Correlation of the degree of clavicle shortening after non-surgical treatment of midshaft fractures with upper limb function

Abstract

BackgroundDespite the use of non-surgical methods to treat for the majority of midshaft fractures of the clavicle, it is remains controversial whether shortening of this bone following non-surgical treatment of a middle third fracture affects upper limb function.MethodsWe conducted a cohort study by sequentially recruiting 59 patients with a fracture of the middle third of the clavicle. All patients were treated nonsurgically with a figure-of-eight bandage until clinical and radiological findings indicated healing of the fracture. Functional outcome was assessed using the Disability of Arm, Hand and Shoulder (DASH) score revalidated for the Portuguese language, other outcomes assessed included: pain measured by visual analogue scale (VAS); radiographies to measure the degree of shortening, fracture consolidation and fracture malunion. Information were also collected regarding the mechanism of injury, patient’s daily activities level and epidemiological features of the patient cohort. The results of our findings are expressed as the comparison of the functional outcome with the degree of shortening.ResultsPatients were assessed six weeks and one year after injury. In the first evaluation, the mean DASH score was 28.84 and pain measured by VAS was 2.57. In the second evaluation (one year after injury) the mean DASH score was 8.18 and pain was 0.84. The mean clavicle shortening was 0.92 cm, ranging from 0 to 3 cm (SD = 0.64). There were no correlation between the degree of shortening and DASH score after six weeks and one year (p = 0.073 and 0.706, respectively). When only patients with of shortening greater than 2 cm were assessed for correlation, the result did not change.ConclusionWe conclude that clavicle shortening after nonsurgical treatment with a figure-of-eight bandage does not affect limb function, even when shortening exceeds 2 cm.Trial registrationISRCTN85206617. Registered 12 May 2014

Healing, Pain and Function after Midshaft Clavicular Fractures: A Systematic Review of Treatment with Immobilization and Rehabilitation

“…Following the title screen, 208 studies were included in abstract screening, of which 87 progressed to full‐text review. A total of 77 studies were removed by the full‐text review, leaving 10 papers to be included for analysis (Figure ) . No additional articles were retrieved through manual reference search of included studies.…”

“…Of the 10 included studies, 5 of the studies were prospective cohort studies, 1 study was a retrospective cohort study, and the remaining 4 were randomized control trials comparing operative and nonoperative treatments. Seven studies were completed in Europe (Netherlands, Finland, Scotland, Ireland, Italy, Norway), two were completed in India, and one in South America (Brazil). The mean sample size of the included studies was 61 patients (range 32‐105), with a pooled total of 613 cases of midshaft clavicle fracture.…”

“…Of the four randomized controlled trials, two studies scored 8 and two studies scored 9 on the PEDro scale. Of the six observational studies, five studies scored 10 and one study scored 8 on the MINORs scale. The majority of fractures were reported as displaced at the time of injury (606 of the 613); however, in one study 8 undisplaced fractures were included …”

The challenge of nonunion after osteosynthesis of the clavicle: is it a biomechanical or infection problem?

“…The same Authors also assert that the operative treatment could significantly reduce the nonunion rate (16). Two recent papers (22,23) reveal that the reduction of the length of the clavicle may reduce shoulder function measured with the DASH and CSS. According to this meta-analysis (24), the risk of septic nonunion is high if internal fixation is used; the same is for deep infection.…”

“…Empirical antibiotic therapy with broad spectrum must always be started before surgery even when there is no clear sign of infection; it can modified or continued once the laboratory results are available (30). Surgical treatment of infected, aseptic or oligotrophic nonunions of the clavicle should be the same, since we cannot afford to create bone gaps and shortening of the clavicle, therefore compromising the upper limb function (22,23). The clavicles are long bones, so in nonunions it may be used the metal plate against the splint bone technique (31).…”