Acute Midshaft Clavicular Fracture

Jeray, Kyle J.

doi:10.5435/00124635-200704000-00007

Cited by 178 publications

(137 citation statements)

References 45 publications

Supporting

Mentioning

108

Contrasting

Unclassified

Order By: Relevance

“…21 Surgery should also be considered for fractures which are grossly displaced and severely comminuted as they have propensity to land up in non union [ Table 5]. 22,23 Recent studies which have compared conservative with operative treatment of displaced midshaft fracture clavicle, have documented better union rates and early functional return with fixation and association of malunion and non union with conservative treatment [ Table 6].…”

Section: Discussionmentioning

confidence: 99%

Comparison of treatment of fracture midshaft clavicle in adults by external fixator with conservative treatment

Shukla

Sinha

Yadav

et al. 2014

Journal of Clinical Orthopaedics and Trauma

View full text Add to dashboard Cite

a b s t r a c tPurpose: High rate of malunion and non union in displaced fracture clavicle treated conservatively lead to use of different types of internal fixation methods which also were found to be associated with various complications. Moreover their superiority over conservative treatment has not been established. This study was designed to compare clinical outcome of conservative treatment with external fixator in cases with displaced midshaft clavicle fractures.Methods: Fifty adult consenting cases of acute midshaft fracture clavicle, displaced >15 mm were included. Twenty five cases were allotted to conservative (group A) and external fixator (group B) each. In group A treatment was given in form of clavicle brace. In group B schanz pins were inserted obliquely between supero-inferior and anterior-posterior direction and connected with rod. The outcome was measured by Constant score, union time and complications.Results: Mean radiographic union time in group A was 23.45 ± 1.40 weeks (with 8% non union and 80% malunion) and in group B it was 9.36 ± 1.49 weeks. Mean Constant score at 6 months in group A was 78.28 ± 6.45 and in group B 92.72 ± 1.48. Mean shortening at 6 months in group A was 19.36 mm. In group B shortening at 6 months was noticed in three cases (6, 5, 6 mm).Conclusion: Close reduction of acute fracture mid clavicle and application of external fixator is a simple procedure providing the benefits of rigid fixation and undisturbed fracture environment. Pain relief is faster, union time is shorter and there are no hardware related problems.

show abstract

Section: Discussionmentioning

confidence: 99%

Comparison of treatment of fracture midshaft clavicle in adults by external fixator with conservative treatment

Shukla

Sinha

Yadav

et al. 2014

Journal of Clinical Orthopaedics and Trauma

View full text Add to dashboard Cite

show abstract

“…Nos résultats démontrent une faible corrélation entre les mesures du raccourcissement obtenues par radiographie et par TDM dans la FTMD aiguë. 3,4 Data presented in recent literature suggest that nonoperative treatment of displaced midshaft clavicle fractures (DMCFs) leads to a higher incidence of nonunion than previously reported as well as reduced shoulder strength and endurance. [5][6][7][8][9][10] Poor functional outcome has been associated with nonoperatively treated fractures that result in an overall clavicle length 15-20 mm shorter than the contralateral (unfractured) clavicle.…”

Section: Discussionmentioning

confidence: 99%

“…[5][6][7][8][9][10] Poor functional outcome has been associated with nonoperatively treated fractures that result in an overall clavicle length 15-20 mm shorter than the contralateral (unfractured) clavicle. 3,11,12 Consequently, 20 mm of shortening has evolved as a relative indication for operative therapy. 3,13,11 The literature that has established 20 mm of shortening as a relative indication for surgical management of DMCF is the product of multiple studies that use different measurement modalities.…”

