Operative treatments compared with nonoperative treatment of displaced midshaft clavicular fractures

Ma, Xianzhi; Wang, Kai; Ma, Jun; Chen, Xiaotao; Han, Shengshou

doi:10.1016/j.jos.2019.04.002

Cited by 6 publications

(9 citation statements)

References 25 publications

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“…The data on treatment of diaphyseal humerus fractures has continued to evolve over the last 20 years with increased prevalence of studies favoring operative management [11][12][13][14]. Denard et al performed a retrospective review of 213 patients with humeral shaft fractures who underwent treatment with a functional brace versus ORIF to determine the difference between non-union, malunion, incidence of radial nerve palsy and elbow range of motion [11].…”

Section: Discussionmentioning

confidence: 99%

“…They also noted no difference between DASH scores and no difference between risk of non-union between the groups. Ma et al in a retrospective chart review noted the decreased healing time in operative management (10.4 weeks) compared to nonoperative management (15.7 weeks) and noted that 93% of patients in the plate fixation group were satisfied with the appearance of their arm compared to the 77% in the non-operative group [13]. Furthermore, Ali et al did a retrospective review of 207 humerus shaft fractures over a 5 year period that were treated non-operatively to determine if there was a particular fracture type that went on to non-union (which was defined that absence of bony union at 1 year or delayed surgical fixation after 6 weeks) [14].…”

Section: Discussionmentioning

confidence: 99%

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Variation in management of humeral and clavicular shaft fractures amongst fellowship trained orthopedic traumatologists

Sharareh

Perkins

2020

BMC Musculoskelet Disord

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Background There exists a wide variety of opinions on the appropriate management of diaphyseal humeral and clavicular fractures amongst orthopedic surgeons. The purpose of this study is to determine if there is a preference amongst orthopedic traumatologists on treatment of diaphyseal humerus and clavicle fractures with respect to various patient populations. Methods A 6-question survey was created using Surveymonkey.com and distributed via the Orthopedic Trauma Association (OTA) website to fellowship trained orthopedic surgery traumatologists to survey the preferred management of a simple oblique middle 1/3rd diaphyseal humerus fracture and a middle 1/3rd displaced diaphyseal clavicle fracture in the following 3 clinical settings: a healthy laborer, an older patient with co-morbidities, and if the surgeon themselves sustained the injury. The ratio of operative to non-operative management was calculated for all 6 questions. A chi-square value was performed to determine if the results are clinically significant based on the clinical scenario. Results There was 56 responses to the survey that were included in the analysis. Overall, there was a statistically significant trend towards surgical management of the surgeon’s own diaphyseal humerus fractures (55%) compared to that of healthy patients (41%) and those with medical comorbidities (21%) (p = 0.02) A similar trend was noted for operative management for diaphyseal clavicle fractures by the surgeon on their own fractures (43%) compared to that of healthy patients (38%) and those with medical comorbidities (18%) (p = 0.02). Conclusion While there are an increasing number of relative indications for treatment of diaphyseal humerus shaft and clavicle fractures, the results of this survey indicate that fellow-ship-trained orthopedic trauma surgeons prefer surgical management of simple humerus and clavicular fractures in young, healthy patients as well as in themselves.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Variation in management of humeral and clavicular shaft fractures amongst fellowship trained orthopedic traumatologists

Sharareh

Perkins

2020

BMC Musculoskelet Disord

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“…The nerve originating from the C3 and C4 nerves is the cutaneous nerve, which exists from the anterior of scalenus medius at 1/2 of the posterior margin of the sternocleidomastoid muscle and is immediately divided into three branches, namely the medial, middle, and lateral branches. xation [3,4,6,11]. In the past, orthopaedic trauma physician often ignored the protection of supraclavicular nerves.…”

Section: Mechanism Of Clavicle Epithelium Injurymentioning

confidence: 99%

“…Although the skin paraesthesia of the affected side appeared after surgery, which did not affect the motor function of the upper limbs, the patient complained of numbness, prickling, itching, burning sensation and other discomfort in the affected shoulder area and superior lateral thoracic area after surgery. The main manifestations were discomfort such as neck and shoulder pain and soreness [3,4,15]: Pain: Acute attack, which can be dull pain, swelling pain, or prickling that can radiate to the head and neck or shoulder-back. Restriction of movement: Restriction of movement of the neck, accompanied by neck stiffness and spasm and paralysis of the muscles under its control.…”

Section: Mechanism Of Clavicle Epithelium Injurymentioning

confidence: 99%

“…Clavicle fractures are prone to occur in the one-third of the medial lateral clavicle [1][2][3][4][5][6][7], which belongs to the area where the supraclavicular nerves are distributed. Clavicle fractures are mainly treated with ORIF, in which the supraclavicular nerve is easily damaged, and the incidence of paresthesia such as numbness and discomfort in the affected shoulder and superior lateral thoracic area after surgery is as high as about 30% [1,3,4,[8][9][10]. Previous clinical studies have found that the main cause of paresthesia in the affected shoulder area and superior lateral thoracic area under ORIF is the injury to the supraclavicular nerve during the operation [2,5,11].…”

Section: Introductionmentioning

confidence: 99%

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Protection of Supraclavicular Nerve in the Surgical Procedures of Clavicle Fracture Fixation

Abula

Liu

et al. 2021

Preprint

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Background: The present study was to evaluate the clinical effectiveness of the protection of the supraclavicular nerve in the treatment of clavicle fracture using fracture reduction and percutaneous external locking plate fixation or open reduction and internal fixation (ORIF).Methods: A total of 27 patients suffered clavicle fracture and underwent fracture reduction and external or internal fixation with reserved clavicular epithelial nerve in our department from January 2015 to January 2020 were retrospectively collected, including 19 males and 8 females with a mean age of 42 years (range 21 to 57 years). Among them, 17 patients were treated with the fracture reduction and percutaneous external locking plate fixation, while the other 10 patients were treated with ORIF. The sensory function of the affected shoulder area and the superior lateral thoracic area after surgery was collected and analyzed, as well as the satisfaction rate after the fixation was removed.Results: All the 27 patients were successfully followed with a mean duration of 1.3 years (1 to 5.8 years). There were significant differences in sensory dysfunction in the shoulder area and superior lateral thoracic area, pricking in the operation area and neck and shoulder, tactile hyperalgesia, and local numbness between the two groups after surgery (P<0.05). All the fractures achieved bone union. The satisfaction rate in the percutaneous external locking plate fixation group was higher than that in the ORIF group after the fixation was removed (P<0.05).Conclusions: Percutaneous external locking plate fixation with reservation of the supraclavicular nerve in the treatment of clavicle fractures can reduce the incidence of postoperative paresthesia in the affected shoulder and superior lateral thoracic area, and improve the satisfaction rate of the surgical effect.

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Less than 1.5 cm shortening in clavicle midshaft fracture has long-term functional impact

Pradel¹,

Brunaud²,

Coulomb³

et al. 2023

Orthopaedics & Traumatology: Surgery & Research

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Operative treatments compared with nonoperative treatment of displaced midshaft clavicular fractures

Cited by 6 publications

References 25 publications

Variation in management of humeral and clavicular shaft fractures amongst fellowship trained orthopedic traumatologists

Variation in management of humeral and clavicular shaft fractures amongst fellowship trained orthopedic traumatologists

Protection of Supraclavicular Nerve in the Surgical Procedures of Clavicle Fracture Fixation

Less than 1.5 cm shortening in clavicle midshaft fracture has long-term functional impact

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