- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02398006
Conservative Interventions for Treating Clavicle Fractures in Adults
March 19, 2015 updated by: Mario Lenza, Hospital Israelita Albert Einstein
Figure-of-eight Bandage Versus Arm Sling for Treating Middle Third Clavicle Fractures in Adults: Study Protocol for a Randomised Controlled Trial
Background: Fracture of the clavicle is common accounting for 2.6% to 4 % of all fractures, with an overall incidence of 36.5 to 64 per 100,000 per year.
Around 80% of clavicle fractures occur in the middle third of the clavicle.
There is a lack of evidence of randomised controlled trials assessing the best treatment of these fractures.
The objective of this study is to evaluate the effects (benefits and harms) of conservative interventions: figure-of-eight bandage versus sling for the treating middle third clavicle fractures.
Methods/Design: this project has been designed as a single-centre, parallel-group randomised controlled trial that will compare figure-of-eight bandage versus sling.
The investigators aim to recruit 110 adults, aged 18 years or older, with an acute (less than 10 days) middle third clavicle fracture.
Primary outcomes will be function or disability measured by DASH questionnaire; the secondary outcomes will be: modified UCLA score pain, treatment failure, adverse events and numbers returning to previous activities.
Data analysis: the chi-square test will be used to analyse the results of categorical variables, and Student t-test will be used to compare groups with respect to the numerical variables.
The Student t-test is used to compare the clinical outcome of each group at 1, 2 and 4 weeks and at 6 and 12 months after the intervention.
The significance level of 5% (alpha = 0.05) is used for all statistical tests such that tests have a value of less than 0.05 are considered statistically significant.
Discussion: According to current evidence there is very limited evidence from two single trials only regarding the effectiveness of different methods of conservative interventions for treating clavicle fractures.
This study is one of the first randomised controlled trials following the CONSORT statements designed to compare two conservative methods for treating clavicle fractures (figure-of-eight versus sling).
Study Overview
Status
Unknown
Conditions
Intervention / Treatment
Detailed Description
Whilst there are several options for conservative treatment for middle third clavicle fractures, only two randomised controlled published in the 80s attempted to determine the effects of different methods for conservative treatment for middle third clavicle fractures.
Thus, a pragmatic trial design has been chosen as it can directly inform clinical practice; our inclusion criteria will reflect the variety in patient presentations that would be encountered by general orthopaedic surgeons in the clinical setting.
The current trial includes design characteristics known to minimise bias.
Participants will be assigned using a concealed random procedure, assessments and data analysis will be blinded and we will use the intention-to-treat analysis.
Study Type
Interventional
Enrollment (Anticipated)
110
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years to 65 years (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Adults aged 18 years or older and 65 years or less with middle third clavicle fracture,
- Acute fracture (less than 10 days), we will include all types of middle third clavicle fractures (non-displaced and displaced fractures),
- No medical contraindication to proposed methods of immobilisation,
- Understanding of Portuguese language and written informed consent.
Exclusion Criteria:
- Pathological fracture,
- Open fracture,
- Neurovascular injury on physical examination,
- Associated head injury (Glasgow Coma Scale score of <12),
- Ipsilateral upper limb fractures and/or dislocation(except hand and fingers),
- History of frozen shoulder,
- Previous disease in the limb that could influence the results (e.g. rheumatoid arthritis),
- Inability to comply with follow-up (inability to read or complete forms).
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Single Group Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Group 1: a standard arm sling
Group 1: the orthopaedic surgeon will apply a standard arm sling that will be used for four weeks; however, during these weeks, participants will be encouraged to discard the sling when their pain has subsided.
After four weeks the same orientations of group 1 will be done to this group.
|
Closed reduction (re-aligning the fragments of the fracture) will be not performed because the reduced position is practically impossible to maintain.
|
Active Comparator: Group 2: a figure-of-eight bandage
Group 2: a figure-of-eight bandage will be used for four weeks, and every week the participants will return to check and adjust the immobilisation.
In this way, the dominant hand can remain free and simple activities will be allowed (writing, keyboarding and other).
After four weeks, participants will be encouraged to discard the bandage, but load bearing will not be allowed before osseous consolidation (around 10 weeks).
|
Closed reduction (re-aligning the fragments of the fracture) will be not performed because the reduced position is practically impossible to maintain.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Function or disability will be measured by DASH - Disability of the Arm, Shoulder, and Hand questionnaire
Time Frame: 12 months
|
Function or disability will be measured by DASH - Disability of the Arm, Shoulder, and Hand questionnaire validated and translated into Portuguese in Brazil, the final score of the DASH questionnaire will be converted to a percentage via the following formula: Scoring = [Sum of answers n/n - 1] X 25, where n is the number of complete answers.
The two optional modules will not be measured.
The value obtained will be directly proportional to the percentage of impairment of the limb function.
|
12 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Modified University of California at Los Angeles (modified - UCLA)
Time Frame: 12 months
|
Modified University of California at Los Angeles (modified - UCLA), validated and translated into Portuguese in Brazil.
|
12 months
|
Pain measured on a 0 to 100 using visual analogue scale (VAS)
Time Frame: 12 months
|
Pain measured on a 0 to 100 using visual analogue scale (VAS) (with 0 indicating no pain and 100 indicating the maximum pain).
As reported in the literature, a clinically important change will be considered as a 30% or more change in pain score.
|
12 months
|
Treatment failure measured by the number of participants who have undergone or are being considered a surgical intervention
Time Frame: 12 months
|
Treatment failure measured by the number of participants who have undergone or are being considered a surgical intervention (e.g.
symptomatic non-union or malunion with intractable pain).
Although studies evaluating patients with fractures without displacement reported low rates of nonunion (about 0.03%), studies with patients with displaced fractures found nonunion rates of up to 15%.
Therefore, we expect between 5 and 10% of our participants might provide symptomatic nonunion during follow-up.
Patients who experience this complication during follow-up study will be treated surgically with open reduction and internal fixation with pre-contoured locking plate counted down the superior surface of the clavicle and bone grafting when necessary.
|
12 months
|
Adverse events
Time Frame: 12 months
|
Adverse events measured by: a) Cosmetic result: perception of deformity or asymmetric result (dichotomous data); b) Asymptomatic non-union (i.e. the fracture has not healed radiographically with no pain); c) Stiffness/restricted of range of shoulder movement (compared with contralateral side).
|
12 months
|
Numbers returning to previous activities (work, sport, activities of daily living), including time to return.
Time Frame: 12 months
|
Numbers returning to previous activities (work, sport, activities of daily living), including time to return.
|
12 months
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Investigators
- Principal Investigator: Mario Lenza, PhD, Hospital Israelita Albert Einstein
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start
April 1, 2015
Primary Completion (Anticipated)
September 1, 2016
Study Completion (Anticipated)
December 1, 2017
Study Registration Dates
First Submitted
March 12, 2015
First Submitted That Met QC Criteria
March 19, 2015
First Posted (Estimate)
March 25, 2015
Study Record Updates
Last Update Posted (Estimate)
March 25, 2015
Last Update Submitted That Met QC Criteria
March 19, 2015
Last Verified
March 1, 2015
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- HIAE orthopaedics
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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