Plate fixation compared with nonoperative treatment of displaced midshaft clavicular fractures: a randomized clinical trial
| Autor: | C M Jensen, Andreas H Qvist, Michael Toft Væsel, Steen Lund Jensen |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Adult
Male Restraint Physical medicine.medical_specialty Orthotic Devices Adolescent Nonunion Bone Screws Bone healing Restraint Physical/instrumentation law.invention 03 medical and health sciences Fracture Fixation Internal Fractures Bone Young Adult 0302 clinical medicine Randomized controlled trial law Fracture fixation Bone plate Clavicular fractures Medicine Humans Orthopedics and Sports Medicine 030212 general & internal medicine Fracture Fixation Internal/instrumentation Fractures Bone/therapy Fracture Healing 030222 orthopedics business.industry Fractures Ununited/surgery Middle Aged medicine.disease Clavicle Orthotic device Surgery medicine.anatomical_structure Treatment Outcome Fractures Ununited Clavicle/injuries Female business Bone Plates Follow-Up Studies |
| Zdroj: | Qvist, A H, Væsel, M T, Jensen, C M & Jensen, S L 2018, ' Plate fixation compared with nonoperative treatment of displaced midshaft clavicular fractures : a randomized clinical trial ', The Bone & Joint Journal, vol. 100-B, no. 10, pp. 1385-1391 . https://doi.org/10.1302/0301-620X.100B10.BJJ-2017-1137.R3 Qvist, A H, Væsel, M T, Jensen, C M & Jensen, S L 2018, ' Plate fixation compared with nonoperative treatment of displaced midshaft clavicular fractures : A randomized clinical trial ', Bone and Joint Journal, vol. 100-B, no. 10, pp. 1385-1391 . https://doi.org/10.1302/0301-620X.100B10.BJJ-2017-1137.R3 |
| ISSN: | 2049-4408 |
| DOI: | 10.1302/0301-620X.100B10.BJJ-2017-1137.R3 |
| Popis: | AimsRecent studies of nonoperatively treated displaced midshaft clavicular fractures have shown a high incidence of nonunion and unsatisfactory functional outcome. Some studies have shown superior functional results and higher rates of healing following operative treatment. The aim of this study was to compare the outcome in these patients after nonoperative management with those treated with fixation.Patients and MethodsIn a multicentre, parallel randomized controlled trial, 146 adult patients with an acute displaced fracture of the midthird of the clavicle were randomized to either nonoperative treatment with a sling (71, 55 men and 16 women with a mean age of 39 years, 18 to 60) or fixation with a pre-contoured plate and locking screws (75, 64 men and 11 women with a mean age of 40 years, 18 to 60). Outcome was assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) Score, the Constant Score, and radiographical evidence of union. Patients were followed for one year.ResultsA total of 60 patients in the nonoperative group and 64 in the operative group completed one-year follow-up. At three months’ follow-up, both the median DASH (1.7 vs 8.3) and median Constant scores (97 vs 90) were significantly better in the operated group (both p = 0.02). After six months and one year, there was no difference in the median DASH or Constant scores. The rate of nonunion was lower in the operative group (2 vs 11 patients, p < 0.02). Nine patients in the nonoperative group underwent surgery for nonunion. The plate was subsequently removed in 16 patients (25%). One patient had a new fracture after removal of the plate and one underwent revision surgery for failure of fixation.ConclusionFixation of a displaced midshaft clavicular fracture using a pre-contoured plate and locking screws results in faster functional recovery and a higher rate of union compared with nonoperative management, but the function of the shoulder is equal after six months and at one year. Cite this article: Bone Joint J 2018;100-B:1385–91. |
| Databáze: | OpenAIRE |
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