Pradel S*, Bauzou F, Coulomb R, Kouyoumdjian P and Mares O
Department of Orthopedic and Traumatologic Surgery, University Hospital Center of Nimes, FranceFulltext PDF
Introduction: Mediolateral shortening of the clavicle is a risk of orthopedic treatment of a diaphyseal clavicle fracture. This shortening may cause scapular dyskinesia and a negative functional impact. Many studies recommend surgical treatment if the shortening is greater than 1.5 cm. We wanted to retrospectively evaluate the impact of this shortening between a groups of patients treated orthopedically vs. a group of patients treated by plate osteosynthesis. Materials and Methods: This is a retrospective, comparative case-control study. The evaluation was performed by an independent evaluator. The measurement of the length of each clavicle was performed clinically with ultrasound and on radiological images. A ratio was calculated between the length of the pathological side and the healthy side. The functional impact was evaluated with Quick DASH Score. Scapular dyskinesia was assessed on a global antepulsion movement. We found 119 cases with a 6-year follow-up. We were able to clinically review 20 patients treated orthopedically (by eight Americans) and 20 patients who had been osteosynthesized by locked plate (Stryker®), with a mean follow-up of 37.5 months. Results: The quick dash score was significantly higher in the orthopedic group compared with the osteosynthesis group (11.363 [0-50] vs. 2.045 [0-11.36] or p=0.0092). The Pearson correlation test between the percentage of shortening and the Quick-DASH was -0.3956 [IC 95% -0.6295; -0.0959] with p=0.012. The clavicle length ratio was statistically different in the operated and non-operated groups (+2.9% vs. -8.2% with p<0.0001). The number of patients with shoulder dyskinesia was significantly higher in the orthopedic group (10 vs. 3, p=0.018). The relationships between clinical and radiological measurements showed a strong correlation. Discussion: Numerous studies report the importance of managing diaphyseal clavicle fractures surgically if the shortening is greater than 1.5 cm. Our study shows that a shortening of 8.2% leads to long-term functional impairment. Conclusion: Therefore, it seems legitimate to propose a surgical approach of osteosynthesis by locked plate in patients with a clinical shortening of more than 8%. Restoration of the length of the scapuloclavicular triangle ensures restoration of shoulder kinetics.
Clavicle fracture; Scapular dyskinesis; Ultrasound; Shortening
Pradel S, Bauzou F, Coulomb R, Kouyoumdjian P, Mares O. Does Scapulothoracic Triangle Imbalance Following Clavicle Fracture In luence Functional Outcome after One Year Follow-Up? Retrospective Series of 40 Cases Comparing Orthopedic and Osteosynthesis Treatment. Ann Orthop Musculoskelet Disord. 2021; 4(3): 1035.