Prospective evaluation of early functional recovery of displaced fractures of the middle third of the clavicle whether operated or not

Echalier, C.; Sakek, Fiona; Soumagne, Thibaud; Rifaï, S. El; Berthier, Francis; Uhring, Julien; Loisel, François; Obert, L.

doi:10.1016/j.otsr.2020.102768

Cited by 9 publications

(8 citation statements)

References 30 publications

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“…Smaller trials, such as the prospective study by Khorami et al, 19 found no significant changes in outcome in either group. Echalier et al 14 published a non-randomized prospective study measuring CMS and DASH. These were significantly better in the surgical group from the second to the sixth week, but there was no significant difference between three and six months.…”

Section: Resultsmentioning

confidence: 99%

“…If the patient's life circumstances dictate that they require improved functional outcomes at six weeks, they may be offered surgery (Echalier et al). 14 In patients with highly physical jobs (e.g. active military personnel or sportsmen) or those with active lifestyles, surgery can be offered to improve functional outcomes, as suggested by Lake et al 32 Shortening on its own is not an indication for surgery, in accordance with the evidence presented by Goudie et al 51 and Malik et al 52 In line with the management strategy developed by Nicholson et al, 42 all patients should be reassessed at six weeks for the following criteria.…”

Section: Discussionmentioning

confidence: 99%

“…An increasing body of evidence subsequently published has suggested that equivalent outcomes can be achieved with nonoperative management. 12 , 14 , 16 , 19 , 34 Additionally Nicholson et al 38 concluded that routine plate fixation of displaced MSCFs was not cost-effective. They suggested that a targeted approach to fixation of patients who are at higher risk of nonunion would be more efficient.…”

Section: Discussionmentioning

confidence: 99%

“…If the patient’s life circumstances dictate that they require improved functional outcomes at six weeks, they may be offered surgery (Echalier et al). 14 In patients with highly physical jobs (e.g. active military personnel or sportsmen) or those with active lifestyles, surgery can be offered to improve functional outcomes, as suggested by Lake et al 32 …”

Section: Discussionmentioning

confidence: 99%

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Closed midshaft clavicle fractures

et al. 2022

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Aims The management of mid-shaft clavicle fractures (MSCFs) has evolved over the last three decades. Controversy exists over which specific fracture patterns to treat and when. This review aims to synthesize the literature in order to formulate an appropriate management algorithm for these injuries in both adolescents and adults. Methods This is a systematic review of clinical studies comparing the outcomes of operative and nonoperative treatments for MSCFs in the past 15 years. The literature was searched using, PubMed, Google scholar, OVID Medline, and Embase. All databases were searched with identical search terms: mid-shaft clavicle fractures (± fixation) (± nonoperative). Results Using the search criteria identified, 247 studies were deemed eligible. Following initial screening, 220 studies were excluded on the basis that they were duplicates and/or irrelevant to the research question being posed. A total of 27 full-text articles remained and were included in the final review. The majority of the meta-analyses draw the same conclusions, which are that operatively treated fractures have lower nonunion and malunion rates but that, in those fractures which unite (either operative or nonoperative), the functional outcomes are the same at six months. Conclusion With regard to the adolescent population, the existing body of evidence is insufficient to support the use of routine operative management. Regarding adult fractures, the key to identifying patients who benefit from operative management lies in the identification of risk factors for nonunion. We present an algorithm that can be used to guide both the patient and the surgeon in a joint decision-making process, in order to optimize patient satisfaction and outcomes. Cite this article: Bone Jt Open 2022;3(11):850–858.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Closed midshaft clavicle fractures

et al. 2022

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“…This contrasts with the former propagation of better results by applying conservative treatment along with sufficient analgesic therapy and transient immobilization (e.g., figure-of-8 bandages, sling, cuff and collar) [ 10 , 11 ]. However, especially in the first rehabilitative phase, surgical treatment shows advantages over conservative therapy due to the earlier possibility of mobilization [ 9 , 12 , 13 ]. Considering the high number of cases in active young male patients, the time that elapsed before patients could return to sports was significantly longer in patients treated conservatively than in patients who underwent surgery [ 9 , 13 , 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

Safe and Effective Treatment of Compromised Clavicle Fracture of the Medial and Lateral Third Using Focused Shockwaves

Mittermayr

Haffner

Eder

et al. 2022

JCM

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A delay or failure to heal is the most common possible complication in clavicle fractures, especially in cases primarily treated conservatively. As the current standard therapy, surgical revision achieves good healing results, but is associated with potential surgery-related complications. Shockwave therapy as a non-invasive therapy shows similar reasonable consolidation rates in the non-union of different localizations, but avoids complications. Compromised clavicle fractures in the middle and lateral third treated with focused high-energy shockwave therapy were compared with those treated with surgical revision (ORIF). In addition, a three-dimensional computer simulation for evaluating the pressure distribution during shockwave application accompanied the clinical study. A comparable healing rate in bony consolidation was achieved in both groups. Significantly fewer complications, however, occurred in the shockwave group. The simulations showed safe application in this instance, particularly in avoiding lung tissue affection. When applied correctly, shockwaves represent a safe and promising therapy option for compromised clavicle fractures in the middle and lateral third.

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Clavicle Fractures: To Operate or Not?

Moreno-García¹,

Rodríguez-Merchán²

2022

Controversies in Orthopedic Surgery of the Upper Limb

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Prospective evaluation of early functional recovery of displaced fractures of the middle third of the clavicle whether operated or not

Cited by 9 publications

References 30 publications

Closed midshaft clavicle fractures

Closed midshaft clavicle fractures

Safe and Effective Treatment of Compromised Clavicle Fracture of the Medial and Lateral Third Using Focused Shockwaves

Clavicle Fractures: To Operate or Not?

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