Operative versus Nonoperative Management of Displaced Midshaft Clavicle Fractures: A Prospective Cohort Study

Kulshrestha, Vikas; Roy, Tapas; Audigé, Laurent

doi:10.1097/bot.0b013e3181d8290e

Cited by 135 publications

(97 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Collation of literature on clavicle fractures suggests that the expected nonunion rate is 8.6%. This percentage was derived from the reported healing rate in 12 separate publications [59][60][61][62][63][64][65][66][67][68][69][70] spanning the period from 2004 to 2013 and including 3168 patients treated with a range of conservative and operative methods. Both samples are large, and the nonunion rate in our database again differs by less than a percentage point from the literature values.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of Fracture Nonunion in 18 Human Bones

et al. 2016

View full text Add to dashboard Cite

IMPORTANCE Failure of bone fracture healing occurs in 5% to 10% of all patients. Nonunion risk is associated with the severity of injury and with the surgical treatment technique, yet progression to nonunion is not fully explained by these risk factors.OBJECTIVE To test a hypothesis that fracture characteristics and patient-related risk factors assessable by the clinician at patient presentation can indicate the probability of fracture nonunion.DESIGN, SETTING, AND PARTICIPANTS An inception cohort study in a large payer database of patients with fracture in the United States was conducted using patient-level health claims for medical and drug expenses compiled for approximately 90.1 million patients in calendar year 2011. The final database collated demographic descriptors, treatment procedures as per Current Procedural Terminology codes; comorbidities as per International Classification of Diseases, Ninth Revision codes; and drug prescriptions as per National Drug Code Directory codes. Logistic regression was used to calculate odds ratios (ORs) for variables associated with nonunion. Data analysis was performed from January 1, 2011, to December 31, 2012, EXPOSURES Continuous enrollment in the database was required for 12 months after fracture to allow sufficient time to capture a nonunion diagnosis. RESULTSThe final analysis of 309 330 fractures in 18 bones included 178 952 women (57.9%); mean (SD) age was 44.48 (13.68) years. The nonunion rate was 4.9%. Elevated nonunion risk was associated with severe fracture (eg, open fracture, multiple fractures), high body mass index, smoking, and alcoholism. Women experienced more fractures, but men were more prone to nonunion. The nonunion rate also varied with fracture location: scaphoid, tibia plus fibula, and femur were most likely to be nonunion. The ORs for nonunion fractures were significantly increased for risk factors, including number of fractures (OR, 2.65; 95% CI, 2.34-2.99), use of nonsteroidal anti-inflammatory drugs plus opioids (OR, 1.84; 95% CI, 1.73-1.95), operative treatment (OR, 1.78; 95% CI, 1.69-1.86), open fracture (OR, 1.66; 95% CI, 1.55-1.77), anticoagulant use (OR, 1.58; 95% CI, 1.51-1.66), osteoarthritis with rheumatoid arthritis (OR, 1.58; 95% CI, 1.38-1.82), anticonvulsant use with benzodiazepines (OR, 1.49; 95% CI, 1.36-1.62), opioid use (OR, 1.43; 95% CI, 1.34-1.52), diabetes (OR, 1.40; 95% CI, 1.21-1.61), high-energy injury (OR, 1.38; 95% CI, 1.27-1.49), anticonvulsant use (OR, 1.37; 95% CI, 1.31-1.43), osteoporosis (OR, 1.24; 95% CI, 1.14-1.34), male gender (OR, 1.21; 95% CI, 1.16-1.25), insulin use (OR, 1.21; 95% CI, 1.10-1.31), smoking (OR, 1.20; 95% CI, 1.14-1.26), benzodiazepine use (OR, 1.20; 95% CI, 1.10-1.31), obesity (OR, 1.19; 95% CI, 1.12-1.25), antibiotic use (OR, 1.17; 95% CI, 1.13-1.21), osteoporosis medication use (OR, 1.17; 95% CI, 1.08-1.26), vitamin D deficiency (OR, 1.14; 95% CI, 1.05-1.22), diuretic use (OR, 1.13; 95% CI, 1.07-1.18), and renal insufficiency (OR, 1.11; 95% CI, 1.04-1.17) (multivariate P < .001 for all).C...

show abstract

Section: Discussionmentioning

confidence: 99%

Epidemiology of Fracture Nonunion in 18 Human Bones

et al. 2016

View full text Add to dashboard Cite

show abstract

“…Three patients had delayed union which were united by 16-18 weeks (5%) and one case of failure of osteosynthesis developed non-union (1.7%). The studies by the COTS [13] and Kulshrestha et al [14] reported non-union rate of 3% and 0% respectively. A major complication in our study was one case of implant failure in out of 60 patients (1.7%).…”

Section: Discussionmentioning

confidence: 99%

“…Patient is satisfied with the outcome as he has full ROM and strength and no pain except a small prominence of the implant. Reported rate of failure of osteosynthesis in literature is about 0-16% [1,10,13,14].…”

Section: Discussionmentioning

confidence: 99%

Locking plate fixation of mid-shaft clavicle fractures: analysis of complications, reoperation rates and functional outcome

Sk¹,

Na²

2017

Int. J. Orthop. Sci.

