Prospective Analysis of Surgical Treatment For Displaced Midshaft Clavicle Fractures in  Adults

Background: The traditional view that the vast majority of midshaft clavicular fractures heal with good functional outcomes following non-operative treatment may be no longer valid for all midshaft clavicular fractures. And it is becoming increasingly apparent that clavicular malunion is a distinct clinical entity with radiographic, orthopedic, neurologic, and cosmetic features. Recent studies have shown a high prevalence of symptomatic malunion and nonunion after nonoperative treatment of displaced midshaft clavicular fractures.Objective: To analyze the demography of midshaft clavicular fracture and to observe union time, DASH score, and complication of surgical treatment. Materials and Methods: This prospective observational study of 34 cases with midshaft clavicle fracture was conducted in Nepalgunj medical college, Kohalpur in a time span of one year. Patients were treated operatively with plating and followed up at 6 weeks, 12 weeks, 18 weeks, 6 and 12 month.Results: Thirty four patients (Male: 29 Female: 5) with average age 32.95 years (range: 19 to 59 years) were operated for clavicular fracture with male predominance (85.30%). The mean time for fracture healing was 16.24 weeks and mean DASH score was 13.58.Conclusions: Displaced midshaft clavicular fracture can be effectively managed with plating and have improved functional outcome and shorter time for union.JNGMC Vol. 13 No. 2 December 2015, Page: 17-20

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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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Exploring patient satisfaction after operative and nonoperative treatment for midshaft clavicle fractures: a focus group analysis

10.21203/rs.3.rs-16871/v1 ◽

2020 ◽

Author(s):

Eric Danjel Tutuhatunewa ◽

Martin Stevens ◽

Olivier C. Dams ◽

Jeffrey van Son ◽

Rebecca D. Louhanepessy ◽

...

Keyword(s):

Patient Satisfaction ◽

Focus Group ◽

Focus Groups ◽

Treatment Options ◽

Clavicle Fracture ◽

Group Analysis ◽

Nonoperative Treatment ◽

Web Based ◽

Face To Face ◽

Clavicle Fractures

Abstract BackgroundThere is no consensus on the optimal treatment for displaced midshaft clavicle fractures. Several studies indicate superior patient satisfaction in favour of operative reconstruction. It is unknown what drives superior satisfaction in this treatment group. The aim of this study was to explore patient satisfaction and identify contributors to patient satisfaction after operative and nonoperative treatment for displaced midshaft clavicle fractures in adults using a focus group approach.MethodsFour face-to-face and two web-based focus groups were hosted. A total of 24 participants who were treated nonoperatively (n = 14) or operatively (n = 10) agreed to participate. Participants were selected using purposive sampling, ensuring variation in gender, age, treatment complications and outcomes. A question script was developed to systematically explore patient expectations, attitudes and satisfaction with different dimensions of care. All focus groups were voice-recorded and transcribed at verbatim. Thematic analysis was conducted on all face-to-face and web-based transcripts. ResultsThe main emerging themes across treatment groups were; need for more information, functional recovery, speed of recovery and patient-doctor interaction. There was no difference in themes observed between operative and nonoperative focus groups. The lack of information was the most important complaint in dissatisfied patients. Conclusion Our study shows that informing patients about their injury, treatment options and expectations for recovery is paramount for overall patient satisfaction after treatment for a displaced midshaft clavicle fracture.

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FIXATION OF A CLOSED DISPLACED MIDSHAFT CLAVICLE FRACTURE BY INTRAMEDULLARY K-WIRE: A CASE REPORT

(JOINTS) Journal Orthopaedi and Traumatology Surabaya ◽

10.20473/joints.v10i2.2021.64-69 ◽

2021 ◽

Vol 10 (2) ◽

pp. 64

Author(s):

Devuandre Naziat ◽

David Haryadi

Keyword(s):

Case Report ◽

Low Cost ◽

Clavicle Fracture ◽

Shoulder Girdle ◽

Nonoperative Treatment ◽

Shoulder Range Of Motion ◽

Good Cosmetic ◽

Treatment Paradigm ◽

Clavicle Fractures ◽

K Wires

Background: Fractures of the clavicle record for practically 50% of all injuries in the shoulder girdle. In recent years, the treatment paradigm for clavicle fractures has shifted from nonoperative treatment toward operative treatment, especially in fractures with significant displacement or shortening. Case Report: A 16 years old female presented to the emergency room with an injury on her right shoulder after a motorcycle accident. The radiograph showed a displaced midshaft clavicle fracture, classified as Robinson 2B1. Operative measures were performed using intramedullary K-Wire. Discussion: There is no universally agreed gold standard for clavicle fracture fixation. The majority of midshaft clavicle fractures with a displaced fragment can be successfully repaired without surgery. On the other hand, conservative therapy of Robinson type 2B clavicle fracture has been linked to a higher rate of nonunion and a decrease in strength and endurance of the shoulder. In this patient, on the two-week follow-up after wire removal surgery, the patient regained full shoulder range of motion without any limitation on activities of daily living with a minimal post-operative scar.Conclusion: We recommend that intramedullary fixation using K-wires is a useful technique in displaced midshaft clavicle fracture as it is effective, has a good cosmetic outcome, and is well-suited for the BPJS era as it had the low-cost burden.

