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

Gustavo Santiago de Lima Figueiredo, Marcel Jun Sugawara Tamaoki, Bruno Dragone, Artur Yudi Utino, Nicola Archetti Netto, Marcelo Hide Matsumoto, Fábio Teruo Matsunaga, Gustavo Santiago de Lima Figueiredo, Marcel Jun Sugawara Tamaoki, Bruno Dragone, Artur Yudi Utino, Nicola Archetti Netto, Marcelo Hide Matsumoto, Fábio Teruo Matsunaga

Abstract

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.

Trial registration: ISRCTN85206617 . Registered 12 May 2014.

Figures

Fig. 1
Fig. 1
Measurement of shortening
Fig. 2
Fig. 2
Correlation of DASH results in 1 year and shortening (cm)

References

    1. Robinson CM. Fractures of the clavicle in the adult. J Bone Joint Surg (Br) 1998;80B:476–84. doi: 10.1302/0301-620X.80B3.8079.
    1. Craig EV. Fractures of the clavicle. In: Rockwood CA, Matsen FA, editors. The shoulder. Philadelphia: WB Saunders; 1990. pp. 367–412.
    1. Craig EV. Fractures of the clavicle. In: Rockwood CA, Green DP, Bucholz RW, Heckman JD, editors. Rockwood and green's fractures in adults. Philadelphia: Lippincott-Raven; 1996. pp. 1109–61.
    1. Craig EV. Fractures of the clavicle. In: Rockwood CA, Matsen FA, editors. The shoulder. 3. Philadelphia: WB Saunders; 1998. pp. 428–82.
    1. Crenshaw AH. Fractures of the shoulder girdle, arm and forearm. In: Willis CC, editor. Campbell's operative orthopaedics. 8. St. Louis: Mosby-Year Book; 1992. pp. 989–95.
    1. Robinson CM, Cairns DA. Primary nonoperative treatment of displaced lateral fractures of the clavicle. J Bone Joint Surge Am. 2004;86A:778–82.
    1. Ledger M, Leeks N, Ackland T, Wang A. Short malunions of the clavicle: an anatomic and functional study. J Shoulder Elbow Surg. 2005;14:349–54. doi: 10.1016/j.jse.2004.09.011.
    1. Neer CS. Nonunion of the clavicle. JAMA. 1960;172:1006–11. doi: 10.1001/jama.1960.03020100014003.
    1. Rowe CR. An atlas of anatomy and treatment of midclavicular fractures. Clin Orthop. 1968;58:29–42. doi: 10.1097/00003086-196805000-00006.
    1. Rasmussen JV, Jensen SL, Petersen JB, Falstie-Jensen T, Lausten G, Olsen BS. A retrospective study of the association between shortening of the clavicle after fracture and the clinical outcome in 136 patients. Injury, Int J Care Injured. 2011;42:414–7. doi: 10.1016/j.injury.2010.11.061.
    1. 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;79B:537–9. doi: 10.1302/0301-620X.79B4.7529.
    1. Zlowodzki M, Zelle BA, Cole PA, et al. Treatment of midshaft clavicle fractures: systemic review of 2144 fractures. J Orthop Trauma. 2005;19:504–7. doi: 10.1097/01.bot.0000172287.44278.ef.
    1. Andermahr J, Jubel A, Elsner A, et al. Malunion of the clavicle causes significant glenoid malposition: a quantitative anatomic investigation. Surg Radiol Anat. 2006;28:447–56. doi: 10.1007/s00276-006-0122-z.
    1. Postacchini R, Gumina S, Farsetti P, Postacchini F. Long-term results of conservative management of midshaft clavicle fracture. Int Orthop. 2010;34(5):731–6. doi: 10.1007/s00264-009-0850-x.
    1. Faldini C, Nanni M, Leonetti D, Acri F, Galante C, Luciani D, Giannini S. Nonoperative treatment of closed displaced midshaft clavicle fractures. J Orthop Traumatol. 2010;11(4):229–36. doi: 10.1007/s10195-010-0113-z.
    1. Kay SP, Dragoo JL, Lee R. Long-term results of arthroscopic resection of the distal claviclewith concomitant subacromial decompression. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2003;19(8):805–9. doi: 10.1016/S0749-8063(03)00682-0.
    1. McKee RC, Whelan DB, Schemitsch EH, McKee MD. Operative versus nonoperative care of displaced midshaft clavicular fractures: a meta-analysis of randomized clinical trials. J Bone Joint Surg Am. 2012;94:675–84. doi: 10.2106/JBJS.J.01364.
    1. Eskola A, Vainionpaa S, Myllynen P, et al. Outcome of clavicular fracture in 89 patients. Arch Orthop Trauma Surg. 1986;105:337–8. doi: 10.1007/BF00449938.
    1. Nordqvist A, Redlund-Johnell I, Von Scheele A, Petersson CJ. Shortening of clavicle after fracture. Incidence and clin- ical significance, a 5-year follow-up of 85 patients. Acta Orthop Scan. 1997;68:349–51. doi: 10.3109/17453679708996175.
    1. De Giorgi S, Notarnicola A, Tafuri S, Solarino G, Moretti LMB. Conservative treatment of fractures of the clavicle. BMC Research Notes. 2011;4:333. doi: 10.1186/1756-0500-4-333.
    1. Nowak J, Holgersson M, Larsson S. Sequelae from clavicular fractures are common: a prospective study of 222 patients. Acta Orthop. 2005;76(4):496–502. doi: 10.1080/17453670510041475.
    1. Lazarides S, Zafiropoulos G. Conservative treatment of fractures at the middle third of the clavicle: the relevance of shortening and clinical outcome. J Shoulder Elbow Surg. 2006;15(2):191–4. doi: 10.1016/j.jse.2005.08.007.
    1. Inman VT, Saunders JB. Observations on the function of the clavicle. Calif Med. 1946;65(4):158–66.
    1. Orfale AG, Araújo PMP, Ferraz MB, Natour J. Translation into Brazilian Portuguese, cultural adaptation and evaluation of the reliability of the disabilities oh the arm, shoulder and hand questionnaire. Braz J Med Biol Res. 2005;38:293–302. doi: 10.1590/S0100-879X2005000200018.

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다