Purpose: VariouS treatments have been suggested for midshaft claviclc fractures. WE analyzed a large series of midshaft clavicle fractures treated conservatively to determine the prevalence of solid union and the causes of unsatisfactory outcomes. Material and Methods: We analyzed the clinical charts of 556 patients with clavicle fracture treated at our Emergency Dept. ftoDn. 1994 to 2001. Fractures were classified using Allnian's system. Pathological fractures, skeletally immature subjects, polytrauma cases, patients aged >75 and fractures associated to AC dislocation were excluded. Fractures of the medial and lateral clavicle were also excluded. Of the remaining 121 patients, 30 could not be traced, thus leaving 91 cases {M; 59 ; F: 32 ; mean age 41 ; left side 58%). The mean F.U was 9.7 years. Shoulder function was assessed with Constant's score (CS). Both shoulders were radiographed (AP and Zanca's view ; magnification: 9%). Hill's system was used to evaluate clavicle shortening. Subjective satisfaction was assessed with SST. Results: The mean CS for Allman's subgroups la, lb, k was 98%, 88%, and 83%, respectively. Shoulder pain was present only in few patients in Groups lb and Ic. CS was lower in patients with severe initial fracture displacement and/or clavicle shortening and in those in Group Ic. Nonunion, confirmed by CT, occurred in 5 cases (5.5%) of Group lb or Ic (atrophic in 3: CS: 84% ; hypertrophic in 2: CS: 81%). In these, initial shortening was greater than 2 cm. 90% of patients had satisfactory results (SST>10). Reasons for dissatisfaction included shoulder weakness, pain related to hypertrophic callus and cosmetic defects. Conclusion: Conservative treatment gives satisfactory results in a high percentage of patients. 90% considered their funnctional result as satisfactory. Nonunion rate is lower than that found in surgically treated series. Indications tor surgery- are fractures with > 2 cm clavicle shortening and thin patients of Group Ic.
Long term results of conservative management of midshaft clavicle fracture / R., Postacchini; Gumina, Stefano; Postacchini, Franco. - STAMPA. - (2008), pp. 49-49. (Intervento presentato al convegno 21st congress of the european society for surgery of the shoulder and the elbow tenutosi a Brugge, Belgium nel 17-20 September, 2008).
Long term results of conservative management of midshaft clavicle fracture
GUMINA, STEFANO;POSTACCHINI, Franco
2008
Abstract
Purpose: VariouS treatments have been suggested for midshaft claviclc fractures. WE analyzed a large series of midshaft clavicle fractures treated conservatively to determine the prevalence of solid union and the causes of unsatisfactory outcomes. Material and Methods: We analyzed the clinical charts of 556 patients with clavicle fracture treated at our Emergency Dept. ftoDn. 1994 to 2001. Fractures were classified using Allnian's system. Pathological fractures, skeletally immature subjects, polytrauma cases, patients aged >75 and fractures associated to AC dislocation were excluded. Fractures of the medial and lateral clavicle were also excluded. Of the remaining 121 patients, 30 could not be traced, thus leaving 91 cases {M; 59 ; F: 32 ; mean age 41 ; left side 58%). The mean F.U was 9.7 years. Shoulder function was assessed with Constant's score (CS). Both shoulders were radiographed (AP and Zanca's view ; magnification: 9%). Hill's system was used to evaluate clavicle shortening. Subjective satisfaction was assessed with SST. Results: The mean CS for Allman's subgroups la, lb, k was 98%, 88%, and 83%, respectively. Shoulder pain was present only in few patients in Groups lb and Ic. CS was lower in patients with severe initial fracture displacement and/or clavicle shortening and in those in Group Ic. Nonunion, confirmed by CT, occurred in 5 cases (5.5%) of Group lb or Ic (atrophic in 3: CS: 84% ; hypertrophic in 2: CS: 81%). In these, initial shortening was greater than 2 cm. 90% of patients had satisfactory results (SST>10). Reasons for dissatisfaction included shoulder weakness, pain related to hypertrophic callus and cosmetic defects. Conclusion: Conservative treatment gives satisfactory results in a high percentage of patients. 90% considered their funnctional result as satisfactory. Nonunion rate is lower than that found in surgically treated series. Indications tor surgery- are fractures with > 2 cm clavicle shortening and thin patients of Group Ic.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
