Smoking status and the Disabilities of the Arm Shoulder and Hand score are early predictors of symptomatic nonunion of displaced midshaft fractures of the clavicle
| Autor: | Nicholas D. Clement, A. J. Brooksbank, T. J. S. Chesser, C M Robinson, Ewan B Goudie |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
musculoskeletal diseases
Adult Male medicine.medical_specialty Shoulder Adolescent Nonunion 03 medical and health sciences Fracture Fixation Internal Young Adult 0302 clinical medicine Bone plate Dash medicine Humans Orthopedics and Sports Medicine Disabled Persons 030212 general & internal medicine Young adult 030222 orthopedics Pain Postoperative business.industry Smoking Retrospective cohort study Odds ratio Middle Aged musculoskeletal system medicine.disease Hand Clavicle Confidence interval Surgery medicine.anatomical_structure Early Diagnosis Fractures Ununited Physical therapy Arm Female business Epidemiologic Methods Bone Plates |
| Zdroj: | The bonejoint journal. (1) |
| ISSN: | 2049-4408 |
| Popis: | AimsThis study identifies early risk factors for symptomatic nonunion of displaced midshaft fractures of the clavicle that aid identification of an at risk group who may benefit from surgery.MethodsWe performed a retrospective study of 88 patients aged between 16 and 60 years that were managed non-operatively.ResultsThe rate of symptomatic nonunion requiring surgery was 14% (n = 13). Smoking (odds ratio (OR) 40.76, 95% confidence intervals (CI) 1.38 to 120.30) and the six week Disabilities of the Arm Shoulder and Hand (DASH) score (OR 1.11, 95% CI 1.01 to 1.22, for each point increase) were independent predictors of nonunion. A six week DASH score of 35 or more was identified as a threshold value to predict nonunion using receiver operating characteristic curve analysis. Smoking and the threshold value in the DASH and were additive risk factors for nonunion, when neither were present the risk of nonunion was 2%, if one or the other were present the nonunion rate was between 17% to 20%, and if both were present the rate increased to 44%.DiscussionPatients with either of these risk factors, which include approximately half of all patients sustaining displaced midshaft fractures of the clavicle, are at an increased risk of developing a symptomatic non-union. Take home message: Smoking and failure of functional return at six weeks are significant predictors of nonunion of the midshaft of the clavicle. Such patients warrant further investigation as to whether they would benefit from early surgical fixation in order to avoid the morbidity of a nonunion. Cite this article: Bone Joint J 2016;98-B:125–30. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|