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Mitchell BC, Ellis H, Wilson P, Pennock AT. An Evidence-Based Approach to Managing Adolescent (Ages 10 to 19 Years) Diaphyseal Clavicle Fractures. J Am Acad Orthop Surg 2024; 32:e156-e165. [PMID: 37903450 DOI: 10.5435/jaaos-d-23-00116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 10/04/2023] [Indexed: 11/01/2023] Open
Abstract
Diaphyseal clavicle fractures occur most frequently in adolescents (defined as ages 10 to 19 years by the World Health Organization). Multiple prospective comparative studies exist in the adult literature, whereas studies focusing on adolescents are limited. Given the notable differences in healing potential between pediatric, adolescent, and adult diaphyseal clavicle fractures, treatment algorithms tailored specifically to children, adolescents, and adults are required. In the past two decades, there has been a dramatic rise in surgical fixation of adolescent diaphyseal clavicle fractures, largely influenced by adult literature. The remodeling potential of the clavicle throughout adolescence and into early adulthood exceeds that of the adult population. Furthermore, prospective outcomes studies of displaced diaphyseal clavicle fractures have demonstrated that, when compared with surgical management, nonsurgical management portends equivalent functional outcomes but a nearly four times greater rate of complications. Even those injuries with comminution and notable shortening, nonsurgical treatment yields good functional outcomes, high rates of return to sport, and low incidence of complications, such as nonunion, symptomatic malunion, and refracture. In rare cases of unsatisfactory nonsurgical treatment, secondary surgical fixation most often results in union and good functional outcomes.
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Affiliation(s)
- Brendon C Mitchell
- From the Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA (Mitchell), Department of Orthopaedic Surgery, University of Texas Southwestern, Texas Scottish Rite Hospital for Children, and Children's Medical Center, Dallas, TX (Ellis and Wilson), Division of Orthopaedic Surgery, Rady Children's Hospital, San Diego, CA (Pennock)
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Ma C, Miao F, Wu H, Li L, Yang Z, Han X. Comparison of the clinical efficacy of three internal fixation methods in the treatment of Edinburgh type IB fractures of the proximal clavicle. Biotechnol Genet Eng Rev 2023:1-15. [PMID: 37092813 DOI: 10.1080/02648725.2023.2202990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Clavicle fractures are one of the most common fractures and usually occur in the medial third of the clavicle. The study explored the efficacy of three internal fixation methods to treat Edinburgh IB fractures of the proximal clavicle. 68 patients with Edinburgh IB fractures of the proximal clavicle were divided into T-shaped plate group, double-miniature steel plate group and memory alloy embracing device group. Postoperative complications, return time to work, and fracture healing time were recorded. The clinical efficacy was evaluated by Constant-Murley score of shoulder joint, Visual Analogue Scale (VAS) score of pain, and arm-shoulder-hand dysfunction score. The operative time of the memory alloy embracing device group was significantly better than T-shaped plate group and double-miniature steel plate group. The length of surgical incision in the double-miniature steel plate group was significantly shorter than that in the T-shaped plate group and the memory alloy embracing device group. The hospitalization cost and recovery time of the double-plate and memory alloy hug groups were lower than those of the T-plate group. The double-miniature steel plate group and the memory alloy embracing device group were significantly better than the T-shaped plate group at two weeks after operation. Satisfactory clinical results can be obtained by using T-shaped plate, double-miniature steel plate and memory alloy embracing device in the treatment of Edinburgh IB fracture of proximal clavicle. However, the double-miniature steel plate group has the advantages of small incision, low cost, and quick postoperative recovery, and has more early advantages.
