Managing lateral end clavicle fracture at a tertiary level hospital in India

Background: With numerous methods and recommendations for managing fracture of lateral end of the clavicle, it always creates a clinical dilemma for the treating surgeon. This study is aimed to compare the functional outcome in patients with lateral end clavicle fracture treated either with operative and non-operative modalities.Methods: This non-randomized comparative study was conducted at Department of Orthopedics, DY Patil Medical College, Pimpri between September 2017 till June 2018, in which all patients with lateral end clavicle fracture were included. Patients were managed either non-operatively or with precontoured locking compression plate was fixed with 4 mm locking screw or 3.5 mm cortical screw. At the final follow up (at least one year) patients’ functional outcome was assessed using the Constant and Murley score.Results: A total of 57 patients were included in the study and 93% of the patients with operative management and 66% with non-operative treatment had a union time of 8 weeks or less. Out of the 27 patients who underwent non-operative treatment, three had malunion, two had non-union and five had deformity. Based on the Constant and Murley score, 27% of the patients in the operative group had an excellent outcome, and in the non-operative group, 8% had excellent functional outcome. The functional outcome was significantly better in the operative group (p=0.034).Conclusions: A better understanding of the risk factors for nonunion would help us to make decision between operative and nonoperative treatment. Randomized trials comparing the operative and non-operative treatments would help in understanding the merits of one method over other.

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

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20172882 ◽

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

Background: 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.Methods: 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.Results: 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.Conclusions:Operative treatment gave statistically significant functional outcome and early healing compared to conservatively treated in displaced, communited lateral end clavicle fractures.

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Comparative Study of Conservative Vs Surgical Management of Clavicle Fractures

Galore International Journal of Health Sciences and Research ◽

10.52403/gijhsr.20210101 ◽

2021 ◽

Vol 6 (1) ◽

pp. 1-5

Author(s):

Vivek Phanswal

Keyword(s):

Functional Outcome ◽

Surgical Management ◽

Clavicle Fracture ◽

Delayed Fracture ◽

Non Union ◽

Conservative Group ◽

Excellent Outcome ◽

Fracture Management ◽

Clavicle Fractures ◽

Radiological Union

Background: Clavicle Fractures is one of the common fractures of upper limb accounting for approximately 40 % of all shoulder fractures. Till recently all clavicle fracture were treated conservatively, but now interest in surgical management is rising. This study was carried out to see if Surgical management outweighs the conservative treatment of Fractures Of Clavicle. Methods: A total of 40 cases satisfying inclusion and exclusion criteria were included in the study. Alternate patients were allocated to operative and conservation groups. In total 20 patients were operated operatively and 20 patients were treated conservatively. Outcome was analysed in terms of radiological union and functional outcome of the patient. Constant and Murley score was used as a score to evaluate final outcome. Results: In this study, the 20 patients who were operated upon had an average union time of 7.8 weeks; 1 patient had delayed fracture union by 12 wks. 20 patients in conservative group had normal union of fractures with 1 patient going into non-union. Average union time in the conservative group was 9.4 weeks, which was more than the 7.8 weeks seen in the group treated operatively. Mal-union was present in 7 of the 20 patients treated conservatively, and 5 of these 7 had a visible deformity. Out of these patients with mal-union 1 had poor functional outcome, 3 had good to excellent outcome and 3 had satisfactory functional outcome. 4 of these had restricted movements terminally and 2 had pain on movement. Conclusions: From our study based on patients of clavicle fractures, it can be concluded that the operative group had significantly higher excellent outcomes as compared to the conservatively- managed group, based on the Constant and Murley score. Keywords: Clavicle Fractures, Constant and Murley Score, Operative Clavicle Fracture Management, Clavicle Fracture Functional Outcome.

