Rates of Operative Management of Midshaft Clavicle Fracture in Adolescents Have Increased in Florida between 2005 and 2014

2021 ◽  
pp. 155633162110591
Author(s):  
Hao-Hua Wu ◽  
Aman Chopra ◽  
Laura A. Carrillo ◽  
Matt Callahan ◽  
Ishaan Swarup
Keyword(s):  
Ambulatory Surgery ◽  
Multivariate Analyses ◽  
Clavicle Fracture ◽  
Operative Management ◽  
Open Reduction Internal Fixation ◽  
The State ◽  
Injury Management ◽  
Clavicle Fractures ◽  
Race Ethnicity ◽  
Inpatient Database

Background: It is not known if the adult literature on midshaft clavicle fracture treatment with open reduction internal fixation (ORIF) has influenced injury management in adolescents. Purpose: We sought to longitudinally evaluate the rates of operative management of adolescent midshaft clavicle fractures in the state of Florida. Methods: We conducted a retrospective review of data from the following Healthcare Cost and Utilization Project databases: the State Inpatient Database, the State Ambulatory Surgery and Services Database, and the State Emergency Department Database. Patients in Florida ages 10 to 18 years with midshaft clavicle fractures between 2005 and 2014 were identified along with data on age, sex, race/ethnicity, insurance type, treatment, and income percentile. We reviewed the data to identify trends in the rates of operative management of midshaft clavicle fractures. We then compared the rates of operative management between the first 3 years and the most recent 3 years (2005–2007 vs 2012–2014). Various demographic and socioeconomic factors were compared between patients treated with and without surgery. Descriptive statistics as well as univariate and multivariate analyses were performed. Results: There were 4297 midshaft clavicle fractures in adolescents identified between 2005 and 2014, and 338 (7.8%) of these fractures underwent operative management. There was a significant increase in the rate of operative management; it increased from 4.3% (n = 59) of the 1373 clavicle fractures that occurred between 2005 and 2007 to 11.2% (n = 130) of the 1164 clavicle fractures that occurred between 2012 and 2014. Patients with commercial insurance and patients who were older were more likely to undergo ORIF. Patients with Medicaid were more likely to undergo ORIF between 2012 and 2014 compared with patients with Medicaid between 2005 and 2007. Conclusions: Operative management rates of adolescent midshaft clavicle fractures have significantly increased in Florida over a decade; additional research is needed to understand these findings.

scholarly journals An unusual case of bipolar segmental clavicle fracture

2012 ◽  
Vol 4 (3) ◽  
pp. 26 ◽  
Author(s):  
Karishma Sethi ◽  
Simon D.S. Newman ◽  
Rajarshi Bhattacharya
Keyword(s):  
Unusual Case ◽  
Clavicle Fracture ◽  
Operative Management ◽  
Shaft Fracture ◽  
Optimal Method ◽  
Clavicle Fractures ◽  
Non Operative Management

Segmental clavicle fractures are uncommon injuries. When they do present, they tend to comprise a distal and mid-shaft fracture. A clavicular injury with proximal and distal fractures is a rarer presentation still which is sparsely covered in the literature. These injuries, which have been termed bipolar, are easily missed at presentation and due to their infrequency the optimal method of management for these patients is unclear. We describe the successful non-operative management of a bipolar clavicle fracture and review the existing literature.

scholarly journals Comparing functional outcome in lateral end clavicle fracture after conservative and plating

2017 ◽  
Vol 3 (4) ◽  
pp. 833
Author(s):  
Sachin Y. Kale ◽  
Prasad Chaudhari ◽  
Shikhar D. Singh ◽  
Sanjay B. Dhar ◽  
Prakash D. Samant ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Functional Outcomes ◽  
Standard Treatment ◽  
Clavicle Fracture ◽  
Operative Management ◽  
Skin Infections ◽  
Non Union ◽  
Medical College ◽  
Clavicle Fractures ◽  
Early Healing