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Affiliation(s)
- Chengzhi Ma
- Department of Emergency Surgery, Dongying People's Hospital, Dongying Hospital Affiliated to Shandong Provincial Hospital Group, Dongying, China
| | - Fengxia Miao
- Department of Emergency Surgery, Dongying People's Hospital, Dongying Hospital Affiliated to Shandong Provincial Hospital Group, Dongying, China
| | - Hongxiao Wu
- Department of Emergency Surgery, Dongying People's Hospital, Dongying Hospital Affiliated to Shandong Provincial Hospital Group, Dongying, China
| | - Liang Li
- Department of Emergency Surgery, Dongying People's Hospital, Dongying Hospital Affiliated to Shandong Provincial Hospital Group, Dongying, China
| | - Zhan Yang
- Department of Emergency Surgery, Dongying People's Hospital, Dongying Hospital Affiliated to Shandong Provincial Hospital Group, Dongying, China
| | - Xiaochuan Han
- Department of Emergency Surgery, Dongying People's Hospital, Dongying Hospital Affiliated to Shandong Provincial Hospital Group, Dongying, China
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Broad Arm Sling vs Figure of 8 Bandage: The Better Choice in Conservative Management of Middle Third Clavicle Fractures in Indian Population. Indian J Orthop 2022; 56:1394-1402. [PMID: 35729892 PMCID: PMC9187896 DOI: 10.1007/s43465-022-00652-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 04/28/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND A prospective randomised trial was conducted to compare the results of conservative management of middle-third clavicular fracture using the figure of 8 bandage and broad-arm sling. METHODS 296 patients with middle-third clavicle fracture were included in the study conducted between March 2017 and January 2020. 152 patients were managed with figure of 8 bandage and 144 patients were managed with a broad arm sling. Results were evaluated based on clinical, radiological and functional outcomes. Visual analogue scale (VAS) for pain was used to evaluate the clinical outcomes, whereas radiological outcomes were assessed with non-union, malunion, clavicle shortening and time to union. Disability of Arm, Shoulder and Hand score (DASH), Constant score and Nottingham Clavicle Score were used to assess functional outcomes. RESULTS The broad arm sling group showed a significantly better VAS score in the first 4 weeks. DASH score was significantly superior in the broad arm sling group in the initial 4 weeks, but with similar outcome thereafter. Constant scores showed a good outcome for both groups at the final follow-up, whereas the Nottingham Clavicle Score was significantly superior in the broad arm sling group at the 2 year follow-up. A satisfactory outcome was achieved with respect to the radiological parameters, without any significant difference between the 2 groups. Incidence of malunion was significantly higher in figure of 8 bandage group. CONCLUSIONS Broad-arm sling proves to be a better modality of management for middle-third clavicular fractures in terms of ease of application, pain relief, incidence of malunion, and functional outcomes.
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Sisman A, Poyraz C, Cicek AC, Kor S, Cullu E. Are there any differences between the shoulder-arm sling and figure-of-eight bandage in the conservative treatment of paediatric clavicle fractures? J Child Orthop 2021; 15:540-545. [PMID: 34987663 PMCID: PMC8670539 DOI: 10.1302/1863-2548.15.210139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 11/03/2021] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Clavicle fractures are treated conservatively in the paediatric age group, except in rare types of fractures. We investigated whether there was a difference between using shoulder-arm sling and figure-of-eight bandage in this age group. METHODS This study was designed as a retrospective study. In all, 41 children among 53 who underwent conservative treatment with a shoulder-arm sling or figure-of-eight bandage between 2014 and 2019 were included in the study and divided into two groups. Treatment results were compared clinically with respect to pain intensity, muscle strength and radiological examinations. RESULTS Group A comprised 20 children with a figure-of-eight bandage and group B comprised 21 children with shoulder sling. According to the Robinson classification, ten fractures were displaced in group A and 12 in group B (p = 0.647). The mean time until the first appointment after the index visit that started the management course was 25.5 days (21 to 31) in group A and 24 days (20 to 30) in group B (p = 0.129). Fracture healing was observed in all patients at the first follow-up and the treatment was discontinued. There was no difference between the groups in the muscle strength examination and shoulder joint range of movement examination at the first-year follow-up (p = 1.00). CONCLUSION In the paediatric age group, there was no significant difference between shoulder-arm sling and figure-of-eight bandage in the conservative treatment of clavicle fractures. Since the shoulder-arm sling is more suitable for treatment, it may be the primary preference. LEVEL OF EVIDENCE Level III (retrospective comparative study).
