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Year : 2017  |  Volume : 9  |  Issue : 2  |  Page : 88-92

Radiographic examination alone is not a good indication for surgical intervention of displace midshaft clavicle fractures

1 Department of Surgery, Meander Medical Centre, Amersfoort, The Netherlands
2 Emergency Department, Meander Medical Centre, Amersfoort, The Netherlands

Correspondence Address:
Dr. Denise J.C. Van Der Ven
Department of Surgery, Meander Medical Centre, PO Box 1502, 3800 BM, Amersfoort
The Netherlands
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jotr.jotr_13_17

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Background: Whether or not to operate midshaft clavicle fractures is mostly based on the amount of shortening and dislocation seen on the radiograph. Previous studies already suggested that radiographic shortening of midshaft clavicle fractures cannot be adequately determined with an anterior-posterior (AP) view alone. Therefore, before a therapeutic decision can be made based on radiographic examination; the observed fracture characteristics should be evaluated. Patients and Methods: Between January and July 2016, ninety patients were prospectively included in this study. When the classification of the fracture was confirmed with a standard AP radiographs, additional radiograph examinations were done; rhomboideus radiograph: a standard AP radiograph in military position. All patients were treated conservatively and followed for 24 weeks. Patients visited the outpatient clinic department after 1, 6, and 24 weeks. The study end-points were investigated (Disabilities of Arm, Shoulder, and Hand [DASH] and constant score) and radiographic combined with physical examinations were done. Results: On the standard AP radiographs in all occasions, radiographic shortening was seen. On the additional rhomboideus views, the degree of shortening was no longer observable. The mean constant and DASH score of 6 were 88.2 ± 11.8, respectively, 18.9 ± 14.4. After conservative treatment, nine patients developed a nonunion and were operated and excluded from this study. Conclusion: In conclusion, our results show that the degree of shortening and displacement cannot be adequately determined on standard 2-view radiographic series and that the correlation between permanent clavicle shortening and functional outcome can be questioned. Good functional outcomes were seen after conservative treatment. This indicates that the importance of shortening seen on a radiograph and the degree of permanent shortening in determining functional outcomes remains unclear.

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