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A comparative study of operative dynamic compression plating versus non-operative management in fracture shaft of humerus

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20200741 ◽

2020 ◽

Vol 6 (2) ◽

pp. 374

Author(s):

Naren Gaur ◽

Naveen Kumar Singh

Keyword(s):

Comparative Study ◽

Functional Outcome ◽

Operative Treatment ◽

Dynamic Compression ◽

Operative Management ◽

Shaft Fracture ◽

Nonoperative Treatment ◽

Humerus Shaft ◽

Compression Plating ◽

Dynamic Compression Plating

Background: Fracture shaft of humerus is among injuries which is commonly seen in clinical practice and frequently seen in polytrauma. Humerus shaft fractures account for 3% of all orthopedic injuries. Nonoperative treatment had been the mainstay of treatment for fracture shaft of humerus earlier. The association of conservative treatment with some morbidity, complications and prolonged immobilization leads to increase in various operative modalities of management. One of the commonly used operative modality is dynamic compression plating (DCP). In view of above considerations, a study was undertaken at our hospital which aimed to compare non-operative treatment with operative DCP for the management of fracture shaft of humerus. Aims and objectives of this study to compare the results of non-operative versus operative treatment of humerus shaft fracture.Methods: It was a prospective comparative study. Total 40 patients were taken for this study. 20 patients for operative and 20 patients for non-operative. Functional outcome was measured by the DASH scoring. P<0.05 was considered statistically significant. Results: Among the 40 patients 14 had excellent results, 12 had good, 8 had fair and 6 had poor results. Functional outcome scores were better for operative group as compared to non- operative group with p<0.0001. Conclusions: Dynamic compression plating of humerus is better method than conservative method because it achieves higher union rates.

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Non-union of Non-operatively Treated Displaced Olecranon Fractures

Shoulder & Elbow ◽

10.1111/j.1758-5740.2012.00194.x ◽

2012 ◽

Vol 4 (4) ◽

pp. 273-276 ◽

Cited By ~ 7

Author(s):

Wendy Bruinsma ◽

Anneluuk Lindenhovius ◽

Michael Mckee ◽

George S. Athwal ◽

David Ring

Keyword(s):

Operative Treatment ◽

Case Series ◽

Operative Management ◽

Olecranon Fracture ◽

Loss Of Function ◽

Non Union ◽

Flexion Extension ◽

Displaced Fracture ◽

And Function ◽

Non Operative Management

Background With this case series, we report the management of patients who present with non-union after no treatment or intentional non-operative management of a displaced olecranon fracture. We hypothesized that the majority of these patients would be satisfied with their symptoms and function. Methods Ten patients (six women and four men) with a mean age of 59 years (range 21 years to 94 years) presented to one of seven surgeons with non-union of a displaced fracture of the olecranon a mean of 17 months (range 3 months to 7 years) after injury. Results The mean flexion-extension arc at presentation was 117° (range 100° to 135°) with a mean flexion of 137° (range 120° to 150°) and a mean extension of 21° (range 10° to 40°). Forearm rotational arc was a mean of 172° (range 150° to 180°) with a mean pronation of 86° (range 75° to 90°) and a mean supination of 86° (range 75° to 90°). Two patients who had difficulty participating in daily activities because of pain or loss of function requested operative treatment. Eight patients declined operative treatment. Conclusions Patients who present with a non-union after a displaced olecranon fracture managed non-operatively have reasonable elbow function and uncommonly request operative treatment.

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Study of surgical outcome of mid third clavicle fractures surgically managed by locking compression plate

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20214965 ◽

2021 ◽

Vol 8 (1) ◽

pp. 72

Author(s):

Potharaju Swetha Rani ◽

M. Zeeshan Vasif

Keyword(s):