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Affiliation(s)
- Ali Sisman
- University Of Health Sciences Istanbul Ümraniye Training and Research Hospital, Istanbul, Turkey
| | - Caner Poyraz
- Department of Orthopaedic and Traumatology, Adnan Menderes University Medical School, Aydin, Turkey,Correspondence should be sent to Caner Poyraz, MD, Department of Orthopaedic and Traumatology, Adnan Menderes University Faculty of Medicine, 09100, Aydin, Turkey. E-mail:
| | - Ali Can Cicek
- Department of Orthopaedic and Traumatology, Adnan Menderes University Medical School, Aydin, Turkey
| | - Suleyman Kor
- Department of Orthopaedic and Traumatology, Iskenderun Public Hospital, Hatay, Turkey
| | - Emre Cullu
- Department of Orthopaedic and Traumatology, Medinova Hospital, Aydin, Turkey
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Abdelghany MS, Ahmed SA, Afandy ME. Superficial cervical plexus block alone or combined with interscalene brachial plexus block in surgery for clavicle fractures: a randomized clinical trial. Minerva Anestesiol 2021; 87:523-532. [PMID: 33591139 DOI: 10.23736/s0375-9393.21.14865-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The regional anesthesia technique which is suitable for fracture clavicle is a matter of debate. This study aimed to compare the use of superficial cervical plexus alone or in combination with interscalene block in patients undergoing internal fixation of fractured clavicle. METHODS Seventy patients undergoing internal fixation of fractured clavicle were enrolled in this clinical trial and randomly distributed into two groups; superficial cervical plexus block (CPB) group and combined superficial cervical plexus block and interscalene block (ISB) group. The regional anesthesia techniques were performed before induction of general anesthesia. The intraoperative fentanyl and isoflurane consumption, the postoperative morphine consumption, the postoperative pain score, the duration of postoperative analgesia, the incidence of perioperative complications, and the patient's satisfaction were recorded. RESULTS In comparison to the use of combined CPB and ISB, the use of CPB alone did not significantly change the postoperative morphine consumption (8.4±3.3 mg versus 7.3±3.2 mg [P=0.2]), the time to the first request of postoperative analgesia (396.7 193.4 min versus 407.7±150.0 min [P=0.8]), or the postoperative pain score (P˃0.05). Also, it did not change the intraoperative fentanyl consumption (P=0.3), the intraoperative isoflurane consumption (P=0.7), the incidence of perioperative complication, or the degree of patient's satisfaction (P˃0.05). It significantly decreased the incidence of phrenic nerve palsy (P=0.03). CONCLUSIONS In patients undergoing internal fixation of clavicular fracture, the perioperative analgesic effect of SCP alone is equally effective to its use in combination with ISB.
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Affiliation(s)
- Mohamed S Abdelghany
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Sameh A Ahmed
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Tanta University, Tanta, Egypt -
| | - Mohamed E Afandy
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Tanta University, Tanta, Egypt
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Buchbinder R, Ramiro S, Huang H, Gagnier JJ, Jia Y, Whittle SL. Measures of Adult Shoulder Function. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:250-293. [PMID: 33091271 DOI: 10.1002/acr.24230] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/21/2020] [Indexed: 12/14/2022]
Affiliation(s)
| | - Sofia Ramiro
- Leiden University Medical Center, Leiden, the Netherlands, and Zuyderland Medical Center, Heerlen, the Netherlands
| | | | | | - Yuanxi Jia
- Johns Hopkins University, Baltimore, Maryland
| | - Samuel L Whittle
- Monash University and Cabrini Institute, Melbourne, Victoria, Australia, and The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
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Tagliapietra J, Belluzzi E, Biz C, Angelini A, Fantoni I, Scioni M, Bolzan M, Berizzi A, Ruggieri P. Midshaft Clavicle Fractures Treated Nonoperatively Using Figure-of-Eight Bandage: Are Fracture Type, Shortening, and Displacement Radiographic Predictors of Failure? Diagnostics (Basel) 2020; 10:diagnostics10100788. [PMID: 33027989 PMCID: PMC7599597 DOI: 10.3390/diagnostics10100788] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/02/2020] [Accepted: 10/04/2020] [Indexed: 12/16/2022] Open
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.