<p class="abstract"><strong>Background:</strong> Fractures of the clavicle have been traditionally treated non- operatively but has been associated with various postoperative complications. In this study, we analyzed the outcomes of the operative management and compare its results with conservative treatment considering it as standard treatment option.</p><p class="abstract"><strong>Methods:</strong> The present study was carried out at the Department of Orthopedics, DY Patil Medical College and Hospital, Navi Mumbai. Open fractures, fractures associated with complication like head injury with associated other bone injuries were included in this study. We excluded patients less than 18 years of age, patients with middle third fracture of clavicle and patients with medial end clavicle fracture. The fractures were classified according to Robinson’s classification. Patients were followed up every week for 4 weeks then at 8 weeks, 12 weeks, 6 months and 1 year. The functional outcomes were assessed by Constant and Murley score.<strong></strong></p><p class="abstract"><strong>Results:</strong> We included 48 patients in the study, 34 of which were males, average age of the patients was 37.53±7.64 years. 23 injuries were on the left. There was statistically significant better union times with operative management (p=0.034). Various complications were observed like infection, implant failure, man union, non-union, deformity and skin infections, statistically seen more in patients who underwent conservative management. Overall, patients experienced excellent and good results with operative management in 6 and 12 patients respectively.</p><strong>Conclusions:</strong>Operative treatment gave statistically significant functional outcome and early healing compared to conservatively treated in displaced, communited lateral end clavicle fractures. <p> </p>

scholarly journals Scapular Notching Following Ipsilateral Traumatic Clavicle Fracture in Reverse Total Shoulder Arthroplasty: A Case Report

2021 ◽  
Vol 5 ◽  
pp. 247154922110206
Author(s):  
Jimmy Tat ◽  
Ujash Sheth ◽  
Diane Nam
Keyword(s):  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Clavicle Fracture ◽  
Open Reduction Internal Fixation ◽  
Reverse Total Shoulder Arthroplasty ◽  
Scapular Notching ◽  
Non Union ◽  
Clavicle Fractures ◽  
And Function ◽  
Reverse Total Shoulder

Introduction Reverse total shoulder arthroplasty (RTSA) procedures are becoming increasingly more common. While the main complications are known, the management of clavicle fractures in patients with an ipsilateral RTSA is not well described. There are three case studies that document clavicular stress fractures following RTSA with an atraumatic etiology, and to our knowledge, no studies have described a traumatic clavicular fracture following RTSA. Case We describe the case of a 75-year-old woman with a traumatic clavicle fracture five years after RTSA for rotator cuff tear arthropathy. With minimal pain and subjective symptoms initially, the patient wished to pursue non-operative treatment. However, she eventually developed a painful non-union and pseudoparalysis of the shoulder with serial radiographs demonstrating progressive superior scapular tilting and scapular notching. Subsequent open reduction internal fixation of her clavicle fracture significantly improved her pain and function. Conclusion We report a traumatic clavicle fracture in the setting of RTSA that not only failed to heal but also resulted in scapular notching and shoulder pseudoparalysis that was improved with surgical stabilization of the fracture. It is possible that the setting of a semi-constrained RTSA, the resulting biomechanical imbalance may predispose to impaired fracture healing and non-union of the clavicle fracture.

scholarly journals Surgical fixation of displaced clavicle fracture in adolescents: a review of literature

2013 ◽  
Vol 5 (3) ◽  
pp. 29 ◽  
Author(s):  
Harish S. Hosalkar ◽  
Gaurav Parikh ◽  
Bernd Bittersohl
Keyword(s):  
Relevant Literature ◽  
Clavicle Fracture ◽  
Operative Management ◽  
Traditional Treatment ◽  
Operative Methods ◽  
Recent Approach ◽  
Surgical Fixation ◽  
Clavicle Fractures ◽  
Open Surgical Treatment ◽  
Displaced Clavicle Fracture

The literature available on patient-orientated outcomes of operative management for clavicle fractures in adolescents is fairly limited. Open surgical treatment of displaced midshaft fractures of the clavicle continues to be a topic of controversy. Traditional treatment of clavicle fractures has been via non-operative methods in both children and adults. Management in adolescent patients remains controversial, and rightly so, as the traditional experience from non-operative methods has been regarded as satisfactory, while the literature on the more recent approach towards fixing some of these fractures is evolving. We present a review of relevant literature.

scholarly journals Variation in management of humeral and clavicular shaft fractures amongst fellowship trained orthopedic traumatologists

