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VOLUME 12 , ISSUE 3 ( November, 2017 ) > List of Articles

Original Article

Midshaft clavicle fractures treatment: threaded Kirschner wire versus conservative approach

Valentino Coppa, Luca Dei Giudici, Stefano Cecconi, Mario Marinelli, Antonio Gigante

Keywords : Clavicle fracture, Midshaft, Conservative treatment, Clavicle pinning, Mini invasive

Citation Information : Coppa V, Dei Giudici L, Cecconi S, Marinelli M, Gigante A. Midshaft clavicle fractures treatment: threaded Kirschner wire versus conservative approach. 2017; 12 (3):141-150.

DOI: 10.1007/s11751-017-0293-7

License: CC BY-NC-SA 4.0

Published Online: 01-12-2015

Copyright Statement:  Copyright © 2017; The Author(s).


Abstract

Clavicle fractures are common, accounting for 2.6 to 10% of all fractures. Treatment of these fractures is usually non-surgical. Recent evidence, however, reveals that the final result of non-surgically midshaft clavicular fractures, particularly those with quite large displacements or shortening, is not like that which was previously thought. This study evaluated retrospectively all patients presented with a clavicle fracture at Emergency Department of our Institution, between January 2006 and December 2011. Fractures were classified according to Allman's radiographic classification system, modified by Nordqvist and Petersson. Patients were distinguished into two groups: one that underwent conservative treatment with a “figure-of-8” orthosis and one that underwent surgery with reduction in fracture and fixation with intramedullary threaded Kirschner wire. Pin removal was performed after 4 weeks of rest in Gilchrist bandage, after clinical and radiographic evaluation demonstrating the bone healing. The QuickDASH score and the Constant Murley Shoulder Score were used to evaluate the clinical outcomes. The radiographic outcome was evaluated at 1 and 6 months of follow-up. Database review provided a final cohort of 58 patients, with similar demographic features. There was no significant difference in qDASH and CS between the two groups. The results of qDASH and CS evaluated in function of the radiographic outcome show a statistically significant correlation between the worst qDASH and CS results and the grade of malunion in both groups. In particular, we have found unsatisfactory results when final shortening of the clavicle was 20 mm or more. On radiographic evaluation, surgical treatment demonstrated a greater efficacy in reducing initial shortening of the fractured bone; this is in opposition to conservative treatment that results very often in malunion, shortening, anatomic alterations and loss of functionality. The use of intramedullary threaded Kirschner wire for fixation of midshaft clavicle fractures is a safe procedure and is recommended in case of shortening greater than 2 cm in high-function-demand patients.

