Length Determination in Midshaft Clavicle Fractures: Validation of Measurement

Smekal, Vinzenz; Deml, Christian; Irenberger, Alexander; Niederwanger, Christian; Lutz, M.; Blauth, M.; Krappinger, Dietmar

doi:10.1097/bot.0b013e318178d97d

Cited by 99 publications

(90 citation statements)

References 29 publications

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“…Additionally, patient positioning (supine v. upright) and distance of the patient from the radiograph cassette may contribute to error in measurement of clavicle shortening on plain films. 17,19 In the present study, 18 patients sustained clavicle fractures as a result of high-energy trauma. As a result, not all patients could sit upright for clavicle films; however, each CT scan was obtained with the patient supine.…”

Section: Discussionmentioning

confidence: 99%

“…These measurement modalities include clinical estimates with tape measure, radiological estimates made on uncalibrated plain films and computed tomography (CT) measurements in both the acute fracture and chronic malunion settings. 5,6,8,10,12,[14][15][16] In a recent study of healed clavicle fractures, Smekal and colleagues 17 established that neither clinical nor plain film measures of clavicle shortening correlate with those obtained by CT (used as a reference measure). Additionally, of the 3 radiographs investigated (15° up-tilted panorama and 15° standardized tilted views) only the posteroanterior (PA) thorax radiograph that demonstrated the contralateral unfractured clavicle for comparison correlated with CT measurements of clavicle shortening.…”

Section: Discussionmentioning

confidence: 99%

“…5,6,10,14,16,31 Measurement from plain film is associated with significant error, highlighting the potential drawback of using this modality as a screening tool to identify operative candidates. 17 Several pitfalls inherent in plain radiography potentially compromise the use of this modality as a reliable measuring tool for clavicle fractures. First, the complex s-shaped morphology of the clavicle prevents the bone from being positioned truly perpendicular to the radiograph cassette, and second, true orthogonal imaging of the clavicle is not easily obtained.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, of the 3 radiographs investigated (15° up-tilted panorama and 15° standardized tilted views) only the posteroanterior (PA) thorax radiograph that demonstrated the contralateral unfractured clavicle for comparison correlated with CT measurements of clavicle shortening. 17 A PA thorax radiograph that includes the injured and normal clavicle is not routinely part of the diagnostic radiograph series for suspected clavicle fracture, and as such clinicians may not currently have access to the necessary imaging required to identify patients who meet shortening criteria for operative intervention. 18 To our knowledge, no reports to date have compared clavicle shortening measured on plain film to that measured on CT in the acute fracture setting.…”

Section: Discussionmentioning

confidence: 99%

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Plain film measurement error in acute displaced midshaft clavicle fractures

Archer

Hunt

Squire³

et al. 2016

Can J Surg

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Plain film measurement error in acute displaced midshaft clavicle fractures

Archer

Hunt

Squire³

et al. 2016

Can J Surg

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“…Clavicle length was defined as the distance between the lateral-most point of the clavicle in the acromioclavicular joint and the medial-most point of the clavicle in the sternoclavicular joint, 13) and differences in length between affected and unaffected limbs were evaluated. Clavicle shortening of more than 2 cm was considered a malunion.…”

Section: Methodsmentioning

confidence: 99%

Mini-open Treatment Using Plate of Clavicle Mid-shaft Fractures

Park

Kang

Kim³

et al. 2017

Clinics in Shoulder and Elbow

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Background: Increased frequency of comminuted clavicle mid-shaft fractures and importance of functional satisfaction through early joint exercise has resulted in higher emphasis on surgical treatments. This study aimed to evaluate the clinical radiological results of treatment of clavicle mid-shaft fractures by open reduction and internal fixation using a plate with a small incision. Methods: The subjects of this study were 80 clavicle mid-shaft fracture cases treated with internal fixation using a plate from October 2010 to July 2014. Clavicle mid-shaft fractures were internally fixated using anatomical plates or locking compression plates. Achievement of bone union, union period, and clavicle length shortening were evaluated radiologically, and clinical assessment was done by using Constant and University of California at Los Angeles (UCLA) scores. Results: All 80 cases were confirmed to have achieved bone union through radiographs with an average union period of 10.9 weeks (range: 7-18 weeks). The average clavicle length of shortening in the affected side was 1.8 mm (range: 0-17 mm). The average UCLA score and Constant score were 33.6 (range: 25-35) and 92.5 (range: 65-100), respectively. Regarding complications, four cases reported skin irritation by metal plates, and one case reported a screw insertion site fracture due to minor trauma history. Conclusions: We were able to induce successful bone union and obtain clinically satisfactory results in displaced mid-shaft fractures of the clavicle without major complications such as nonunion through treatment of internal fixation using a plate.

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