrated radiologically confirmed healing at 3 months. However, at 1-year follow-up, she presented with painful nonunion. Diagnostic MRI and CT exams confirmed a pseudoarthrosis, requiring elective open reduction and internal fixation with the aid of an ipsilateral iliac crest bone graft.

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Intrinsic and extrinsic risk factors for nonunion after nonoperative treatment of midshaft clavicle fractures

Abstract: Level III, case-control study.

Cited by 46 publications

References 24 publications

Do smokers have greater risk of delayed and non-union after fracture, osteotomy and arthrodesis? A systematic review with meta-analysis

Do smokers have greater risk of delayed and non-union after fracture, osteotomy and arthrodesis? A systematic review with meta-analysis

Avaliação clínica do tratamento cirúrgico das fraturas do terço médio da clavícula em um hospital do sul de Santa Catarina

Posttraumatic Pseudoarthrosis of a Clavicle Fracture in an 11-Year-Old Girl: A Case Report and Analysis

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