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  1. O'Neill BJ, Hirpara KM, O'Briain D, McGarr C, Kaar TK (2011) Clavicle fractures: a comparison of five classification systems and their relationship to treatment outcomes. Int Orthop 35:909-914. doi:10.1007/s00264-010-1151-0
  2. Stanley D, Trowbridge EA, Norris SH (1988) The mechanism of clavicular fracture. A clinical and biomechanical analysis. J Bone Joint Surg Br 70:461-464
  3. Xu JJ, Xu L, Xu W, Gu Y, Xu JJ (2014) Operative versus nonoperative treatment in the management of midshaft clavicular fractures: ameta-analysis of randomized controlled trials. J Shoulder Elb Surg 23:173-181. doi:10.1016/j.jse.2013.06.025
  4. Hübner EJ, Hausschild O, Südkamp NP, Strohm PC (2011) Clavicle fractures—is there a standard treatment? Acta Chir Orthop Traumatol Cech 78:288-296
  5. Neer CS (1960) Nonunion of the clavicle. J Am Med Assoc 172:1006-1011
  6. Rowe CR (1968) An atlas of anatomy and treatment of midclavicular fractures. Clin Orthop Relat Res 58:29-42
  7. Hill JM, McGuire MH, Crosby LA (1997) Closed treatment of displaced middle-third fractures of the clavicle gives poor results. J Bone Jt Surg 79:537-539. doi:10.1302/0301-620X.79B4.7529
  8. Narsaria N, Singh AK, Arun GR, Seth RRS (2014) Surgical fixation of displaced midshaft clavicle fractures: elastic intramedullary nailing versus precontoured plating. J Orthop Traumatol 15:165-171. doi:10.1007/s10195-014-0298-7
  9. McKee MD, Pedersen EM, Jones C, Stephen DJG, Kreder HJ, Schemitsch EH, Wild LM, Potter J (2006) Deficits following nonoperative treatment of displaced midshaft clavicular fractures. J Bone Joint Surg Am 88:35-40. doi:10.2106/JBJS.D.02795
  10. Nordqvist A, Petersson CJ, Redlund-Johnell I (1998) Mid-clavicle fractures in adults: end result study after conservative treatment. J Orthop Trauma 12:572-576
  11. Nowak J, Holgersson M, Larsson S (2005) Sequelae from clavicular fractures are common A prospective study of 222 patients. Acta Orthop 76:496-502. doi:10.1080/17453670510041475
  12. Ledger M, Leeks N, Ackland T, Wang A (2005) Short malunions of the clavicle: an anatomic and functional study. J Shoulder Elb Surg 14:349-354. doi:10.1016/j.jse.2004.09.011
  13. Wick M, Müller EJ, Kollig E, Muhr G (2001) Midshaft fractures of the clavicle with a shortening of more than 2 cm predispose to nonunion. Arch Orthop Trauma Surg 121:207-211. doi:10.1007/s004020000202
  14. Nowak J, Holgersson M, Larsson S (2004) Can we predict longterm sequelae after fractures of the clavicle based on initial findings? A prospective study with nine to ten years of follow-up. J Shoulder Elb Surg 13:479-486. doi:10.1016/j.jse.2004.01.026
  15. van der Meijden OA, Gaskill TR, Millett PJ (2012) Treatment of clavicle fractures: current concepts review. J Shoulder Elb Surg 21:423-429. doi:10.1016/j.jse.2011.08.053
  16. Lenza M, Belloti JC, Gomes Dos Santos JB, Matsumoto MH, Faloppa F (2009) Surgical interventions for treating acute fractures or non-union of the middle third of the clavicle. Cochrane Database Syst Rev. doi:10.1002/14651858.CD007428.pub2
  17. Postacchini F, Gumina S, De Santis P, Albo F (2002) Epidemiology of clavicle fractures. J Shoulder Elbow Surg 11:452-456
  18. Allman FL (1967) Fractures and ligamentous injuries of the clavicle and its articulation. J Bone Joint Surg Am 49:774-784
  19. Nordqvist A, Petersson C (1994) The incidence of fractures of the clavicle. Clin Orthop Relat Res 300:127-132
  20. Geckeler EO (1951) Fractures of the clavicle in adults. Am J Surg 81:333-335. doi:10.1016/0002-9610(51)90237-1
  21. Gummesson C, Ward MM, Atroshi I (2006) The shortened disabilities of the arm, shoulder and hand questionnaire (Quick- DASH): validity and reliability based on responses within the full-length DASH. BMC Musculoskelet Disord 7:44. doi:10.1186/1471-2474-7-44
  22. Mintken PE, Glynn P, Cleland JA, Mintken PE, Glynn P, Cleland JA (2009) Psychometric properties of the shortened disabilities of the Arm, Shoulder, and Hand Questionnaire (QuickDASH) and Numeric Pain Rating Scale in patients with shoulder pain. J Shoulder Elbow Surg 18:920-926. doi:10.1016/j.jse.2008.12.015
  23. Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 160-4
