Elastic stable intramedullary nailing versus nonoperative treatment of displaced midshaft clavicular fractures—a randomized, controlled, clinical trial. J Orthop Trauma
ABSTRACT To compare elastic stable intramedullary nailing (ESIN) with nonoperative treatment of fully displaced midshaft clavicular fractures in adults.
The study was a randomized, controlled, clinical trial.
Level 1 trauma center.
Sixty patients between 18 and 65 years of age participated and completed the study. They were randomized to either operative or nonoperative treatment with a 2-year follow-up.
Thirty patients were treated with a simple shoulder sling and 30 patients with ESIN within 3 days after trauma.
Complications after operative and nonoperative treatments, Disabilities of the Arm, Shoulder and Hand (DASH) score and Constant Shoulder Score for outcome measurement, and clavicular shortening.
Fracture union was achieved in all patients in the operative group, whereas nonunion was observed in 3 of 30 patients of the nonoperative group. Two symptomatic malunions required corrective osteotomy in the nonoperative group. Medial nail protrusion occurred in 7 cases in the operative group. Implant failure with revision surgery was necessary in 2 patients after an additional adequate trauma. DASH scores were lower in the operative group throughout the first 6 months and 2 years after trauma, with a significant difference during the first 18 weeks. Constant scores were significantly higher after 6 months and 2 years after intramedullary stabilization. Patients in the operative group showed a significant improvement of posttraumatic clavicular shortening; they were also more satisfied with cosmetic appearance and overall outcome.
ESIN of displaced midshaft clavicular fractures resulted in a lower rate of nonunion and delayed union, a faster return to daily activities, and a better functional outcome. Clavicular shortening was significantly lower, and overall satisfaction was higher in the operative group.
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- "Duplicates (n = 116) Studies after duplicates removed (n = 1,072) Records identified through database searching (n = 1,188) Studies excluded (n = 842) – incorrect subject – case report – review Studies retrieved for more detailed evaluation (n = 230) Studies included in qualitative synthesis (n = 14) Hoofwijk 1988 Jubel 2005 Canadian Orthopaedic Trauma Society 2007 Lee 2007 Lee 2008 Shen 2008 Judd 2009 Pai 2009 Smekal 2009 a Ferran 2010 Hsu 2010 Böhme 2011 Kulshrestha 2011 Smekal 2011 a Studies excluded (n = 203) – did not meet eligibility criteria – case report – retrospective – review Potentially appropriate studies (n = 27) Studies excluded (n = 13) – did not meet eligibility criteria (3) – language, not able to read (3) – retrospective (6) – incorrect reference (1) Acta Orthop Downloaded from informahealthcare.com by 188.8.131.52 on 05/20/14 "
ABSTRACT: Traditionally, clavicle fractures have been treated nonoperatively. However, many recent studies have concentrated on the results of operative treatment. We assessed and compared the outcomes of operative and nonoperative treatment for acute clavicle fractures in adults. We performed a systematic search of the medical literature from 1966 until the end of March 2011. We included randomized controlled trials and controlled clinical trials comparing operative and nonoperative treatment and studies comparing different operative and nonoperative treatments. We required that there should be at least 30 adult patients and a follow-up of at least 6 months in each individual trial. We used the GRADE method to assess the quality of evidence. 6 randomized controlled trials (n = 631) and 7 controlled clinical trials (n = 559) were included. There was moderate-quality evidence (i.e. of grade B) (1) that surgery has considerable effectiveness on better function and less disability at short follow-up, (2) of similar risk of relatively mild complications after operative or nonoperative treatment, (3) that delayed union and nonunion were more common in patients who were treated nonoperatively than in those treated operatively, and (4) that the osteosynthesis method had no effect on the incidence of delayed union or nonunion. Only 1 controlled clinical trial was found on lateral clavicle fractures with very limited (grade D) evidence. Patients treated operatively have slightly better function and less disability than those treated nonoperatively at short follow-up, but then the effectiveness diminishes and is weak at 6 months. The different operative techniques may not differ in effectiveness or in adverse effects, but the evidence is very limited or conflicting. Surgery could be considered for active patients who require recovery to the previous level of activity in the shortest possible time.Acta Orthopaedica 02/2012; 83(1):65-73. DOI:10.3109/17453674.2011.652884 · 2.45 Impact Factor
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ABSTRACT: To present the case of surgical treatment and rehabilitation of a midshaft clavicular fracture in a National Collegiate Athletic Association Division I football athlete. While attempting to catch a pass during practice, the athlete jumped up and then landed on the tip of his shoulder. On-the-field evaluation was inconclusive, with a sideline evaluation diagnosis of clavicular fracture. Postinjury radiographs revealed a midshaft clavicular fracture. Spiral oblique midshaft clavicular fracture. The sports medicine staff discussed surgical and nonsurgical options. A surgical procedure of internal fixation with an 8-hole plate was performed. Surgical treatment for clavicular fractures is becoming increasingly common. This is the first report of an advanced rehabilitation protocol for surgical repair. We suggest that new rehabilitation protocols for clavicular repairs be investigated now that surgical treatment is being pursued more frequently. More aggressive treatment procedures and rehabilitation protocols for clavicular fractures have evolved in recent years. With these medical advancements, athletes are able to return to play much more quickly without compromising their health and safety.Journal of athletic training 01/2011; 46(1):107-11. DOI:10.4085/1062-6050-46.1.107 · 1.51 Impact Factor
Article: Klavikulaschaftfrakturen[Show abstract] [Hide abstract]
ABSTRACT: Zusammenfassung Hintergrund Ziel dieses systematischen Reviews war es, die Wirksamkeit und Sicherheit für die verschiedenen Therapiekonzepte bei Klavikulaschaftfrakturen in Abhängigkeit vom Frakturtyp und sonstigen Parametern zu erarbeiten. Material und Methoden Es wurde nach systematischen Reviews und kontrollierten Studien, die im Zeitraum 1998–2009 publiziert wurden, gesucht. Ergebnisse Es gibt mittlere Evidenz dafür, dass bei Klavikulaschaftfrakturen ein chirurgischer Eingriff die Gefahr einer Pseudarthrose senkt und das patientenrelevante Outcome verbessert. Da die Ereignisrate für eine Pseudarthrose aber gering ist und chirurgische Eingriffe bestimmte therapieinhärente unerwünschte Wirkungen haben können, müssen die Risikofaktoren vor einer Therapieentscheidung bestimmt und abgewogen werden. Zu den wichtigsten Risikofaktoren zählen das Ausmaß der Dislokation und die Anzahl betroffener Knochenfragmente. Von allen operativen Techniken gibt es für die Plattenosteosynthese und die elastische stabile intramedulläre Nagelung (ESIN) derzeit die beste Evidenz der Wirksamkeit. Schlussfolgerung Die Arbeit präsentiert einen Algorithmus, der sich aus der vorliegenden Evidenz ableitet und in der klinischen Arbeit Hilfestellung bei der Therapieentscheidung geben kann.Der Unfallchirurg 11/2010; DOI:10.1007/s00113-010-1823-7 · 0.61 Impact Factor