Displacement of diaphyseal clavicle fractures related to patient position and progressive displacement in the peri-injury period

Onizuka, Naoko; Anderson, Jeffrey P.; Gilbertson, Jeffrey A.; MacCormick, Lauren M.; Cole, Peter A.

doi:10.1016/j.jse.2018.01.004

Cited by 8 publications

(14 citation statements)

References 27 publications

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“…Open fractures, skin tenting with the potential for progression to open fracture, “floating shoulder”, and associated neurovascular injuries represent the only accepted indications for surgery in acute lesions. There are still controversies in cases of comminution, severe displacement, and shortening; in the latter cases, in fact, the choice of treatment seems to be strongly influenced by the professional background and experience of the orthopedic surgeon [ 10 , 14 , 24 , 25 , 26 , 27 , 28 ].…”

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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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 for vertical displacement, we found statistically significantly larger odds of 4.7 (95% CI: 2.2-9.8) to be scored a category higher between the supine and upright patient positioning. Multiple other authors 3 , 23 , 26 also report an increase in vertical displacement between supine and upright patient positioning. Unlike the present study, they do not report these differences in categories but in absolute measurements.…”

Section: Discussionmentioning

confidence: 83%

“…Malik et al 23 found an increase in vertical displacement from 9.42 to 15.72 mm between the 2 patient positions. Lastly, Onizuka et al 26 report an increase of 2.4 mm in vertical displacement. No statistically significant differences in vertical displacement were found between the different orientations of the arm.…”

Section: Discussionmentioning

confidence: 93%

“…Radiographic measurements of shortening and vertical displacement in the fractured clavicle are subject to a variety of factors such as patient positioning, 3 , 23 , 26 point in time after trauma, 26 , 27 anatomic side-to-side difference, 6 , 14 and projection. 2 , 30 , 32 Combined with the sigmoid shape of the clavicle in 2 planes, adequate and reliable measurements of the shortening and vertical displacement on a 2-dimensional radiographic image are challenging.…”

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confidence: 99%

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Influence of radiographic projection and patient positioning on shortening of the fractured clavicle

Hoogervorst¹,

Geene²,

Gundlach³

et al. 2020

JSES International

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Background Radiographic measurements of shortening and vertical displacement in the fractured clavicle are subject to a variety of factors such as patient positioning and projection. The aims of this study were (1) to quantify differences in shortening and vertical displacement in varying patient positions and X-ray projections, (2) to identify the view and patient positioning indicating the largest amount of shortening and vertical displacement, and (3) to identify and quantify the inter- and intraobserver agreement. Methods A prospective clinical measurement study of 22 acute Robinson type 2B1 clavicle fractures was performed. Each patient underwent 8 consecutive standardized and calibrated X-rays in 1 setting. Results In the upright patient position, the difference of absolute shortening was 4.5 mm (95% confidence interval [CI]: 3.0-5.9, P < .0001) larger than in the supine patient position. For vertical displacement, the odds of being scored a category higher in the upright patient position were 4.7 (95% CI: 2.2-9.8) times as large as the odds of being scored a category higher in supine position. The odds of being scored a category higher on the caudocranial projection were 5.9 (95% CI: 2.8-12.6) times as large as the odds of being scored a category higher on the craniocaudal projection. Conclusion Absolute shortening, relative shortening, and vertical displacement were found to be the greatest in the upright patient positioning with the arm protracted orientation on a 15° caudocranial projection. No statistically significant differences were found for a change in position of the arm between neutral and protracted.

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“…Literature underlines the impact of combined clavicle fractures and multiple upper rib fractures, as it may lead to severe thoracic deformities and loss of function of the shoulder [12]. Furthermore, ipsilateral chest wall injuries have been shown to contribute to secondary displacement of the clavicle fracture, especially in patients with upper rib fractures [13,14].…”

Section: Introductionmentioning

confidence: 99%

Epidemiology of combined clavicle and rib fractures: a systematic review

Sweet

Beks

IJpma

et al. 2021

Eur J Trauma Emerg Surg

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Purpose The aim of this systematic review was to provide an overview of the incidence of combined clavicle and rib fractures and the association between these two injuries. Methods A systematic literature search was performed in the MEDLINE, EMBASE, and CENTRAL databases on the 14th of August 2020. Outcome measures were incidence, hospital length of stay (HLOS), intensive care unit admission and length of stay (ILOS), duration of mechanical ventilation (DMV), mortality, chest tube duration, Constant–Murley score, union and complications. Results Seven studies with a total of 71,572 patients were included, comprising five studies on epidemiology and two studies on treatment. Among blunt chest trauma patients, 18.6% had concomitant clavicle and rib fractures. The incidence of rib fractures in polytrauma patients with clavicle fractures was 56–60.6% versus 29% in patients without clavicle fractures. Vice versa, 14–18.8% of patients with multiple rib fractures had concomitant clavicle fractures compared to 7.1% in patients without multiple rib fractures. One study reported no complications after fixation of both injuries. Another study on treatment, reported shorter ILOS and less complications among operatively versus conservatively treated patients (5.4 ± 1.5 versus 21 ± 13.6 days). Conclusion Clavicle fractures and rib fractures are closely related in polytrauma patients and almost a fifth of all blunt chest trauma patients sustain both injuries. Definitive conclusions could not be drawn on treatment of the combined injury. Future research should further investigate indications and benefits of operative treatment of this injury.

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Displacement of diaphyseal clavicle fractures related to patient position and progressive displacement in the peri-injury period

Cited by 8 publications

References 27 publications

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

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

Influence of radiographic projection and patient positioning on shortening of the fractured clavicle

Epidemiology of combined clavicle and rib fractures: a systematic review

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