Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
권호 표지
DOI QR코드

DOI QR Code

Clinical and Radiological Outcome after Surgical Treatment in Displaced Clavicular Midshaft Fracture

  • Gwak, Heui-Chul (Department of Orthopaedic Surgery, Inje University Busan Paik Hospital, Inje University College of Medicine) ;
  • Kim, Jung-Han (Department of Orthopaedic Surgery, Inje University Busan Paik Hospital, Inje University College of Medicine)
  • Received : 2015.07.10
  • Accepted : 2016.01.06
  • Published : 2016.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

Background: The first purpose of this study is to compare the clinical and radiological outcomes of surgical treatment for displaced midshaft clavicle fracture (Robinson type 2B1 vs. 2B2) with 3.5-mm low profile clavicular locking compression plate. The second purpose is to evaluate the difference of the results depending on the presence of accompanying injuries. Methods: Forty-nine patients who underwent an operation for the fractures were reviewed retrospectively. Fracture patterns were classified according to group 2B1 and 2B2 using Robinson's classification. For radiological outcome, time to union after operation was evaluated and for clinical outcome, American Shoulder and Elbow Society (ASES) score, University of California in Los Angeles (UCLA) score, visual analogue scale (VAS), and range of motion (ROM) were evaluated from preoperative period to last follow-up period. Results: The mean time for union was not significantly different in the 2B1 group and 2B2 group (p=0.062). No statistically significant difference in ASES score, UCLA score, and VAS was observed between 2B1 and 2B2 (p=0.619, p=0.896, p=0.856, respectively). In ROM, significant higher mean forward flexion and abduction was observed in 2B2 (p=0.025, p=0.017, respectively) and there was no difference in external rotation and external rotation at shoulder $90^{\circ}$ abduction position (p=0.130, p=0.180, respectively). There was no significant difference in clinical outcomes according to the accompanying injuries. Conclusions: There was no difference in clinical and radiological outcome between Robinson 2B1 and 2B2 type fracture after the operation. Accompanying injuries may not affect the clinical result of displaced midshaft clavicle fractures.

Keywords

References

  1. Johnson EW Jr, Collins HR. Nonunion of the clavicle. Arch Surg. 1963;87(6):963-6. https://doi.org/10.1001/archsurg.1963.01310180079013
  2. Paffen PJ, Jansen EW. Surgical treatment of clavicular fractures with Kirschner wires: a comparative study. Arch Chir Neerl. 1978;30(1):43-53.
  3. Khan LA, Bradnock TJ, Scott C, Robinson CM. Fractures of the clavicle. J Bone Joint Surg Am. 2009;91(2):447-60. https://doi.org/10.2106/JBJS.H.00034
  4. Haidukewych GJ. Innovations in locking plate technology. J Am Acad Orthop Surg. 2004;12(4):205-12. https://doi.org/10.5435/00124635-200407000-00001
  5. Perren SM. Evolution and rationale of locked internal fixator technology. Introductory remarks. Injury. 2001;32 Suppl 2:B3-9.
  6. McKee MD, Schemitsch EH, Stephen DJG, Kreder HJ, Yoo D, Harrington J. Functional outcome following clavicle fractures in trauma patients. J Trauma Inj Infect Crit Care. 1999;47(3):616.
  7. Hill JM, McGuire MH, Crosby LA. Closed treatment of displaced middle-third fractures of the clavicle gives poor results. J Bone Joint Surg Br. 1997;79:537-9. https://doi.org/10.1302/0301-620X.79B4.7529
  8. Neer CS 2nd. Nonunion of the clavicle. J Am Med Assoc. 1960;172:1006-11. https://doi.org/10.1001/jama.1960.03020100014003
  9. Kulshrestha V, Roy T, Audige L. Operative versus nonoperative management of displaced midshaft clavicle fractures: a prospective cohort study. J Orthop Trauma. 2011;25(1):31-8. https://doi.org/10.1097/BOT.0b013e3181d8290e
  10. Eskola A, Vainionpaa S, Myllynen P, Patiala H, Rokkanen P. Outcome of clavicular fracture in 89 patients. Arch Orthop Trauma Surg. 1986;105(6):337-8. https://doi.org/10.1007/BF00449938
  11. Wilkins RM, Johnston RM. Ununited fractures of the clavicle. J Bone Joint Surg Am. 1983;65(6):773-8. https://doi.org/10.2106/00004623-198365060-00008
  12. Wick M, Muller EJ, Kollig E, Muhr G. Midshaft fractures of the clavicle with a shortening of more than 2 cm predispose to nonunion. Arch Orthop Trauma Surg. 2001;121(4):207-11. https://doi.org/10.1007/s004020000202
  13. Davids PH, Luitse JS, Strating RP, van der Hart CP. Operative treatment for delayed union and nonunion of midshaft clavicular fractures: AO reconstruction plate fixation and early mobilization. J Trauma. 1996;40(6):985-6. https://doi.org/10.1097/00005373-199606000-00021
  14. Robinson CM, Court-Brown CM, McQueen MM, Wakefield AE. Estimating the risk of nonunion following nonoperative treatment of a clavicular fracture. J Bone Joint Surg Am. 2004; 86(7):1359-65. https://doi.org/10.2106/00004623-200407000-00002
  15. Poigenfurst J, Rappold G, Fischer W. Plating of fresh clavicular fractures: results of 122 operations. Injury. 1992;23(4):237-41. https://doi.org/10.1016/S0020-1383(05)80006-3
  16. Schwarz N, Hocker K. Osteosynthesis of irreducible fractures of the clavicle with 2.7-MM ASIF plates. J Trauma. 1992;33(2): 179-83. https://doi.org/10.1097/00005373-199208000-00003
  17. Jupiter JB, Ring D. Fractures of the clavicle. In: Iannotti JP, Williams GR, eds. Disorders of the shoulder: diagnosis and management. Philadelphia: Lippincott Williams & Wilkins; 1999. 1427-70.
  18. Canadian Orthopaedic Trauma Society. Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial. J Bone Joint Surg Am. 2007;89(1):1-10. https://doi.org/10.2106/JBJS.F.00020
  19. Moseley HF. The clavicle: its anatomy and function. Clin Orthop Relat Res. 1968;58:17-27.
  20. Robinson CM. Fractures of the clavicle in the adult. Epidemiology and classification. J Bone Joint Surg Br. 1998;80(3):476-84. https://doi.org/10.1302/0301-620X.80B3.8079
  21. Stanley D, Trowbridge EA, Norris SH. The mechanism of clavicular fracture. A clinical and biomechanical analysis. J Bone Joint Surg Br. 1988;70(3):461-4. https://doi.org/10.2106/00004623-198870030-00024