Management of Displaced Midshaft Clavicle Fractures with Figure-of-Eight Bandage: The Impact of Residual Shortening on Shoulder Function

Biz, Carlo; Scucchiari, Davide; Pozzuoli, Assunta; Belluzzi, Elisa; Bragazzi, Nicola Luigi; Berizzi, Antonio; Ruggieri, Pietro

doi:10.3390/jpm12050759

Cited by 4 publications

(10 citation statements)

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“…With respect to treatment of clavicle fractures, both surgical and conservative treatment can achieve satisfactory outcomes with a high bone union rate [ 2 , 24 , 25 ]. Pediatric clavicular fractures [ 26 ] as well as stable or non-displaced dislocation of the AC joint [ 5 ] or SC joint [ 4 ] can be successfully managed with conservative treatment.…”

Section: Discussionmentioning

confidence: 99%

“…The clavicle is a double-curved S-shaped bone, and it is the only long horizontal bone connecting the axial and upper girdle bones. Clavicle fractures are very common injuries, representing 2.6% to 4.0% of all fractures, and up to 82% of clavicle fractures occur in the middle third of the clavicle [ 1 , 2 ]. By contrast, lateral clavicle fractures and medial clavicle fractures account for 28% [ 3 ] and 3% [ 1 ] of all clavicle fractures, respectively.…”

Section: Introductionmentioning

confidence: 99%

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Treatment of bipolar clavicle injury with internal plating: a case series and literature review

Feng

Liu

Huang

et al. 2023

BMC Musculoskelet Disord

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Background Bipolar clavicle injury is a rare injury involving any combination of dislocation and/or fracture at both ends of the clavicle. Most reports of bipolar clavicle injury have been based on a single case, and treatment of this injury remains controversial. The present study was performed to evaluate the efficacy of surgical management with internal plating for bipolar clavicle injuries. Methods We performed internal plating to treat seven consecutive bipolar clavicle injuries with different injury patterns from May 2013 to June 2021. A clavicle hook plate was used for five sternoclavicular joint injuries (including a revision surgery) and three acromioclavicular joint dislocations, a T plate was used for one sternoclavicular joint injury, and an anatomic plate was used for one distal clavicle fracture. At follow-up, radiographs were assessed for bone alignment, joint congruity, fracture union or malunion, and implant failure or migration. Clinical evaluation included determination of the Disability of the Arm, Shoulder, and Hand (DASH) score; Constant–Murley score; visual analog scale (VAS) score; and complications. Results The patients were regularly followed up after the operation, and functional parameters were assessed over time. At a mean follow-up of 28.1 ± 22.0 months, each fracture had solid bone union, and each dislocation showed no sign of recurrent instability. The mean shoulder forward flexion was 159.3° ± 7.9°, and the mean DASH score was 8.8 ± 5.1. The mean Constant–Murley score was 88.9 ± 7.9, with six cases assessed as excellent and one case assessed as good. The mean VAS score was 1.0 ± 1.5, and the mean patient satisfaction score was 9.3 ± 0.8. No complications occurred, and each patient was able to resume their preinjury daily activity and was highly satisfied with their treatment. Conclusions In the present study, internal plating for bipolar clavicle injury allowed early mobilization and resulted in good joint function. We recommend fixation of the more severely affected side first because the other side may be passively reduced and acquire stability once the more severely affected side has been fixed. Internal fixation of the other end may therefore be unnecessary unless residual instability exists.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Treatment of bipolar clavicle injury with internal plating: a case series and literature review

Feng

Liu

Huang

et al. 2023

BMC Musculoskelet Disord

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“…At our level-1 healthcare trauma centre, a standardised institutional treatment protocol for patients with ADMCFs was adopted based on our previous experience and applied methodologically as has already been described in the literature [ 27 , 28 , 29 ].…”

Section: Methodsmentioning

confidence: 99%

“…Radiographic fracture features were evaluated on standard X-rays performed at patient admission in the ER as follows: type of fracture type according to Classification of the Association for Osteosynthesis/Orthopedic Trauma Association (AO/OTA) [ 37 ]; initial shortening (IS) and residual shortening (RS), measured before and after the F8-B application, respectively, based on the overlap of proximal and distal fragments and expressed as a percentage of the same clavicle length on the antero-posterior view; initial displacement (ID) and residual displacement (RD), measured before and after the F8-B. Fragment displacement was defined as the amount of vertical translation and measured as a percentage of the clavicle width at the fracture site on a 20° cephalic tilt view of the clavicle [ 27 , 28 ]. Intra-reader and inter-reader reliability were found to be good (>0.80) for all measurements.…”

