Acute plate fixation of displaced midshaft clavicular fractures is not associated with earlier return of normal shoulder function when union is achieved
Aims: It is unclear whether acute plate fixation facilitates earlier return of normal shoulder function following a displaced mid-shaft clavicular fracture compared with nonoperative management when union occurs. The primary aim of this study was to establish whether acute plate fixation was associa...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
The British Editorial Society of Bone & Joint Surgery
2021-07-01
|
| Series: | Bone & Joint Open |
| Subjects: | |
| Online Access: | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.27.BJO-2021-0049.R1 |
| _version_ | 1818348209572937728 |
|---|---|
| author | Jamie A. Nicholson Nick D. Clement Andrew D. Clelland Deborah J. MacDonald A. Hamish R. W. Simpson C. Mike Robinson |
| author_facet | Jamie A. Nicholson Nick D. Clement Andrew D. Clelland Deborah J. MacDonald A. Hamish R. W. Simpson C. Mike Robinson |
| author_sort | Jamie A. Nicholson |
| collection | DOAJ |
| description | Aims: It is unclear whether acute plate fixation facilitates earlier return of normal shoulder function following a displaced mid-shaft clavicular fracture compared with nonoperative management when union occurs. The primary aim of this study was to establish whether acute plate fixation was associated with a greater return of normal shoulder function when compared with nonoperative management in patients who unite their fractures. The secondary aim was to investigate whether there were identifiable predictors associated with return of normal shoulder function in patients who achieve union with nonoperative management. Methods: Patient data from a randomized controlled trial were used to compare acute plate fixation with nonoperative management of united fractures. Return of shoulder function was based on the age- and sex-matched Disabilities of the Arm, Shoulder and Hand (DASH) scores for the cohort. Independent predictors of an early recovery of normal shoulder function were investigated using a separate prospective series of consecutive nonoperative displaced mid-shaft clavicular fractures recruited over a two-year period (aged ≥ 16 years). Patient demographics and functional recovery were assessed over the six months post-injury using a standardized protocol. Results: Data from the randomized controlled trial consisted of 86 patients who underwent operative fixation compared with 76 patients that united with nonoperative treatment. The recovery of normal shoulder function, as defined by a DASH score within the predicted 95% confidence interval for each respective patient, was similar between each group at six weeks (operative 26.7% vs nonoperative 25.0%, p = 0.800), three months (52.3% vs 44.2%, p = 0.768), and six months post-injury (86.0% vs 90.8%, p = 0.349). The mean DASH score and return to work were also comparable at each timepoint. In the prospective cohort, 86.5% (n = 173/200) achieved union by six months post-injury (follow-up rate 88.5%, n = 200/226). Regression analysis found that no specific patient, injury, or fracture predictor was associated with an early return of function at six or 12 weeks. Conclusion: Return of normal shoulder function was comparable between acute plate fixation and nonoperative management when union was achieved. One in two patients will have recovery of normal shoulder function at three months, increasing to nine out of ten patients at six months following injury when union occurs, irrespective of initial treatment. |
| first_indexed | 2024-12-13T17:46:25Z |
| format | Article |
| id | doaj.art-5587979184c44e9e86f54c3113e6ac31 |
| institution | Directory Open Access Journal |
| issn | 2633-1462 |
| language | English |
| last_indexed | 2024-12-13T17:46:25Z |
| publishDate | 2021-07-01 |
| publisher | The British Editorial Society of Bone & Joint Surgery |
| record_format | Article |
| series | Bone & Joint Open |
| spelling | doaj.art-5587979184c44e9e86f54c3113e6ac312022-12-21T23:36:37ZengThe British Editorial Society of Bone & Joint SurgeryBone & Joint Open2633-14622021-07-012752252910.1302/2633-1462.27.BJO-2021-0049.R1Acute plate fixation of displaced midshaft clavicular fractures is not associated with earlier return of normal shoulder function when union is achievedJamie A. Nicholson0Nick D. Clement1Andrew D. Clelland2Deborah J. MacDonald3A. Hamish R. W. Simpson4C. Mike Robinson5Department of Orthopaedic Surgery, University of Edinburgh, Edinburgh, UKDepartment of Orthopaedic Surgery, University of Edinburgh, Edinburgh, UKDepartment of Orthopaedic Surgery, University of Edinburgh, Edinburgh, UKDepartment of Orthopaedic Surgery, University of Edinburgh, Edinburgh, UKDepartment of Orthopaedic Surgery, University of Edinburgh, Edinburgh, UKDepartment of Orthopaedic Surgery, University of Edinburgh, Edinburgh, UKAims: It is unclear whether acute plate fixation