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Effectiveness of ultrasound-guided hydrostatic reduction of intussusception in children

Journal of Dhaka Medical College ◽

10.3329/jdmc.v27i2.45825 ◽

2020 ◽

Vol 27 (2) ◽

pp. 134-140

Author(s):

Sumi Datta ◽

Md Jamal ◽

Yesmina Rahman ◽

Mahbuba Hussain ◽

Fahmida Yeshmina ◽

...

Keyword(s):

Success Rate ◽

Nonoperative Treatment ◽

Age Group ◽

Ultrasound Guided ◽

Interventional Study ◽

Hydrostatic Reduction ◽

Medical College ◽

Study Population ◽

One Year ◽

Successful Reduction

Aim: To review the effectiveness of ultrasound- guided hydrostatic reduction of intussusception in children. Methods: This prospective interventional study was done during one year period from January 2014 to December 2014 in the department of Radiology and Imaging of Dhaka Medical College and Hospital, Dhaka and included 30 children clinically and radiologically diagnosed as intussusception with symptoms d” 48 hours. They underwent ultrasound-guided hydrostatic reduction using normal saline and the effectiveness of this technique was reviewed. Results: Majority of the study population were in the age group of 7-24 months with mean age of 9.04± 2.48 months. 100% patients who presented within 24 hours of their symptoms achieved successful reduction whereas success rate of reduction were 95% and 0% respectively in patients presented within 24-36 hours and after 36 hours of their symptoms. 60% cases required 5-10 minutes for successful reduction, 20% cases required 3-5 minutes and 10% patients needed > 10 minutes. Within 3 attempts, reduction happened in 90% cases whereas 10% cases failed to reduce. No case was tried for reduction after 3 attempts in consideration of the bowel pathology and complications. Only 10% patients developed negligible complications. No case showed recurrence. Conclusion: Ultrasound guided hydrostatic reduction of intussusception is an effective nonoperative treatment of intussusception in children because of its high success rate, less complications and recurrence rate. J Dhaka Medical College, Vol. 27, No.2, October, 2018, Page 134-140

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The external fixation can be a good alternative to plate-screw treatment in the surgical treatment of bilateral distal radius fractures: A retrospective cohort study

Joint Diseases and Related Surgery ◽

10.52312/jdrs.2021.151 ◽

2021 ◽

Vol 32 (2) ◽

pp. 406-413

Author(s):

Mirza Zafer Dağtaş ◽

Ömer Kays Ünal

Keyword(s):

Surgical Treatment ◽

Distal Radius ◽

Treatment Options ◽

Operation Time ◽

Good Alternative ◽

Distal Radius Fractures ◽

Dash Score ◽

Functional Difference ◽

Radius Fractures ◽

One Year

Objectives: We aimed to compare the outcomes of two surgical treatment options, external fixator (EF) or open reduction and internal fixation (ORIF), in patients with bilateral distal radius fractures (DRFs). Patients and methods: Twenty-one patients (11 males 10 females; mean age: 40.0±16.0 years; range, 20 to 67 years) who underwent ORIF (n=10) or EF (n=11) due to bilateral DRF at between January 2011 and December 2019 were retrospectively analyzed. The Quick Disability of the Arm, Shoulder and Hand (Q-DASH) was used to calculate functional and symptomatic evaluation. The MAYO wrist scores were used to evaluate pain, functional status, ROM, and grip strength and the Michigan Hand Outcomes Questionnaire (MHOQ) was used to measure hand performance in daily life. Results: The operation time was statistically significantly longer in the ORIF group, compared to the EF group (p<0.001). Radial shortening was statistically significantly greater in the EF group, compared to the ORIF group (p<0.001). While the Q-DASH score was lower in the EF group on Day 15 and at one and two months (p<0.001, for each), it was similar between the groups at one year (p=0.507). The MAYO wrist score was higher in the EF group on Day 15 and at one and two months and one year (p<0.05, for each). While the MHOQ score was higher in the EF group on Day 15 and at one and two months (p<0.001, for each), it was similar between the groups at one year (p=0.557). Conclusion: In bilateral DRF cases, hand functions in the first two months after treatment were better in the EF group, compared to the ORIF group. This functional difference between the two groups gradually decreased in the first year and reached similar levels. Our results demonstrate that EF can be a good alternative in the surgical treatment of bilateral DRFs owing to its acceptable results, particularly in the short-term.