Functional Outcome ◽

Road Traffic ◽

Constant Score ◽

Clavicle Fracture ◽

High Energy ◽

Bony Union ◽

Non Union ◽

Fall From Height ◽

Clavicle Fractures ◽

A Prospective Study

Clavicle is one of the most frequently fractured bones in young and active individuals. They account for 2.6-12% of all fractures and for 44-66% of fractures around the shoulder. Majority of clavicle fractures are mid shaft (80-85%). Functional outcome of midshaft fracture not only depends on the union but also on its length which has to be maintained. Thus a displaced or comminuted fracture carries a risk of symptomatic malunion, non-union or poor functional outcome with cosmetic deformity. The recent trend is shifting to internal fixation of these displaced mid shaft clavicle fracture. This was a prospective study of 20 cases of fresh mid third clavicle fracture admitted to MNR medical college and hospital from August 2020 to September 2021. Cases were taken according to inclusion and exclusion criteria. Medically unsuitable and patients not willing for surgery were excluded from the study. There were 17 male patients and 3 female patients with mid 1/3 closed clavicle fracture. 12 patients had right sided clavicle fracture and 8 patients had fracture of the left clavicle. All 20 fractures were closed fractures. Majority of the patients sustained fracture due to road traffic accident (high energy trauma) in 16 cases, fall from height in 3 cases and assault in one case. The mean duration to surgery from the day of presentation and injury was 2.1 days for middle third clavicle fractures. Functional outcome as assessed by constant and Murley scoring was favourable with excellent to good result in 97% cases and fair in 3% cases. The average constant score was 93.35 in one year follow up in middle third group. This study has some limitations. The conclusions drawn from this analysis cannot be generalized because of the small number of cases. In conclusion, for middle third clavicle fractures bony union could be achieved with locking compression plates and the clinical outcomes were satisfactory. All the fractures united and there were no cases of nonunion.

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Autogenous Onlay Graft with Compression Plate for Treatment of Persistent Humeral Shaft Aseptic Non-union with Failed Previous Surgery

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2021.6511 ◽

2021 ◽

Vol 9 (C) ◽

pp. 118-123

Author(s):

Falih Waheed Hashmi ◽

Mohammed Baqir Al-Shara ◽

Mohammed Al-Edanni

Keyword(s):

Functional Outcome ◽

Nonoperative Treatment ◽

Humeral Shaft ◽

Teaching Hospitals ◽

Previous Surgery ◽

Infected Nonunion ◽

Hardware Failure ◽

Non Union ◽

Onlay Graft ◽

Compression Plate

BACKGROUND: The humeral shaft fractures have a good rate of union, despite this fact, still there is a significant rate of nonunion after nonoperative treatment and more often after operative treatment. AIM: The aim of the study is to evaluate the autogenous onlay graft with compression plate for treatment of persistent humeral shaft non-union with failed previous surgery both radiological and functional outcome. MATERIALS AND METHODS: A prospective study on twenty patients having persistent aseptic non-union age between 20 and 60 years old, after failed surgical treatment of fractures humeral shaft in Al-Zahra teaching and Al-Kindy teaching hospitals, while infected nonunion, diabetes mellitus, secondary metastasis, smoking, alcoholism, and patients on long medication with corticosteroid were excluded from the study. All our patients were treated with corticocancellous onlay bone grafting harvesting from the ipsilateral upper tibia and compression plating (graft parallel to plate) and follow-up for at least 18 months post-operative to evaluate both radiology and functional using Mayo elbow performance index. RESULTS: All the patients ended with a solid union without hardware failure, and no one patient needs further surgery, even with significant resorption of the graft, there is a good chance of graft re-calcification and solid union with good to excellent functional outcome. CONCLUSION: Very successful solid union results achieve in those patients with established aseptic nonunion and pseudoarthrosis of the humerus.

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Physician treatment preferences in non-displaced distal fibula fractures

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00366 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0036

Author(s):

Steven Neufeld ◽

Dan Merenstein

Keyword(s):