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Affiliation(s)
- Jacopo Tagliapietra
- Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, 35128 Padova, Italy
| | - Elisa Belluzzi
- Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, 35128 Padova, Italy
- Musculoskeletal Pathology and Oncology Laboratory, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, 35128 Padova, Italy
| | - Carlo Biz
- Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, 35128 Padova, Italy
| | - Andrea Angelini
- Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, 35128 Padova, Italy
| | - Ilaria Fantoni
- Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, 35128 Padova, Italy
| | - Manuela Scioni
- Department of Statistical Sciences, University of Padova, 35121 Padova, Italy
| | - Mario Bolzan
- Department of Statistical Sciences, University of Padova, 35121 Padova, Italy
| | - Antonio Berizzi
- Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, 35128 Padova, Italy
| | - Pietro Ruggieri
- Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, 35128 Padova, Italy
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Hehn FH, Bonavides PS, Oliveira Júnior AN, Silva HC, Back Neto M, Stipp WN. Clinical Evaluation of the Surgical Treatment of Midshaft Clavicle Fractures at a Hospital in the South of Santa Catarina. Rev Bras Ortop 2020; 55:100-105. [PMID: 32123453 PMCID: PMC7048566 DOI: 10.1055/s-0039-1697013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 08/08/2018] [Indexed: 11/03/2022] Open
Abstract
Objective To evaluate the results of the surgical treatment of fractures of the middle third of the clavicle. Methods A retrospective cross-sectional study, in which 36 patients who suffered fractures of the middle third of the clavicle and who were surgically treated from January 2012 to February 2017 were evaluated. They were evaluated for types of fracture, age, smoking, osteosynthesis material, and Constant-Murley and Modified-University of California at Los Angeles Shoulder Rating Scale (UCLA-M) scores. Results The mean Constant-Murley and UCLA-M scores were 91.59 and 31.29 respectively. The mean age was 37.62 years, and it was statistically related to the type of osteosynthesis ( p < 0.05), but the osteosynthesis material did not show significance with the improvement in the rates of the functional scores. Conclusion The surgical treatment provides good functional results after diaphyseal fractures of the clavicle, regardless of the line of the fracture, with a low rate of pseudarthrosis.
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Affiliation(s)
- Fernando H.S. Hehn
- Faculdade de Medicina, Universidade do Sul de Santa Catarina (Unisul), Tubarão, SC, Brasil
| | - Paola S.G. Bonavides
- Faculdade de Medicina, Universidade do Sul de Santa Catarina (Unisul), Tubarão, SC, Brasil
| | | | - Helena C.G. Silva
- Faculdade de Medicina, Universidade do Sul de Santa Catarina (Unisul), Tubarão, SC, Brasil
- Departamento de Ortopedia e Traumatologia, Hospital Nossa Senhora da Conceição, Tubarão, SC, Brasil
| | - Martins Back Neto
- Departamento de Ortopedia e Traumatologia, Hospital Nossa Senhora da Conceição, Tubarão, SC, Brasil
| | - Willian N. Stipp
- Departamento de Ortopedia e Traumatologia, Hospital Nossa Senhora da Conceição, Tubarão, SC, Brasil
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Vargas-Vila MA, Mehlman CT, Pennock AT. The Community Orthopaedic Surgeon Taking Trauma Call: Pediatric Midshaft Clavicle Fracture Pearls and Pitfalls. J Orthop Trauma 2019; 33 Suppl 8:S1-S5. [PMID: 31290838 DOI: 10.1097/bot.0000000000001546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Pediatric diaphyseal clavicle fractures are a common injury, particularly in the adolescent athlete. There are no consensus guidelines for operative versus nonoperative management of these injuries; however, there has been a dramatic increase in operative treatment over the past 15 years, primarily guided by literature pertaining to the adult population. Despite this trend, current literature suggests that the majority of these injuries can be treated nonoperatively with good functional outcomes, high rates of return to sport, and low incidence of complications such as nonunion, symptomatic malunion, and refracture. For the rare patient treated nonoperatively who develops a symptomatic nonunion or malunion, delayed corrective surgery remains a viable treatment option. When surgical fixation is pursued, good outcomes have been universally reported, but the optimal indication for surgery remains elusive in this adolescent population.