View full text Add to dashboard Cite

Introduction: Clavicle fractures account for about 5-10% of all fractures and most of these fractures are located in the middle third of clavicle. Traditionally, these fractures have been treated by conservative methods. In recent years, surgical fixation of these fractures is becoming a prefered method of treatment and locking plate fixation is a commonly used mode of osteosynthesis. However, the functional results and complications of locking plate fixation documented in the literature are not clear and often conflicting. So the aim of this study is to analyse the results of locking plate osteosynthesis of mid-shaft clavicle fractures. Objective: To study complications, reoperation rates and functional outcome of clavicle fractures treated with locking plate osteosynthesis. Methods: Sixty Seven cases of mid-shaft clavicle fractures who underwent locking plate fixation in our orthopaedic department from January 2013 to December 2016 were identified. Those patients who attended regular follow-up and had recorded Constant-Murley Scores (CMS) were included. Seven patients who did not attend regular follow-up or had incomplete records were excluded from analysis. The study group comprising 60 patients were analysed for complications and functional outcome by studying patient records and x-rays. Results: There was one case of failure of fixation with non-union and 8 patients had their plate removed for discomfort. Overall, there were 92 % excellent to good, 5% fair and 3% poor results. There were no cases of infection. Conclusion: The locking plate osteosynthesis gives good to excellent functional outcome in most of the patients. It helps with early mobilisation and prevents shoulder stiffness. The overall rate of implant failure and non-union after plate fixation is low. The necessity of removal of implant in significant number of patients should be kept in mind.

show abstract

“…7) Displaced fracture of the clavicular midshaft shows a higher rate of delayed and nonunion than nondisplaced fracture patterns. [8][9][10][11][12][13][14] However, with the development of plates such as low-profile LCP, more stable fixation is possible and good results have been reported after surgical treatment in clavicle midshaft fracture. 4,5) 15) suggested leaving a plate in place for 12 to 18 months and placement of restrictions against contact sports for 2 to 3 months after plate removal.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Radiological Outcome after Surgical Treatment in Displaced Clavicular Midshaft Fracture

Gwak¹,

Kim²

2016

Clinics in Shoulder and Elbow

View full text Add to dashboard Cite

Background: The first purpose of this study is to compare the clinical and radiological outcomes of surgical treatment for displaced midshaft clavicle fracture (Robinson type 2B1 vs. 2B2) with 3.5-mm low profile clavicular locking compression plate. The second purpose is to evaluate the difference of the results depending on the presence of accompanying injuries. Methods: Forty-nine patients who underwent an operation for the fractures were reviewed retrospectively. Fracture patterns were classified according to group 2B1 and 2B2 using Robinson's classification. For radiological outcome, time to union after operation was evaluated and for clinical outcome, American Shoulder and Elbow Society (ASES) score, University of California in Los Angeles (UCLA) score, visual analogue scale (VAS), and range of motion (ROM) were evaluated from preoperative period to last follow-up period. Results: The mean time for union was not significantly different in the 2B1 group and 2B2 group (p=0.062). No statistically significant difference in ASES score, UCLA score, and VAS was observed between 2B1 and 2B2 (p=0.619, p=0.896, p=0.856, respectively). In ROM, significant higher mean forward flexion and abduction was observed in 2B2 (p=0.025, p=0.017, respectively) and there was no difference in external rotation and external rotation at shoulder

show abstract

Operative versus Nonoperative Management of Displaced Midshaft Clavicle Fractures: A Prospective Cohort Study

Abstract: In this prospective cohort study, primary open reduction and internal plate fixation of acute displaced midshaft clavicular fractures resulted in improved outcomes and a decreased rate of nonunion and symptomatic malunion compared with nonoperative treatment.

Cited by 135 publications

References 23 publications

Epidemiology of Fracture Nonunion in 18 Human Bones

Epidemiology of Fracture Nonunion in 18 Human Bones

Locking plate fixation of mid-shaft clavicle fractures: analysis of complications, reoperation rates and functional outcome

Clinical and Radiological Outcome after Surgical Treatment in Displaced Clavicular Midshaft Fracture

Contact Info

Product

Resources

About