Operative Treatment ◽

Practice Guidelines ◽

Evidence Based Practice ◽

Operative Management ◽

The United States ◽

Nonoperative Treatment ◽

Treatment Preferences ◽

Evidence Based ◽

Foot And Ankle ◽

Orthopedic Surgeons

Category: Trauma Introduction/Purpose: Background: Several studies have demonstrated equivocal long-term functional outcomes for both operative and nonoperative treatment of Weber-B fractures, however there are currently no evidence-based practice guidelines. The purpose of this study was to determine which treatment modality was preferred by orthopedic surgeons in the United States and Internationally, despite the lack of accepted guidelines. Methods: Methods: A survey of 428 practicing orthopedic surgeons was conducted to evaluate physician treatment preferences for non-displaced Weber-B fractures. Analyses were performed to determine physician preference for operative versus nonoperative fracture treatment, as well as to determine group differences between U.S, international and foot and ankle orthopedic surgeons compared to all other orthopedic surgeons. A cost effective analysis was conducted to compare differences among nonoperative and operative preferences. Results: Nonoperative treatment of non-displaced Weber-B fractures was preferred by 90.4% of orthopedic surgeons compared to operative treatment (9.6%; P<0.0001). Internationally-based orthopedic surgeons chose operative management at a higher rate (30/129) than U.S.-based surgeons (11/299; P<0.0001). General orthopedic surgeons were not more likely than subspecialty orthopedic surgeons to choose operative management, but foot and ankle subspecialists chose operative treatment at a higher rate compared to all other orthopedic surgeons (11/61 versus 29/362; P=0.0185). The direct medical costs and the indirect societal costs are likely to be 249 percent greater if managed operatively. Conclusion: Our findings suggest that while the vast majority of practicing surgeons choose to non-operatively manage non-displaced Weber-B fractures, there still exist a significant percentage of physicians who prefer to operate on these fractures. Given the existing literature suggesting equivalent outcomes for operatively and non-operatively treated Weber-B fractures, the current data suggests the need for further research into the reasons behind such differences in treatment preferences, as well as the evolution of evidence-based practice guidelines to guide the management of this very common fracture.

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Operative versus Conservative Treatment for the Management of Displaced Midshaft Clavicle Fractures in Adults

Journal of Armed Forces Medical College Bangladesh ◽

10.3329/jafmc.v13i1.41030 ◽

2017 ◽

Vol 13 (1) ◽

pp. 81-85

Author(s):

Md Maksudul Haque ◽

Masud Ahmed ◽

Md Zakir Hossain ◽

Md Ali Faisal ◽

Mohammad Saiful Islam ◽

...

Keyword(s):

Conservative Treatment ◽

Functional Outcome ◽

Open Reduction ◽

Plate Fixation ◽

Major Complication ◽

Armed Forces ◽

Operative Management ◽

Cross Sectional Study ◽

Cross Sectional ◽

Non Union

Introduction: Displaced fractures of mid third clavicle are common in young athletic population and choice of management is still controversial. Recent studies have shown that these fractures do not have favourable outcomes with non-operative management and nonunion rates could be as high as 20%, in addition, there is symptomatic malunion with shortening. Objective: To compare the results of the operative versus that of conservative treatment for the management of displaced midshaft clavicular fractures. Materials and Methods: This prospective cross-sectional study was carried out in Orthopaedic and Trauma center, CMH, Dhaka, from the period of January 2014 to December 2016 to compare results of open reduction and internal fixation by plating with that of conservative management. Total 60 patients (30 in each group) were analyzed in terms of fracture union and functional outcome. Patients in the non-operative group were managed by triangular sling with or without strapping whereas in the operative group fractures were reduced and fixed with a contoured reconstruction plate. Patients were actively followed up for 12 months and functional outcome was measured by Rowe and Oxford shoulder scoring system. Complications were monitored clinically and radiologically. Results: All fractures in the operated group united compared with thirteen cases of symptomatic malunion (43.33%) in the non-operated group which is statistically significant. Rowe and Oxford scores was significantly higher in the operated group than the non-operated group in every occasion of follow-up. There was no major complication of surgery. In one patient (3.33%) plate had to be removed for hardware irritation and prominence. Conclusion: Open reduction and internal plate fixation in acute displaced midshaft clavicular fractures resulted in improved outcome decreased rate of non-union and symptomatic mal-union compared with non-operative treatment Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 81-85

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Functional Outcome and Quality of Life After Nonoperative Treatment of Posterior Process Fractures of the Talus

Foot & Ankle International ◽

10.1177/1071100719868712 ◽

2019 ◽

Vol 40 (12) ◽

pp. 1403-1407 ◽

Cited By ~ 1

Author(s):