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Affiliation(s)
- Mario A Vargas-Vila
- Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, CA
| | - Charles T Mehlman
- Division of Pediatric Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Andrew T Pennock
- Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, CA.,Department of Orthopaedic Surgery, Rady Children's Hospital, San Diego, CA
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Chu JY, Yeh KT, Lee RP, Yu TC, Chen IH, Peng CH, Liu KL, Wang JH, Wu WT. Open reduction and internal fixation with plating is beneficial in the early recovery stage for displaced midshaft clavicular fractures in patients aged 30-65 years old. Tzu Chi Med J 2018; 30:242-246. [PMID: 30305789 PMCID: PMC6172902 DOI: 10.4103/tcmj.tcmj_25_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Objectives: Midshaft clavicular fractures are increasingly treated operatively rather than nonoperatively. Studies have shown mixed results for both types of treatment. The aim of this study was to compare the early-stage functional status associated with open reduction and internal fixation (ORIF) with plating and that associated with conservative treatment for displaced midshaft clavicular fractures. Materials and Methods: A single-center retrospective review of the results of 120 cases of displaced midshaft clavicular fractures in patients aged 30–65 years old was conducted. The primary outcome was fracture union status at 6 months. Other outcomes were subjective shoulder value (SSV) scores, visual analog scale (VAS) scores, and radiographic shortening at 6 weeks, 3 months, and 6 months. The complication rates in the operative and nonoperative groups were recorded. Results: The delayed union rate at 6-month postoperatively and VAS scores at 6 weeks, 3 months, and 6 months postinjury were significantly higher in the conservative treatment group than in the ORIF group. SSV scores were significantly improved at 6-month postinjury in the ORIF group. Conclusions: This is the first study to discuss the importance of early-stage functional restoration after ORIF with plating for displaced midshaft clavicular fractures. This surgery leads to lower pain complications in the earlier stages of bone healing and lower delayed union rates compared with conservative treatment, in patients aged 30–65 years old.
