Operative versus nonoperative treatment for displaced midshaft clavicle fractures: a meta-analysis based on current evidence

Wang, Xinhua; Guo, Weihua; Li, A-Bing; Cheng, Guang-Jun; Tao, Lei; Zhao, You-Ming

doi:10.6061/clinics/2015(08)09

Cited by 52 publications

(47 citation statements)

References 46 publications

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“…They have concluded that operative treatment is superior to nonoperative treatment in the management of displaced midshaft clavicle fractures. 16 In our study we did not encounter any neurological complication, which may support their finding.…”

Section: Discussionsupporting

confidence: 86%

Fracture union and complication following internal fixation of clavicle by plate and screw

2016

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INTRODUCTIONClavicle is the only bone that is most neglected in a polytrauma patient. But its importance was more convincing after dealing floating shoulder injuries. When there was both clavicle and scapular fracture more attention was given to clavicle fracture to maintain the leverage action of shoulder. Clavicle fracture amounts to 2.6% of all fractures and accounts for 34% to 45% of shoulder girdle injuries in adults.1-3 Of all clavicle fractures it is most common in middle one third i.e. about 69% to 81%, lateral one-third 17% and medial one-third 2%. 4,6 Most of the clavicles fractures are treated nonoperatively, results vary from good union, mal-union to non-union. Even united or not most patients have good functional outcomes and a high level of patient satisfaction except few where there is functional disability following nonunion. 2,7-11As nonoperative treatment are not as favourable as once thought, there is increase trend for internal fixation. 12-13Besides non-union was lower in operated group as compared to conservative group, pooled data showed that 14% of 452 patients in the nonoperative group developed non-union, which is significantly higher (p=0.00001) than the 1.7% rate of non-union in the 507 patients of the ABSTRACT Background: Among all long bones clavicle is the only bone placed horizontally and has membranous ossification. Clavicle fractures accounting for about 2.6% of total body fractures and 34% to 45% of total shoulder girdle injuries in adults. Most fractures occur in middle third of clavicle and common in young male patients. It has wide range of management from conservative to variant internal fixation. Each procedure has its own outcome and complications. We tried to find out the outcome and complications following internal fixation of clavicle with plate and screws. Methods: In a prospective study 50 patients of fracture mid shaft clavicle who were treated with plate and screw were followed for a period of two years. Only adults more than 18 years were included in the study. All patients were followed at 2 nd post-operative day 5 th post-operative day 14 th post-operative day and at 1, 2, 6, 12 and 24 months. Only two parameters were observed i.e. union of fracture and post-operative complications. Results: Of all patients operated with plate and screw 48 patients had good radiological union by six months. Only two patients had non-union and one with implant failure at 12 months. Of complications one had stitch abscess and seven had hardware discomfort. Conclusions: Clavicle fracture in adults has multimodal treatment option. Though conservative management has good results it has high chance of mal-union and non-union. Operative fixation should be opted for adult individuals where chance of non-union is high. Plate and screw fixation has good results in terms of union with least complication.

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Section: Discussionsupporting

confidence: 86%

Fracture union and complication following internal fixation of clavicle by plate and screw

2016

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“…Most midshaft clavicle fractures are displaced, as a result of the muscular action and the weight of the arm [ 6 , 8 ]. Treatment of displaced midshaft clavicle fractures is still controversial [ 10 , 11 , 12 , 13 , 14 , 15 ]. Traditionally, these fractures have been treated nonoperatively, even in cases of severe displacement or comminution, based on the high capacity of healing and remodeling of the clavicle [ 16 , 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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.

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“…The risk of a misleading X-ray is either malunion of the clavicle in conservative treatment, which can lead to shoulder complaints or unexpected finding during surgery, which can complicate the operation. 4 Due to the risk of non-union and the young age of the patient an operation was planned. Although this type of fracture (and the operative possibilities) is already described by Neer in 1963, till this date there is no universally agreed standard operative procedure for displaced distal clavicle fractures.…”

Section: Relevant Literature/discussionmentioning

confidence: 99%

A Distal Clavicle Fracture With Unusual Displacement of the Medial Part: A Case Report

Rijn¹,

Kaas²,

Beumer³

et al. 2016

Emerg Med Open J

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Citation Case ReportPage 39 ABSTRACT Introduction: A 22-year-old man came to the emergency department after a fall on right shoulder. The radiographs showed a distal clavicle fracture with apparent disruption of the acromioclavicular joint (AC-joint). The CT-scan however showed an intact AC-joint with a Neer type IIb fracture pattern, except for a dislocation of the medial fragment to dorsocaudal. Intervention: Ten days after trauma the patient was treated with open reduction and internal fixation using a hook plate. Outcome: Six weeks after surgery the patient had no pain and full range of motion of the arm. Discussion: There are two ways to classify a distal clavicle fracture; the Craig's classification or the Neer classification. In both classifications there is the medial part of the clavicle is elevated in a type IIb distal clavicle fracture. The X-ray in this case was misleading, appearing as a disruption of the AC-joint. In this case there probably was a blow to the shoulder and the medial part of the clavicle was pushed caudally and got captured under the distal fragment of the clavicle. There are two systematic reviews and one meta-analysis about the treatment of a distal clavicle fracture. They all state that a hook plate is the most frequently used fixation technique, although it seems to have the highest complication rate.

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Operative versus nonoperative treatment for displaced midshaft clavicle fractures: a meta-analysis based on current evidence

Cited by 52 publications

References 46 publications

Fracture union and complication following internal fixation of clavicle by plate and screw

Fracture union and complication following internal fixation of clavicle by plate and screw

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

A Distal Clavicle Fracture With Unusual Displacement of the Medial Part: A Case Report

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