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

Abstract

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.

Management of Displaced Midshaft Clavicle Fractures with Figure-of-Eight Bandage: The Impact of Residual Shortening on Shoulder Function

“…Inclusion criteria were: (1) patients with a traumatic, non-pathological, acute displaced MCF; (2) active patients between 18 and 65 years old; (3) at least 1-year clinical and radiographic follow-up; (4) RD ≤ 140% (see Section 2.3 . Patient assessment) [ 29 ]. Exclusion criteria were: (1) ipsilateral neurological involvement; (2) patients receiving chemotherapy, radiotherapy and/or immunotherapy; (3) patients with a bilateral clavicle fracture; (4) patients with previous injury or surgery of the ipsilateral clavicle and/or shoulder; (5) patients who did not complete the entire follow-up program; (6) competitive athletes; (7) polytrauma patients; (8) RD > 140% (see Section 2.3 .…”

“…Based on standard X-rays performed at patient admission at the ER of our hospital, radiographic fracture features were recorded as follows: fracture type (FT) according to the AO/OTA (Association for Osteosynthesis/Orthopedic Trauma Association) Classification [ 24 ]; initial shortening (IS) and residual shortening (RS), defined as the overlap of proximal and distal fragments and assessed as a percentage of the same clavicle length on a standard antero-posterior view, measured before and after the F8-B application; initial displacement (ID) and residual displacement (RD), measured as a percentage of the clavicle width at the fracture site on a 20° cephalic tilt view of the clavicle before and after the F8-B [ 29 ].…”

“…In a previous study published by our research group, predictive factors of delayed union and nonunion in adult patients with an MCF treated with a figure-of-eight bandage (F8-B) were investigated [ 29 ]. A residual displacement (RD) of 104%, assessed immediately after the application of the F8-B, was found to be a predictor that can help to differentiate patients who will heal, from patients who will develop delayed union and nonunion.…”

“…A residual displacement (RD) of 104%, assessed immediately after the application of the F8-B, was found to be a predictor that can help to differentiate patients who will heal, from patients who will develop delayed union and nonunion. Moreover, an RD of 140% was identified as an optimal cut-off point to distinguish between delayed union and nonunion [ 29 ]. Based on these findings, a treatment protocol for displaced MCFs was adopted in our clinic.…”

Incisional paresthesia following clavicle plate fixation: does it matter to patients?

“…They most often occur in young males and in the middle third of the bone [1,[3][4][5][6]. Traditionally, these fractures were treated non-operatively, but studies have since demonstrated improvement in union rates, less fracture deformity, and earlier return to function, following surgical stabilization [7][8][9][10][11]. Consequently, a trend towards operative management has emerged with good overall outcomes [12,13].…”