  24. Holmgren T, Oberg B, Adolfsson L, Björnsson Hallgren H, Johansson K (2014) Minimal important changes in the Constant- Murley score in patients with subacromial pain. J Shoulder Elb Surg. doi:10.1016/j.jse.2014.01.014
  25. Smekal V, Deml C, Irenberger A, Niederwanger C, Lutz M, Blauth M, Krappinger D (2008) Length determination in midshaft clavicle fractures: validation of measurement. J Orthop Trauma 22:458-462. doi:10.1097/BOT.0b013e318178d97d
  26. Smekal V, Irenberger A, Struve P, Wambacher M, Krappinger D, Kralinger FS (2009) Elastic stable intramedullary nailing versus nonoperative treatment of displaced midshaft clavicular fracturesa randomized, controlled, clinical trial. J Orthop Trauma 23:106-112. doi:10.1097/BOT.0b013e318190cf88
  27. Society COT (2007) Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial. J bone Jt Surg Am 89:1-10. doi:10.2106/JBJS.F.00020
  28. Lenza M, Buchbinder R, Johnston R, Belloti J, Faloppa F (2013) Surgical versus conservative interventions for treating fractures of the middle third of the clavicle (Review). Cochrane database Syst Rev Online. doi:10.1002/14651858.CD009363.pub2. Copyright
  29. Smekal V, Irenberger A, El Attal R, Oberladstaetter J, Krappinger D, Kralinger F (2011) Elastic stable intramedullary nailing is best for mid-shaft clavicular fractures without comminution: results in 60 patients. Injury 42:324-329. doi:10.1016/j.injury.2010.02.033
  30. Ristevski B, Hall JA, Pearce D, Potter J, Farrugia M, McKee MD (2013) The radiographic quantification of scapular malalignment after malunion of displaced clavicular shaft fractures. J Shoulder Elb Surg 22:240-246. doi:10.1016/j.jse.2012.04.011
  31. Lazarides S, Zafiropoulos G (2006) Conservative treatment of fractures at the middle third of the clavicle: the relevance of shortening and clinical outcome. J Shoulder Elb Surg 15:191-194. doi:10.1016/j.jse.2005.08.007
  32. Oroko PK, Buchan M, Winkler A, Kelly IG (1999) Does shortening matter after clavicular fractures? Bull Hosp Jt Dis 58:6-8
  33. Rasmussen JV, Jensen SL, Petersen JB, Falstie-Jensen T, Lausten G, Olsen BS (2011) A retrospective study of the association between shortening of the clavicle after fracture and the clinical outcome in 136 patients. Injury 42:414-417. doi:10.1016/j.injury.2010.11.061
  34. McKee MD, Wild LM, Schemitsch EH (2003) Midshaft malunions of the clavicle. J Bone Joint Surg Am 85-A:790-797
  35. Naveen BM, Joshi GR, Harikrishnan B (2017) Management of mid-shaft clavicular fractures: comparison between non-operative treatment and plate fixation in 60 patients. Strateg Trauma Limb Reconstr 12:11-18. doi:10.1007/s11751-016-0272-4
  36. Andermahr J, Jubel A, Elsner A, Johann J, Prokop A, Rehm KE, Koebke J (2007) Anatomy of the clavicle and the intramedullary nailing of midclavicular fractures. Clin Anat 20:48-56. doi:10.1002/ca.20269
  37. Kettler M, Schieker M, Braunstein V, König M, Mutschler W (2007) Flexible intramedullary nailing for stabilization of displaced midshaft clavicle fractures: technique and results in 87 patients. Acta Orthop 78:424-429. doi:10.1080/17453670710014022
  38. Wijdicks FJG, Houwert RM, Millett PJ, Verleisdonk EJJM, Van Der Meijden OAJ (2013) Systematic review of complications after intramedullary fixation for displaced midshaft clavicle fractures. Can J Surg 56:58-64. doi:10.1503/cjs.029511
  39. Frigg A, Rillmann P, Perren T, Gerber M, Ryf C (2009) Intramedullary nailing of clavicular midshaft fractures with the titanium elastic nail: problems and complications. Am J Sports Med 37:352-359. doi:10.1177/0363546508328103
  40. Golish SR, Oliviero JA, Francke EI, Miller MD (2008) A biomechanical study of plate versus intramedullary devices for midshaft clavicle fixation. J Orthop Surg Res 3:28. doi:10.1186/1749-799X-3-28
  41. Omid R, Kidd C, Yi A, Villacis D, White E (2016) Measurement of clavicle fracture shortening using computed tomography and chest radiography. Clin Orthop Surg 8:367-372. doi:10.4055/cios.2016.8.4.367
  42. Archer LA, Hunt S, Squire D, Moores C, Stone C, O'Dea F, Furey A (2016) Plain film measurement error in acute displaced midshaft clavicle fractures. Can J Surg 59:311-316. doi:10.1503/cjs.0
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