facilitates earlier return of normal shoulder function following a displaced mid-shaft clavicular fracture compared with nonoperative management when union occurs. The primary aim of this study was to establish whether acute plate fixation was associated with a greater return of normal shoulder function when compared with nonoperative management in patients who unite their fractures. The secondary aim was to investigate whether there were identifiable predictors associated with return of normal shoulder function in patients who achieve union with nonoperative management. Methods: Patient data from a randomized controlled trial were used to compare acute plate fixation with nonoperative management of united fractures. Return of shoulder function was based on the age- and sex-matched Disabilities of the Arm, Shoulder and Hand (DASH) scores for the cohort. Independent predictors of an early recovery of normal shoulder function were investigated using a separate prospective series of consecutive nonoperative displaced mid-shaft clavicular fractures recruited over a two-year period (aged ≥ 16 years). Patient demographics and functional recovery were assessed over the six months post-injury using a standardized protocol. Results: Data from the randomized controlled trial consisted of 86 patients who underwent operative fixation compared with 76 patients that united with nonoperative treatment. The recovery of normal shoulder function, as defined by a DASH score within the predicted 95% confidence interval for each respective patient, was similar between each group at six weeks (operative 26.7% vs nonoperative 25.0%, p = 0.800), three months (52.3% vs 44.2%, p = 0.768), and six months post-injury (86.0% vs 90.8%, p = 0.349). The mean DASH score and return to work were also comparable at each timepoint. In the prospective cohort, 86.5% (n = 173/200) achieved union by six months post-injury (follow-up rate 88.5%, n = 200/226). Regression analysis found that no specific patient, injury, or fracture predictor was associated with an early return of function at six or 12 weeks. Conclusion: Return of normal shoulder function was comparable between acute plate fixation and nonoperative management when union was achieved. One in two patients will have recovery of normal shoulder function at three months, increasing to nine out of ten patients at six months following injury when union occurs, irrespective of initial treatment.https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.27.BJO-2021-0049.R1claviclerecoveryacute fixation |
| spellingShingle | Jamie A. Nicholson Nick D. Clement Andrew D. Clelland Deborah J. MacDonald A. Hamish R. W. Simpson C. Mike Robinson Acute plate fixation of displaced midshaft clavicular fractures is not associated with earlier return of normal shoulder function when union is achieved Bone & Joint Open clavicle recovery acute fixation |
| title | Acute plate fixation of displaced midshaft clavicular fractures is not associated with earlier return of normal shoulder function when union is achieved |
| title_full | Acute plate fixation of displaced midshaft clavicular fractures is not associated with earlier return of normal shoulder function when union is achieved |
| title_fullStr | Acute plate fixation of displaced midshaft clavicular fractures is not associated with earlier return of normal shoulder function when union is achieved |
| title_full_unstemmed | Acute plate fixation of displaced midshaft clavicular fractures is not associated with earlier return of normal shoulder function when union is achieved |
| title_short | Acute plate fixation of displaced midshaft clavicular fractures is not associated with earlier return of normal shoulder function when union is achieved |
| title_sort | acute plate fixation of displaced midshaft clavicular fractures is not associated with earlier return of normal shoulder function when union is achieved |
| topic | clavicle recovery acute fixation |
| url | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.27.BJO-2021-0049.R1 |
| work_keys_str_mv | AT jamieanicholson acuteplatefixationofdisplacedmidshaftclavicularfracturesisnotassociatedwithearlierreturnofnormalshoulderfunctionwhenunionisachieved AT nickdclement acuteplatefixationofdisplacedmidshaftclavicularfracturesisnotassociatedwithearlierreturnofnormalshoulderfunctionwhenunionisachieved AT andrewdclelland acuteplatefixationofdisplacedmidshaftclavicularfracturesisnotassociatedwithearlierreturnofnormalshoulderfunctionwhenunionisachieved AT deborahjmacdonald acuteplatefixationofdisplacedmidshaftclavicularfracturesisnotassociatedwithearlierreturnofnormalshoulderfunctionwhenunionisachieved AT ahamishrwsimpson acuteplatefixationofdisplacedmidshaftclavicularfracturesisnotassociatedwithearlierreturnofnormalshoulderfunctionwhenunionisachieved AT cmikerobinson acuteplatefixationofdisplacedmidshaftclavicularfracturesisnotassociatedwithearlierreturnofnormalshoulderfunctionwhenunionisachieved |