Early Versus Delayed Operative Intervention in Displaced Clavicle Fractures

Das, Avishek; Rollins, Katie E.; Elliott, Kathleen; Johnston, P.; van-Rensburg, Lee; Tytherleigh-Strong, Graham; Ollivere, B.

doi:10.1097/bot.0b013e3182a2968e

Cited by 34 publications

(16 citation statements)

References 11 publications

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“…This may be related to earlier fracture healing and early rehabilitation after ORIF, which is known to be a critical factor for functional restoration of the shoulder girdle. One study revealed no statistically significant differences in any of the functional outcome evaluation methods between early and late fixation of displaced midshaft clavicular fractures, and the authors suggested that operative intervention for clavicle fractures between 3- and 12-week postinjury may be safe with no risk of excess complications [ 15 ]. However, our study results indicated improved functional restoration with ORIF for patients aged 30–65 years old, which may assist patients in returning to their preinjury social function, quality of life, and activity level in the early stage.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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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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Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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“… 24 Early identification of patients at increased risk of nonunion following nonoperative treatment for targeted fixation is an emerging strategy from recent evidence. 25 - 28 …”

Section: Discussionmentioning

confidence: 99%

Acute plate fixation of displaced midshaft clavicular fractures is not associated with earlier return of normal shoulder function when union is achieved

et al. 2021

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Aims It is unclear whether acute plate fixation facilitates earlier return of normal shoulder function following a displaced mid-shaft clavicular fracture compared with nonoperative management when union occurs. The primary aim of this study was to establish whether acute plate fixation was associated with a greater return of normal shoulder function when compared with nonoperative management in patients who unite their fractures. The secondary aim was to investigate whether there were identifiable predictors associated with return of normal shoulder function in patients who achieve union with nonoperative management. Methods Patient data from a randomized controlled trial were used to compare acute plate fixation with nonoperative management of united fractures. Return of shoulder function was based on the age- and sex-matched Disabilities of the Arm, Shoulder and Hand (DASH) scores for the cohort. Independent predictors of an early recovery of normal shoulder function were investigated using a separate prospective series of consecutive nonoperative displaced mid-shaft clavicular fractures recruited over a two-year period (aged ≥ 16 years). Patient demographics and functional recovery were assessed over the six months post-injury using a standardized protocol. Results Data from the randomized controlled trial consisted of 86 patients who underwent operative fixation compared with 76 patients that united with nonoperative treatment. The recovery of normal shoulder function, as defined by a DASH score within the predicted 95% confidence interval for each respective patient, was similar between each group at six weeks (operative 26.7% vs nonoperative 25.0%, p = 0.800), three months (52.3% vs 44.2%, p = 0.768), and six months post-injury (86.0% vs 90.8%, p = 0.349). The mean DASH score and return to work were also comparable at each timepoint. In the prospective cohort, 86.5% (n = 173/200) achieved union by six months post-injury (follow-up rate 88.5%, n = 200/226). Regression analysis found that no specific patient, injury, or fracture predictor was associated with an early return of function at six or 12 weeks. Conclusion Return of normal shoulder function was comparable between acute plate fixation and nonoperative management when union was achieved. One in two patients will have recovery of normal shoulder function at three months, increasing to nine out of ten patients at six months following injury when union occurs, irrespective of initial treatment. Cite this article: Bone Jt Open 2021;2(7):522–529.

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“…There is increasing evidence that delayed primary fixation in the first three months post-injury is a valid alternative without an apparent increase in complications [47][48][49] . Delayed recovery following non-operative management may predict union and can be accurately judged on a patient reported QuickDASH score and other objective clinical features at six weeks post-injury [ 50 , 51 ].…”

Section: Claviclementioning

confidence: 99%

Fracture nonunion in long bones: A literature review of risk factors and surgical management

Nicholson

Makaram

Simpson³

et al. 2021

Injury

154

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Nonunion following a long bone fracture causes considerable morbidity when it occurs. Risk factors depend on specific fractures but there is a complex interplay of injury severity, comorbidities, patient medication and infection. The majority of nonunions occur after long bone fractures with the tibia, femur, forearm, humerus and clavicle predominating. Despite interest in the biological augmentation of fracture healing, the majority of nonunions can be effectively managed with conventional surgical techniques. In this review we present a review of risk factors for nonunion and the outcome following surgical management.

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Early Versus Delayed Operative Intervention in Displaced Clavicle Fractures

Abstract: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Cited by 34 publications

References 11 publications

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

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

Acute plate fixation of displaced midshaft clavicular fractures is not associated with earlier return of normal shoulder function when union is achieved

Fracture nonunion in long bones: A literature review of risk factors and surgical management

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