Section: Methodsmentioning

confidence: 99%

“…Recently, residual displacement (RD), measured after figure-of-eight bandage (F8-B) application, was identified as a predictive factor of delayed union and non-union for patients with ADMCFs non-operatively treated (RD of 104% for delayed union and 140% for non-union) [ 27 ]. Based on these findings, a protocol for the treatment of ADMCFs was developed at our institution whose strict application showed that in patients with a RD of less than 104%, good to excellent clinical outcomes could be achieved without non-union when treated conservatively [ 28 ].…”

Section: Introductionmentioning

confidence: 99%

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An Institutional Standardised Protocol for the Treatment of Acute Displaced Midshaft Clavicle Fractures (ADMCFs): Conservative or Surgical Management for Active Patients?

et al. 2023

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Background and Objectives: The treatment of acute displaced midshaft clavicle fractures (ADMCFs) is still under debate. The aim of this study was to verify the effectiveness of our institutional protocol by comparing the clinical and radiographic outcomes of two groups of patients with ADMCFs treated operatively and non-operatively. Materials and Methods: active patients with a traumatic, isolated non-pathological ADMCF with at least 1-year clinical and radiographic follow up were included. Surgical treatment was performed in the cases where the residual displacement was higher than 140% after the application of a figure-of-eight bandage (F8-B). All other cases were treated conservatively with a F8-B. A total of 134 patients were enrolled and divided into two groups: surgical and conservative groups, with 59 and 75 patients, respectively. Radiological and clinical parameters were evaluated. Results: Good clinical (Constant-Murley Score, the Quick Disability of the Arm, Shoulder and Hand score, and VAS satisfaction) and radiographic outcomes (initial and residual shortening, initial and residual displacement) were obtained for ADMCFs in both groups. Multivariate analysis showed that patients treated conservatively had better clinical outcomes compared to surgically treated patients (p < 0.001). Return to sports was longer in those treated with surgery. Initial shortening was found to impact clinical outcomes as well as initial displacement. None of the patients showed signs of non-union in both groups. Conclusions: Very good mid-term clinical results can be obtained in adult patients with ADMCFs, conservatively or operatively managed, by applying our institutional treatment protocol based on objective radiographic parameters evaluated in the ER.

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Comprehensive comparison between conservative therapy and surgical management for completely displaced and comminuted mid-shaft clavicle fractures

Han,

Zhang,

Zhang

et al. 2024

International Orthopaedics (SICOT)

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Purpose It is still controversial whether complete displaced mid-shaft clavicle fractures should be treated with internal fixation or conservative therapy. This retrospective study aims to compare clinical outcomes of two treatment protocols. Materials and methods 105 patients with displaced and comminuted mid-shaft clavicle fractures were included in this study, among which 55 patients were treated conservatively and 50 patients accepted surgical fixation and were followed up for over 20 months on average. Rate of union, malunion, time taken for union, functional outcome, self-reported satisfaction and complications were compared. Results Union rate of operative group (n=49, 98.0%) was higher than the non-operative group (n=48, 87.3%). Time taken for union in operative group (2.37±1.06 months) was shorter than the non-operative group (3.69±1.01 months). Malunion and asymmetric were only seen in the conservative group. Numbness of the shoulder was only reported in the operative group (n=23, 46.0%). Most of patients in the operative group (n=45, 90%) accepted a second operation to remove the implant. No statistically difference was found in self-reported satisfaction, Quick-DASH and Constant-Murley score. The operative group returned to work faster (1.47±0.89 to 3.34±1.37 months), regained full range of motion earlier (1.66±0.78 to 3.83±1.24 months) and regained strength faster (3.86±2.45 to 8.03±2.78 months) than the non-operative group. Conclusion Complete displaced and comminuted mid-shaft clavicle fractures treated surgically have more reliable union and faster recovery when compared to conservatively treated fractures.

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Management of Displaced Midshaft Clavicle Fractures with Figure-of-Eight Bandage: The Impact of Residual Shortening on Shoulder Function

Cited by 4 publications

References 60 publications

Treatment of bipolar clavicle injury with internal plating: a case series and literature review

Treatment of bipolar clavicle injury with internal plating: a case series and literature review

An Institutional Standardised Protocol for the Treatment of Acute Displaced Midshaft Clavicle Fractures (ADMCFs): Conservative or Surgical Management for Active Patients?

Comprehensive comparison between conservative therapy and surgical management for completely displaced and comminuted mid-shaft clavicle fractures

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