Olivier Wijers ◽

Esmee W.M. Engelmann ◽

Jelle J. Posthuma ◽

Jens A. Halm ◽

Tim Schepers

Keyword(s):

Quality Of Life ◽

Patient Satisfaction ◽

Functional Outcome ◽

Case Series ◽

Operative Management ◽

Nonoperative Treatment ◽

Index Score ◽

Posterior Process ◽

The Mean

Background: Fractures of the posterior process of the talus are frequently overlooked, possibly leading to nonunion, arthritis, and chronic pain. Given the rare occurrence, previous case series have been small and without functional outcome scores. Therefore, we aimed to provide evidence on outcomes after nonoperative and operative management of posterior process fractures of the talus. Methods: All patients treated at a level 1 trauma center between 2012 and 2018 were retrospectively evaluated. Patient, fracture, and treatment characteristics were collected, and functional outcome as well as quality of life were assessed. Twenty-nine patients with posterior process fractures of the talus were identified in our database. Results: The most frequently seen mechanism of trauma was fall from height in 13 patients (44.8%). Twenty-two patients underwent primary arthrodesis or operative reduction and fixation of the fracture (75.9%). Eighty-two percent of the patients returned the questionnaires with a mean follow-up of 6 years. The 2 patients with primary arthrodesis were excluded from outcome analysis. The mean Foot Function Index score was 1.8 (range 0.0-10). The mean American Orthopaedic Foot & Ankle Society (AOFAS) score was 78.7 points (range 0-100). The mean quality of life EuroQol-5D (EQ-5D) index score was 0.78 (range −0.26 to 1). The mean visual analog scale (VAS) on overall patient satisfaction was 8.2 (range 1-10). Conclusion: Operative management of extended posterior talar fractures was found to provide good functional outcome, quality of life, and patient satisfaction. Although the patients treated nonoperatively were found to have less severe injuries, they demonstrated worse overall outcome, which is supportive of surgical management. Nonoperative treatment is therefore only justified in selected patients. Level of Evidence: Level IV, retrospective case series.

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CASE STUDY OF TITANIUM ELASTIC NAIL FOR FRACTURES

International Medical Science Research Journal ◽

10.51594/imsrj.v1i3.64 ◽

2020 ◽

Vol 1 (3) ◽

pp. 50-60

Author(s):

Mohammad Sadiq ◽

Mohammad Alam

Keyword(s):

Plate Fixation ◽

Clavicle Fracture ◽

Operating Time ◽

Operative Management ◽

Clinical Results ◽

Deep Infection ◽

Implant Removal ◽

Superficial Infection ◽

Non Union ◽

Plate Group

Mostly, clavicle fracture is treated conservatively but because of higher rates of delayed union, non-union, symptomatic, malunion cosmetic deformity and other complications, there is increased used of operative management for clavicle fracture. In this regard, plating and intramedullary nailing are common surgical options. The operative technique is also found to be producing favorable results compare to the traditional method based on recent prospective randomized studies. In this study, the objective is to make a comparison between clinical results, operative method, and resulting complications proportion. The study was conducted on 66 patients who had OTA type B DMCFs and underwent surgical fixation with antegrade TENs and 1/3rd tubular plate. The study participants were divided in to two groups based on TENS and other with plate fixation with 1/3rd tubular plate. We conducted evaluation using constant-murley shoulder outcome and dash scores at 6, 12, weeks, 3, 6, and 12 months for determining outcomes. It was observed that among TENS group, there was easier implant removal and minimal complications, less blood loss, lesser operating time, with only complication of shortening of about 0.5 cm in fewer cases. In the other group which is plate group, no major complications were observed except minor one such as deep infection, superficial infection, hypertrophied scarring without pain, and decreased shoulder motion with no case of shortening. In terms of union and stability, no significant differences were found in both groups. Based on the result, it is suggested that TENS is more preferable since it involves fewer morbidity, better cosmetic results, and easier implant removal. Fixation with plate seems to be little more stable and its implant of choice is comminuted fracture.

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