Nonoperative treatment of closed displaced midshaft clavicle fractures

Faldini, Cesare; Nanni, Matteo; Leonetti, Danilo; Acri, Francesco; Galante, Claudio; Luciani, Deianira; Giannini, Sandro

doi:10.1007/s10195-010-0113-z

Cited by 39 publications

(50 citation statements)

References 30 publications

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“…According to some authors [11,14,18], shortening greater than 1,5 -2,0 cm is associated with worse functional outcome. In contrast, others have demonstrated no direct relationship between the degree of shortening and function [10,15]; this result is also Studies that demonstrate a direct relationship between the shortening and loss of function in the limb are generally retrospective, whereas prospective studies such as present study do not show this result. The differences in findings may result from factors such as selection bias; patients with longer follow-up periods tend to be those with the worst outcome.…”

Section: Discussioncontrasting

confidence: 86%

Correlation of the degree of clavicle shortening after non-surgical treatment of midshaft fractures with upper limb function

Figueiredo¹

2014

http://isrctn.org/>

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Background: Despite the use of non-surgical methods to treat for the majority of midshaft fractures of the clavicle, it is remains controversial whether shortening of this bone following non-surgical treatment of a middle third fracture affects upper limb function. Methods: We conducted a cohort study by sequentially recruiting 59 patients with a fracture of the middle third of the clavicle. All patients were treated nonsurgically with a figure-of-eight bandage until clinical and radiological findings indicated healing of the fracture. Functional outcome was assessed using the Disability of Arm, Hand and Shoulder (DASH) score revalidated for the Portuguese language, other outcomes assessed included: pain measured by visual analogue scale (VAS); radiographies to measure the degree of shortening, fracture consolidation and fracture malunion. Information were also collected regarding the mechanism of injury, patient's daily activities level and epidemiological features of the patient cohort. The results of our findings are expressed as the comparison of the functional outcome with the degree of shortening. Results: Patients were assessed six weeks and one year after injury. In the first evaluation, the mean DASH score was 28.84 and pain measured by VAS was 2.57. In the second evaluation (one year after injury) the mean DASH score was 8.18 and pain was 0.84. The mean clavicle shortening was 0.92 cm, ranging from 0 to 3 cm (SD = 0.64). There were no correlation between the degree of shortening and DASH score after six weeks and one year (p = 0.073 and 0.706, respectively). When only patients with of shortening greater than 2 cm were assessed for correlation, the result did not change. Conclusion: We conclude that clavicle shortening after nonsurgical treatment with a figure-of-eight bandage does not affect limb function, even when shortening exceeds 2 cm.

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Section: Discussioncontrasting

confidence: 86%

Correlation of the degree of clavicle shortening after non-surgical treatment of midshaft fractures with upper limb function

Figueiredo¹

2014

http://isrctn.org/>

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“…Our results can be compared with other recent studies (Table 1) [3,4,6,8,10,12,16,19,23,24]. Our investigation is the only one that compared nonoperative versus plating treatment using both DASH and CSS scores.…”

Section: Discussionmentioning

confidence: 61%

“…Third, DASH and CSS scores do not consider individual patient differences resulting from age, general health, or personal problems. Even so, DASH and CSS have been used widely as standard measures of function [3,4,6,8,10,12,16,19,23,24]. Fourth, there was substantial preoperative delay in some cases, so some fractures may have partially healed by 28 days.…”

Section: Discussionmentioning

confidence: 99%

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Function Plateaus by One Year in Patients With Surgically Treated Displaced Midshaft Clavicle Fractures

Schemitsch

Veillette

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Based on short-term (1 year or less) followup, primary fixation of displaced midshaft clavicle fractures reportedly results in better function compared with that reported for nonoperative methods. Whether better function persists beyond 1 year is unclear. Questions/purposes For displaced midshaft clavicle fractures, do the better mean Disabilities of the Arm, Shoulder and Hand (DASH) and Constant-Murley Shoulder (CSS) scores for operative versus nonoperative treatment at 1 year change between 1-and 2-year followup? Patients and Methods We previously reported 132 patients in a randomized prospective trial at 1 year, and here we report a further followup of 95 of the 132 patients (72%) at 2 years after injury. We evaluated all patients with the DASH and CSS scores. Results The mean DASH and CSS scores were similar at 2 years compared with 1 year postinjury for both the nonoperated and operated patients. The mean scores for the operated patients remained higher than those in the nonoperative group (DASH operative 4

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“…In the case of a middle part facture of the clavicle, conservative treatment using a figure-of-8 bandage is often successfully employed [4,5]. However, the bandage cannot be correctly applied to a patient who must undertake complete bed rest for any particular reason of poor general condition.…”

Section: Introductionmentioning

confidence: 99%

Late Thoracic Outlet Syndrome after Clavicle Fractures in Patients with Multiple Trauma: A Pitfall of Conservative Treatment

Ishimaru¹,

Ogawa²,

Sumi³

et al. 2012

OJO

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Late thoracic outlet syndrome is a rare complication of clavicle fractures and usually warrants surgical treatment though its cause of clavicle fractures are a common injury and in most cases are treated conservatively. We report a case of a clavicle fracture accompanying severe multiple trauma, which was necessarily treated conservatively because of the severe associated injuries of the patient. The patient was unable to wear a figure-of-8 bandage for the fracture because of the need for complete supine bed rest, due to his other injuries. In this common situation, the clavicle fracture shortened and eventually resulted in the late thoracic outlet syndrome. We believe the cause of this was because a figure-of-8 bandage could not be applied due to the need for complete supine bed rest, and thus was inevitable because of his general condition. This case suggests that the conservative treatment of clavicle fractures, where there is the need for complete bed rest, potentially induces late thoracic outlet syndrome, and that this is indeed a pitfall in the treatment of clavicle fractures in multiple trauma.

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Nonoperative treatment of closed displaced midshaft clavicle fractures

Cited by 39 publications

References 30 publications

Correlation of the degree of clavicle shortening after non-surgical treatment of midshaft fractures with upper limb function

Correlation of the degree of clavicle shortening after non-surgical treatment of midshaft fractures with upper limb function

Function Plateaus by One Year in Patients With Surgically Treated Displaced Midshaft Clavicle Fractures

Late Thoracic Outlet Syndrome after Clavicle Fractures in Patients with Multiple Trauma: A Pitfall of Conservative Treatment

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