Section: Discussionmentioning

confidence: 99%

Plain film measurement error in acute displaced midshaft clavicle fractures

Archer

Hunt

Squire³

et al. 2016

Can J Surg

View full text Add to dashboard Cite

Background: Clavicle fractures are common and optimal treatment remains controversial. Recent literature suggests operative fixation of acute displaced mid-shaft clavicle fractures (DMCFs) shortened more than 2 cm improves outcomes. We aimed to identify correlation between plain film and computed tomography (CT) measurement of displacement and the inter-and intraobserver reliability of repeated radiographic measurements. Methods:We obtained radiographs and CT scans of patients with acute DMCFs. Three orthopedic staff and 3 residents measured radiographic displacement at time zero and 2 weeks later. The CT measurements identified absolute shortening in 3 dimensions (by subtracting the length of the fractured from the intact clavicle). We then compared shortening measured on radiographs and shortening measured in 3 dimensions on CT. Interobserver and intraobserver reliability were calculated. Results:We reviewed the fractures of 22 patients. Bland-Altman repeatability coefficient calculations indicated that radiograph and CT measurements of shortening could not be correlated owing to an unacceptable amount of measurement error (6 cm). Interobserver reliability for plain radiograph measurements was excellent (Cronbach α = 0.90). Likewise, intraobserver reliabilities for plain radiograph measurements as calculated with paired t tests indicated excellent correlation (p > 0.05 in all but 1 observer [p = 0.04]). Conclusion:To establish shortening as an indication for DMCF fixation, reliable measurement tools are required. The low correlation between plain film and CT measurements we observed suggests further research is necessary to establish what imaging modality reliably predicts shortening. Our results indicate weak correlation between radiograph and CT measurement of acute DMCF shortening.

show abstract

“…1 Fractures of the midshaft account for approximately 80% of all clavicular fractures because the junction between the lateral and middle third is the thinnest portion of the bone and lacks muscular and ligamentous reinforcement. 2,3 Historically, fractures of the middle third of the clavicle were managed nonoperatively because closed treatment was believed to yield a low nonunion rate and minimal functional impairment. 4 In addition, clavicular malunion, which occurs to some degree in approximately two-thirds of midshaft clavicle fractures, was previously described as being solely a radiographic anomaly with no clinical significance.…”

Section: Introductionmentioning

confidence: 99%

Treatment of Midshaft Clavicle Fractures: Application of Local Autograft With Concurrent Plate Fixation

Slette

Mikula

Turnbull

et al. 2016

Arthroscopy Techniques

View full text Add to dashboard Cite

Abstract:Currently, open reductioneinternal fixation using contoured plates or intramedullary nails is considered the standard operative treatment for midshaft clavicle fractures because of the immediate rigid stability provided by the fixation device. In addition, autologous iliac crest bone graft has proved to augment osteosynthesis during internal fixation of nonunion fractures through the release of osteogenic factors. The purpose of this article is to describe a surgical technique developed to reduce donor-site morbidity and improve functional and objective outcomes after open reductioneinternal fixation with autologous bone graft placement through local autograft harvesting and concurrent plate fixation.T he clavicle is one of the most commonly fractured bones, representing 5% to 15% of all fractures. 1 Fractures of the midshaft account for approximately 80% of all clavicular fractures because the junction between the lateral and middle third is the thinnest portion of the bone and lacks muscular and ligamentous reinforcement. 2,3 Historically, fractures of the middle third of the clavicle were managed nonoperatively because closed treatment was believed to yield a low nonunion rate and minimal functional impairment. 4 In addition, clavicular malunion, which occurs to some degree in approximately two-thirds of midshaft clavicle fractures, was previously described as being solely a radiographic anomaly with no clinical significance. 2,5-8 However, more recent studies have suggested that operative treatment results in increased patient satisfaction, superior functional capabilities, and decreased rates of nonunion and malunion when compared with nonoperative management. [9][10][11][12] Operative management of midshaft clavicle fractures may involve the use of various techniques for reduction and fixation. 12 Currently, open reductioneinternal fixation is considered the gold-standard treatment because of the immediate rigid stability provided by the fixation device. 2,11,[13][14][15][16][17] Internal fixation of midshaft clavicle fractures may involve the use of contoured plates or intramedullary nails. [18][19][20] In addition, autologous iliac crest bone graft (ICBG) has proved to augment osteosynthesis during fixation of nonunion fractures through the release of osteogenic factors. 2,11,[13][14][15][16][17] However, studies have associated ICBG harvesting with significant donor-site morbidity, including neurologic and vascular injury, incisional hernia, donor-site fracture, and deep infection. [21][22][23][24] Therefore, the purpose of this article was to describe a surgical technique developed to reduce donor-site morbidity and improve functional outcomes after open reductioneinternal fixation with autologous bone graft placement through local autograft harvesting and concurrent plate fixation.

show abstract

Acute Midshaft Clavicular Fracture

Cited by 178 publications

References 45 publications

Comparison of treatment of fracture midshaft clavicle in adults by external fixator with conservative treatment

Comparison of treatment of fracture midshaft clavicle in adults by external fixator with conservative treatment

Plain film measurement error in acute displaced midshaft clavicle fractures

Treatment of Midshaft Clavicle Fractures: Application of Local Autograft With Concurrent Plate Fixation

Contact Info

Product

Resources

About