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Behnam Sharareh ◽  
Christopher Perkins
Keyword(s):  
Surgical Management ◽  
Clavicle Fracture ◽  
Operative Management ◽  
Orthopedic Trauma ◽  
Chi Square ◽  
Medical Comorbidities ◽  
Clavicle Fractures ◽  
Clinically Significant ◽  
Non Operative Management ◽  
Trauma Surgeons

Abstract Background There exists a wide variety of opinions on the appropriate management of diaphyseal humeral and clavicular fractures amongst orthopedic surgeons. The purpose of this study is to determine if there is a preference amongst orthopedic traumatologists on treatment of diaphyseal humerus and clavicle fractures with respect to various patient populations. Methods A 6-question survey was created using Surveymonkey.com and distributed via the Orthopedic Trauma Association (OTA) website to fellowship trained orthopedic surgery traumatologists to survey the preferred management of a simple oblique middle 1/3rd diaphyseal humerus fracture and a middle 1/3rd displaced diaphyseal clavicle fracture in the following 3 clinical settings: a healthy laborer, an older patient with co-morbidities, and if the surgeon themselves sustained the injury. The ratio of operative to non-operative management was calculated for all 6 questions. A chi-square value was performed to determine if the results are clinically significant based on the clinical scenario. Results There was 56 responses to the survey that were included in the analysis. Overall, there was a statistically significant trend towards surgical management of the surgeon’s own diaphyseal humerus fractures (55%) compared to that of healthy patients (41%) and those with medical comorbidities (21%) (p = 0.02) A similar trend was noted for operative management for diaphyseal clavicle fractures by the surgeon on their own fractures (43%) compared to that of healthy patients (38%) and those with medical comorbidities (18%) (p = 0.02). Conclusion While there are an increasing number of relative indications for treatment of diaphyseal humerus shaft and clavicle fractures, the results of this survey indicate that fellow-ship-trained orthopedic trauma surgeons prefer surgical management of simple humerus and clavicular fractures in young, healthy patients as well as in themselves.

scholarly journals Epidemiology of Clavicle Fractures Sustained at a Colorado Ski Resort

2021 ◽  
Vol 9 (5) ◽  
pp. 232596712110067
Author(s):  
Lauren Oberle ◽  
Lauren Pierpoint ◽  
Jack Spittler ◽  
Morteza Khodaee
Keyword(s):  
Medical Center ◽  
Descriptive Analysis ◽  
Clavicle Fracture ◽  
Sports Injury ◽  
Common Mechanism ◽  
Ski Resort ◽  
Incidence Data ◽  
Injury Mechanisms ◽  
Fracture Diagnosis ◽  
Clavicle Fractures

Background: Although clavicle fractures are a common sports injury, there are limited studies on the incidence and causes of clavicle fractures among winter sports athletes. Purpose: To evaluate the characteristics and injury mechanisms associated with clavicle fractures among patients evaluated at a Colorado ski resort. Study Design: Descriptive epidemiology study. Methods: This was a retrospective descriptive analysis of patients with clavicle fractures at the Denver Health Winter Park Medical Center during the 2012-2013 to 2016-2017 ski seasons. Chart review was performed on the patient cohort to confirm clavicle fracture diagnosis and to evaluate factors associated with clavicle fracture. Results: A total of 393 clavicle fractures (6.2% of total clinic visits) occurred during the study period, corresponding to an overall clavicle fracture incidence of 8.4 per 100,000 participant-visits. The mean patient age was 26.4 years (range, 5-73 years). The majority were middle-third fractures (85.5%), occurring mainly in men (87.3%). More than half of the fractures were comminuted (54.5%) and occurred in snowboarders (55.0%). The most common mechanism of injury was a fall onto snow while skiing or snowboarding (92.4%). Women sustained more clavicle fractures while skiing compared with snowboarding (82.0% vs 18.0%; P < .001), while men sustained more fractures while snowboarding compared with skiing (60.3% vs 39.7%; P < .001). Conclusion: Clavicle fractures are relatively common, but there are scant incidence data for clavicle fractures in mountain sports. Consistent with prior studies, clavicle fractures were more common in younger patients and men. The most common anatomic fracture location was the midclavicle. A greater proportion of clavicle fractures among men were sustained during snowboarding and among women during skiing.

