Evidence on treatment of clavicle fractures

von Rüden, Christian; Rehme-Röhrl, Julia; Augat, Peter; Friederichs, Jan; Hackl, Simon; Stuby, Fabian; Trapp, Oliver

doi:10.1016/j.injury.2023.05.049

Cited by 6 publications

(3 citation statements)

References 93 publications

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“…In our reference table, the maximal clavicular diameter differs only by one millimetre. In addition to the site dependency from right/left clavicle diameters, it enables thoughts about planning plate osteosynthesis for clavicle fractures with more precise preparation, which seems to lead to better outcomes [ 33 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

Normative Values for Sternoclavicular Joint and Clavicle Anatomy Based on MR Imaging: A Comprehensive Analysis of 1591 Healthy Participants

Languth,

Prietzel,

Bülow

et al. 2024

JCM

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Background: The clavicle remains one of the most fractured bones in the human body, despite the fact that little is known about the MR imaging of it and the adjacent sternoclavicular joint. This study aims to establish standardized values for the diameters of the clavicle as well as the angles of the sternoclavicular joint using whole-body MRI scans of a large and healthy population and to examine further possible correlations between diameters and angles and influencing factors like BMI, weight, height, sex, and age. Methods: This study reviewed whole-body MRI scans from the Study of Health in Pomerania (SHIP), a German population-based cross-sectional study in Mecklenburg–Western Pomerania. Descriptive statistics, as well as median-based regression models, were used to evaluate the results. Results: We could establish reference values based on a shoulder-healthy population for each clavicle parameter. Substantial differences were found for sex. Small impacts were found for height, weight, and BMI. Less to no impact was found for age. Conclusions: This study provides valuable reference values for clavicle and sternoclavicular joint-related parameters and shows the effects of epidemiological features, laying the groundwork for future studies. Further research is mandatory to determine the clinical implications of these findings.

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Section: Discussionmentioning

confidence: 99%

Normative Values for Sternoclavicular Joint and Clavicle Anatomy Based on MR Imaging: A Comprehensive Analysis of 1591 Healthy Participants

Languth,

Prietzel,

Bülow

et al. 2024

JCM

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“…On the other hand, in the current study, operative clavicle fracture treatment was only performed when the patients' overall clinical status was good enough for surgery. Furthermore, it was accepted as a relatively minor operative procedure compared to polytraumatization [37].…”

Section: Discussionmentioning

confidence: 99%

Early Internal Fixation of Concomitant Clavicle Fractures in Severe Thoracic Trauma Prevents Posttraumatic Pneumonia

Rehme-Röhrl,

Sicklinger,

Brand

et al. 2023

JCM

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Background: Severe thoracic trauma can lead to pulmonary restriction, loss of lung volume, and difficulty with ventilation. In recent years, there has been increasing evidence of better clinical outcomes following surgical stabilization of clavicle fractures in the setting of this combination of injuries. The aim of this study was to evaluate surgical versus non-surgical treatment of clavicle fractures in severe thoracic trauma in terms of clinical and radiological outcomes in order to make a generalized treatment recommendation based on the results of a large patient cohort. Patients and Methods: This retrospective study included 181 patients (42 women, 139 men) from a European level I trauma centre with a median of 49.3 years in between 2005 and 2021. In 116 cases, the clavicle fracture was stabilized with locking plate or hook plate fixation (group 1), and in 65 cases, it was treated non-surgically (group 2). Long-term functional outcomes at least one year postoperatively using the disabilities of the arm, shoulder and hand (DASH) questionnaire and the Nottingham Clavicle Score (NCS) as well as radiological outcomes were collected in addition to parameters such as hospital days, intensive care days, and complication rates. Results: The Injury Severity Score (ISS) was 17.8 ± 9.8 in group 1 and 19.9 ± 14.4 in group 2 (mean ± SEM; p = 0.93), the time in hospital was 21.5 ± 27.2 days in group 1 versus 16 ± 29.3 days in group 2 (p = 0.04). Forty-seven patients in group 1 and eleven patients in the group 2 were treated in the ICU. Regarding the duration of ventilation (group 1: 9.1 ± 8.9 days, group 2: 8.1 ± 7.7 days; p = 0.64), the functional outcome (DASH group 1: 11 ± 18 points, group 2: 13.7 ± 18. 4 points, p = 0.51; NCS group 1: 17.9 ± 8.1 points, group 2: 19.4 ± 10.3 points, p = 0.79) and the radiological results, no significant differences were found between the treatment groups. With an overall similar complication rate, pneumonia was found in 2% of patients in group 1 and in 14% of patients in group 2 (p = 0.001). Discussion: This study could demonstrate that surgical locking plate fixation of clavicle fractures in combination with CWI significantly reducing the development of posttraumatic pneumonia in a large patient collection and, therefore, can be recommended as standard therapeutic approach for severe thoracic trauma.

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“…The traditional literature shows a good evolution in non-surgical treatment in fractures of the middle third of the clavicle. 5 While surgical treatment was recommended for cases with bone exposure, associated neurovascular injury, floating shoulder, scapulothoracic dissociation, polytraumatized, 6 and presence of bone shortening equal to or greater than 15 to 20 millimeters, 7 , 8 the latter being the main predisposing factor for non-bone union, identified in 15% to 21% of cases. 9 …”

Section: Introductionmentioning

confidence: 99%

Shortening of Clavicle Fractures: Physical Versus Image Examinations

Beraldo,

Silva,

de Paiva Junior

et al. 2024

Acta ortop. bras.

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Objective: Determine the reliability of three different methods of evaluating bone shortening in displaced midshaft clavicle fractures (DCMF). Method: A cross-sectional analytical study evaluated bone shortening by metric tape (MT), radiography (X-ray), and computed tomography (CT). Twenty-six men had been evaluated and used clavícula not broken as control. The collection of data was of the blind type for three specialists. Differences and reliability were analyzed with the Friedman and Kappa tests and validated with the T-test (CI: 95%; significance index p<0.05; Software "R" version 3.2.2). Results: The MT measurements (control) showed abnormal distribution and significant statistical difference concerning the imaging tests (p=0.000008). There was a similarity between X-ray and CT and Kappa agreement of 0.65. The fractured clavicles presented similar measurements between the three methods (p=0.059), and the T-tests proved that the similarity was caused by chance or possible measurement errors. Conclusion: Measurement by metric tape showed a tendency to overestimate bone shortening. The CT showed more reliable results for the diagnosis; however, the X-ray was sufficient for decision-making by surgeons, and therefore, it is not possible to rule out the importance of this resource for DCMF. Level of Evidence IV; Case-Control Study.

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Evidence on treatment of clavicle fractures

Cited by 6 publications

References 93 publications

Normative Values for Sternoclavicular Joint and Clavicle Anatomy Based on MR Imaging: A Comprehensive Analysis of 1591 Healthy Participants

Normative Values for Sternoclavicular Joint and Clavicle Anatomy Based on MR Imaging: A Comprehensive Analysis of 1591 Healthy Participants

Early Internal Fixation of Concomitant Clavicle Fractures in Severe Thoracic Trauma Prevents Posttraumatic Pneumonia

Shortening of Clavicle Fractures: Physical Versus Image Examinations

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