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Affiliation(s)
- Jian-Yuan Chu
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Kuang-Ting Yeh
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Ru-Ping Lee
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
| | - Tzai-Chiu Yu
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Ing-Ho Chen
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Cheng-Huan Peng
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Kuan-Lin Liu
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Jen-Hung Wang
- Department of Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Wen-Tien Wu
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
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Lenza M, Faloppa F. Conservative interventions for treating middle third clavicle fractures in adolescents and adults. Cochrane Database Syst Rev 2016; 12:CD007121. [PMID: 27977849 PMCID: PMC6463869 DOI: 10.1002/14651858.cd007121.pub4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Clavicle (collarbone) fractures account for around 4% of all fractures. Most (76%) clavicle fractures involve the middle-third section of the clavicle. Treatment of these fractures is usually non-surgical (conservative). Commonly used treatments are arm slings, strapping and figure-of-eight bandages.This is an update of a Cochrane review first published in 2009 and updated in 2014. OBJECTIVES To evaluate the effects (benefits and harms) of different methods for conservative (non-operative) treatment for acute (treated soon after injury) middle third clavicle fractures in adolescents and adults. SEARCH METHODS We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE (from 1966), Embase (from 1980), LILACS (from 1982), trial registers, orthopaedic proceedings and reference lists of articles. We applied no language or publication restrictions. The date of the last search was 5 January 2016. SELECTION CRITERIA Randomised and quasi-randomised controlled trials testing conservative interventions for treating adolescents and adults with acute middle third clavicle fractures. The primary outcomes were shoulder function or disability, pain and treatment failure. DATA COLLECTION AND ANALYSIS For this update, two review authors selected eligible trials, independently assessed risk of bias and cross-checked data extraction. We calculated risk ratios and 95% confidence intervals for dichotomous variables, and mean differences and 95% confidence intervals for continuous variables. There was very limited pooling of data. MAIN RESULTS We included four trials in this review with 416 participants, who were aged 14 years or above. One new trial was included in this update.Very low quality evidence was available from three trials (296 participants) that compared the figure-of-eight bandage with an arm sling for treating acute middle third clavicle fractures. The three trials were underpowered and compromised by poor methodology. Shoulder function was assessed in different ways in the three trials (data for 51, 61 and 152 participants); each trial provided very low quality evidence of similar shoulder function in the two groups. Pooled data from two trials (203 participants) showed no clinical difference between groups after two weeks in pain (visual analogue scale: 0 (no pain) to 10 (worst pain); mean difference (MD) 0.43, 95% confidence interval (CI) -0.35 to 1.21; I² = 74%; very low quality evidence). A third trial (61 participants) provided very low quality evidence based on a non-validated scoring system of more pain and discomfort during the course of treatment in the figure-of-eight group. Treatment failure, measured in terms of subsequent surgery, was not reported in two trials; the third trial (152 participants) reported one participant in the arm sling group had surgery for secondary plexus nerve palsy. There was very low quality evidence from one trial (148 participants) of little difference in time to clinical fracture healing (MD 0.2 weeks, 95% CI -0.11 to 0.51); data from four non-symptomatic non-unions in the figure-of-eight group were not included. The very low evidence quality data for individual adverse outcomes (poor cosmetic appearance; change in allocated treatment due to pain and discomfort, worsened fracture position on healing; shortening > 15 mm; non-symptomatic non-union and permanent pain) did not confirm a difference between the two groups. There was no clear between group difference in the time to return to school or work activities (MD -0.12 weeks, 95% CI -0.69 to 0.45; 176 participants; very low quality evidence).Moderate quality evidence was available from one trial (120 participants; reporting data for 101 participants), which evaluated therapeutic ultrasound. This trial was at low risk of bias but was underpowered and did not report on shoulder function or quality of life. The trial found no evidence of a difference between low-intensity pulsed ultrasound and placebo in pain, treatment failure (subsequent surgery: 6/52 versus 5/49; RR 1.13, 95% CI 0.37 to 3.47), the time to clinical fracture healing (MD -0.32 days, 95% CI -5.85 to 5.21), adverse events (one case of skin irritation was reported in each group) or time to resume previous activities. AUTHORS' CONCLUSIONS The current evidence available from randomised controlled trials is insufficient to determine which methods of conservative treatment are the most appropriate for acute middle third clavicle fractures in adolescents and adults. Further research is warranted.
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Affiliation(s)
- Mário Lenza
- Faculdade Israelita de Ciencias da Saude Albert Einstein and Hospital Israelita Albert EinsteinOrthopaedic Department and School of MedicineAv. Albert Einstein, 627/701São PauloSão PauloBrazilCEP 05651‐901
| | - Flávio Faloppa
- Universidade Federal de São PauloDepartment of Orthopaedics and TraumatologyRua Borges Lagoa, 783‐5th FloorSão PauloSão PauloBrazil
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