scholarly journals Intraoperative Nice knots assistance for reduction in displaced comminuted clavicle fractures

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Fangning Hu ◽  
Xi Liu ◽  
Fanxiao Liu ◽  
Honglei Jia ◽  
Xiaolong Lv ◽  
...  
Keyword(s):  
Blood Loss ◽  
Rating Scale ◽  
Clavicle Fracture ◽  
Operation Time ◽  
Clinical Results ◽  
Intraoperative Blood Loss ◽  
Traditional Group ◽  
Significant Difference ◽  
Clavicle Fractures ◽  
Displaced Clavicle Fracture

Abstract Purpose The Nice knots have been widely used in orthopedic surgeries to fix torn soft tissue and fracture in recent years. The study aims to investigate the clinical efficacy and prognosis of intraoperative and postoperative Nice Knots-assisted reduction in the treatment of displaced comminuted clavicle fracture. Methods From Jan 2014 to Dec 2019, 75 patients diagnosed with unilateral closed displaced comminuted clavicle fracture were treated with open reduction and internal fixation (ORIF) in this study. Nice knot group (the NK group) included 38 patients and the other 37 patients were in the traditional group (the TK group). The time of operation and the amount of bleeding during operation were recorded. Post-operative clinical outcomes and radiographic results were recorded and compared between these two groups. The Visual Analogue Scale (VAS), Neer score, Rating Scale of the American Shoulder and Elbow Surgeons, Constant-Murley score and complications such as infection, nonunion, implant loosening, fragment displacement and hardware pain were observed in the two groups. Results In the comparison between the two groups, there was no significant difference in age, sex, the cause of displaced clavicle fracture, and other basic information between the two groups. The operation time, intraoperative fluoroscopy time, and intraoperative blood loss were significantly reduced in the NK group (P < 0.01). There were 2 cases of plate fracture in the TK group. The follow-up results showed that there was no significant difference in VAS, Neer score, ASES, and Constant-Murley scores between the two groups. Conclusion The use of Nice knot, in comminuted and displaced clavicle fractures can reduce intraoperative blood loss, shorten operation time, facilitate intraoperative reduction, and achieve satisfactory postoperative clinical results. This study demonstrates that Nice knot is a simple, safe, practical and effective auxiliary reduction method.

scholarly journals Refracture after locking compression plate removal in displaced midshaft clavicle fractures after bony union: a retrospective study

2021 ◽  
Author(s):  
Ho-Youn Park ◽  
Seok-Jung Kim ◽  
Yoo-Joon Sur ◽  
Jae-Woong Jung ◽  
Chae-Gwan Kong
Keyword(s):  
Clavicle Fracture ◽  
Locking Compression Plate ◽  
Bony Union ◽  
Related Factors ◽  
Patient Demographics ◽  
Radiographic Measurements ◽  
Significant Difference ◽  
Compression Plate ◽  
Segmental Fractures ◽  
Clavicle Fractures

Background: A midshaft clavicle fracture is a common fracture that typically responds well to open reduction and internal fixation (ORIF). However, refracture can occur after implant removal (IR). This study aimed to analyze the rate of refracture and related factors after removal of the locking compression plate (LCP) for displaced midshaft clavicle fractures. Methods: We retrospectively reviewed the medical records of 201 patients who had undergone ORIF with LCP for midshaft clavicle fractures after IR after bony union from January 2011 to May 2018 at our institute. We evaluated basic demographic characteristics and radiographic parameters. All patients were treated with an LCP for primary fracture. The patients were divided into two groups: a refracture group that experienced a second fracture within 1 year after IR and a no-fracture group.Results: There were four cases (1.99%) of refracture; three were treated conservatively, while one was treated surgically. All patients achieved bony union. The average interval between refracture and IR was 64 days (range, 6–210 days). There was a significant difference in classification of fractures (AO Foundation/Orthopaedic Trauma Association [AO/OTA] classification) between the two groups. However, other patient demographics and radiographic measurements between refracture and IR, such as bone diameter, showed no significant difference between the two groups. Conclusions: This study showed that one in 50 patients suffered from refracture after removal of the LCP. Thus, if patients desire IR, the surgeon should explain that there is a relatively higher possibility of refracture for cases with simple or segmental fractures than for other types of fracture.

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