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A Study on Functional Outcomes after Plating of Middle Third Fractures of Clavicle

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2020/573 ◽

2020 ◽

Vol 7 (47) ◽

pp. 2793-2798

Author(s):

Pardhasarathi B ◽

Balaji Rao R ◽

Manikumar C.J.

Keyword(s):

Functional Outcome ◽

Conservative Management ◽

Functional Outcomes ◽

Clavicle Fracture ◽

Dash Score ◽

Non Union ◽

Plating Technique ◽

Fracture Clavicle ◽

Comminuted Fractures ◽

Clavicle Fractures

BACKGROUND Fracture clavicle is one of the most common conservatively treated fractures. Conservative management showed lesser rates of non-union and satisfactory results for fracture clavicle initially. Recent studies showed that the functional outcome following conservative management was not as optimal as it was thought to be. With changing injury patterns, increased incidence of high velocity trauma and increased functional demands of the modern patients which led to thorough evaluation of the functional outcomes following conservative management of fracture clavicle, the outcome was not optimal. Recent studies showed increased rate of non-union among conservatively managed cases compared to those which were fixed internally. Some found residual deficits among patients treated conservatively. We wanted to study the functional outcome and complications following internal fixation of clavicle fractures by using plating techniques. METHODS This prospective study was done in Department of Orthopaedics, Andhra Medical College, Visakhapatnam. We studied functional outcome of 30 fractures of clavicle which were fixed using plating technique during the period October 2016 - October 2018. Thirty patients (n = 30) were treated with plating technique using precontoured locking plates and recon plates. The fractures in this study were middle third clavicle fractures which were divided into two types based on the classification of Robinson. Type 2 Robinson clavicle fracture implies that it is a middle third clavicular fracture, which is further divided based on fracture morphology. 2b1: Displaced simple or wedge comminuted fractures 2b2: Segmental comminuted fractures. In this study, superior plating was done. The implants used were precontoured LCP and recon plates. Functional outcome was assessed using Constant Murley scoring and Quick Dash score at 10 weeks. The follow up period was for 1 year - October 2016 to October 2018. RESULTS The average time of union for the fractures treated with plating technique in our study was around 10.2 weeks. The mean Constant Murley score of our study was 91. Eighteen out of 30 patients had excellent outcomes. One patient had fair outcome due to stiffness of the shoulder. 10 patients had good result. The average DASH score of the patients was about 9.8. CONCLUSIONS Treatment of fracture middle third of clavicle using plating technique provides good functional outcome and faster recovery with minimal complications. KEYWORDS Clavicle A02.835.232.087.227, Wounds and Injuries C26, Postoperative Complications C23.550.767

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Co-morbidities and micronutrient deficiencies in children with severe acute malnutrition

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20172113 ◽

2017 ◽

Vol 4 (4) ◽

pp. 1225

Author(s):

Kumar Saurabh ◽

Shilpi Ranjan ◽

J P Narayan

Keyword(s):

Severe Acute Malnutrition ◽

Retrospective Chart Review ◽

Acute Malnutrition ◽

Nutritional Deficiencies ◽

Micronutrient Deficiencies ◽

Medical College ◽

Paediatric Unit ◽

High Prevalence ◽

The Mean ◽

One Year

Background: To study the co-morbidities and nutritional deficiencies in hospitalized children of severe acute malnutrition (SAM).Methods: One year retrospective chart review of 150 cases of SAM was done in Paediatric unit of a medical college of northern India.Results: The mean age of study group was 17.3 months (6 months to 60 months’ age group). Diarrhoea (34.7%) and respiratory tract infection (31.33%) were the most common co-morbid conditions associated with this study. Tuberculosis was seen in 20% of cases whereas Measles was associated in 6.7% cases. Anaemia and Vitamin A deficiencies were common micronutrient deficiencies. A very high prevalence of intestinal helminthic infestation was present in this study. Ascaris lumbricoides being the most common parasite involved. Polyparasitism was present in 20% of cases.Conclusions: Early identification and management of co-morbidities can improve overall outcome and survival.

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A simple surgical technique for correcting malunion after midshaft clavicle fracture

Shoulder & Elbow ◽

10.1177/1758573220933247 ◽

2020 ◽

pp. 175857322093324

Author(s):

Tom van Essen ◽

Robert Jan Hillen

Keyword(s):

Surgical Treatment ◽

Surgical Technique ◽

Clavicle Fracture ◽

Treatment Modalities ◽

Shoulder Dysfunction ◽

The Past ◽

Clavicle Fractures ◽

New Surgical Technique

Clavicle malunion occurs in two-thirds of all clavicle fractures treated conservatively. It can lead to pain, shoulder dysfunction and cosmetic complaints. Surgical treatment of all midshaft fractures will lead to overtreatment, as not all malunions are symptomatic. In the past, several treatment modalities for correcting malunion of the clavicle have been described, and all have been successful but none have shown superiority. This article describes a new surgical technique with excising a wedge to realign the clavicle malunion.

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Complex clavicle fractures in children: Kids are not little adults

Trauma ◽

10.1177/1460408617724815 ◽

2017 ◽

Vol 21 (1) ◽

pp. 35-39

Author(s):

Hayk Stepanyan ◽

William Hennrikus ◽

Derek Flynn ◽

David Gendelberg

Keyword(s):

Pediatric Patients ◽

Adult Population ◽

Clavicle Fracture ◽

The Body ◽

Bony Union ◽

Dash Score ◽

Non Union ◽

Fractures In Children ◽

Clavicle Fractures

Background The clavicle is the most commonly fractured bone in the body and accounts for 10–15% of all pediatric fractures. Adult patients with complete midshaft clavicle fractures often undergo surgical management. Pediatric patients have a thicker periosteum, more robust blood supply and a greater healing potential. Controversy exists as to whether to treat adolescents with surgery similar to adults versus with a sling as children are treated. Some orthopaedic surgeons are now operating on adolescent clavicle fractures. Objective The objective of the study was to evaluate the outcomes of displaced midshaft clavicle fractures in adolescent who were treated conservatively with a sling. Methods We performed a retrospective chart review of 25 pediatric patients aged 12–16 with complete midshaft clavicle fracture. The outcomes of the study were bony union and functional outcomes such as pain, problems with ADL measured by the modified Disability of Arm, Shoulder, and Hand (DASH) score. Results All patients in our cohort had excellent outcomes at follow-up visits with no complaints of pain or limitations of activities of daily living. Mean follow-up time was 12 months. All patients had perfect modified DASH score of 18. Injury radiographs demonstrated an average of 13 mm shortening initially and 8 mm shortening in final follow-up. Average fracture angulation at final follow-up was 15°. Normal clavicle angulation at the mid shaft is 8°. All clavicles healed completely with no case of malunion or non-union reported. Conclusion Clavicle fractures are common. Although operative treatment of clavicle fractures in the adult population is gaining popularity due to issues in adults with non-union and malunion, the adolescent population is different. The adolescent clavicle fracture demonstrates robust healing and remodeling and complete return to full function. We therefore recommend that adolescent patients aged 12–16 with complete clavicle fracture be treated conservatively with a sling.

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Effect of Malunited Midshaft Clavicular Fractures on Shoulder Function

ISRN Orthopedics ◽

10.5402/2011/507287 ◽

2011 ◽

Vol 2011 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Shachar Shapira ◽

Zeevi Dvir ◽

Uri Givon ◽

Ariel Oran ◽

Amir Herman ◽

...

Keyword(s):

Muscle Strength ◽

Range Of Motion ◽

Treatment Success ◽

Clavicle Fracture ◽

Functional Results ◽

Shoulder Function ◽

Strength Testing ◽

Dash Score ◽

Fracture Function ◽

Clavicle Fractures

Background and Purpose. Displaced middle third clavicle fractures are traditionally treated non-operatively and heal with residual deformity. Few studies assessed treatment success by using patient-oriented outcome measures or objective muscle strength testing. The purpose of our study was to determine whether clavicle malunion affects functional results. Methods. Union was documented in 25 patients who were treated conservatively due to a displaced mid shaft clavicle fracture. Ten had significant malunion. Patients were examined at least 12 months following the fracture. Function was assessed by DASH and UCLA questionnaires. Clinical assessment included Range of Motion (ROM) measurement, manual and isokinetic muscle strength testing. Healthy shoulder served as a control. Results. Mean follow up time was 38 months. The mean DASH score was 9, mean UCLA score was 31.7. Range of motion was preserved—less than 6° side-to-side difference. Abduction strength reduction in the involved side amounted to 7%. No correlation was found between radiographic malunion and the functional results. Interpretation. Displaced healed middle clavicle fractures result in satisfactory functional results. The average deficits detected in strength and ROM were within the normal limits compared to the non-injured side. Radiographic healing position had no effect on functional outcome.

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