Assessment of Clavicular Shortening in Displaced Midshaft Clavicular Fractures Treated by Nonoperative Method, Plating, and Elastic Nailing: Comparative Functional Analysis—A Case Series
Introduction: Clavicular shortening can occur after midshaft clavicular fractures, and its impact on functional outcomes has been a subject of interest in orthopedic research. Some studies have reported that clavicular shortening is associated with worse functional effects, while others have not fou...
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Jaypee Brothers Medical Publisher
2024-01-01
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| Series: | Journal of Orthopedics and Joint Surgery |
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| Online Access: | https://www.jojs.in/doi/JOJS/pdf/10.5005/jojs-10079-1133 |
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| author | Makesh Ram Sriraghavan Poornima Kumararaja Balakannan Jeyabalan |
| author_facet | Makesh Ram Sriraghavan Poornima Kumararaja Balakannan Jeyabalan |
| author_sort | Makesh Ram Sriraghavan |
| collection | DOAJ |
| description | Introduction: Clavicular shortening can occur after midshaft clavicular fractures, and its impact on functional outcomes has been a subject of interest in orthopedic research. Some studies have reported that clavicular shortening is associated with worse functional effects, while others have not found a significant correlation. Our series aims to equate the outcomes between nonoperative management and surgical interventions using two different techniques—plating and elastic nailing.
Materials and methods: A cohort of 60 patients with displaced middle-third fracture of clavicle managed by three procedures—nonoperative, elastic nailing, and plating each of 20 cases, respectively were reviewed after a mean follow-up of 2 years. The primary outcome variables were assessed.
Results: The mean shortening observed was 1 ± 0.75 cm. Patients with clavicular length shortening of >2 cm had distinct differences in their clinical outcomes compared to patients with less severe shortening (<1 cm), as it's associated with discomfort or pain, which can negatively impact a patient's quality of life and functional ability. Severe shortening, greater than 2 cm, can result in functional impairment similar to nonunion. Those cases operated by elastic nailing have shortening of <0.5 mm, with plating of <0.75 cm.
Conclusion: When the clavicle is shortened, it can alter the balance of muscles and ligaments around the shoulder joint, leading to functional impairment. The treatment choice is not solely based on fracture configuration but also considers other factors, including the patient's age, activity level, and the surgeon's judgment. There can be variations in the threshold for surgery among different surgeons and institutions. Elastic nailing to be used in displaced midshaft fractures and comminuted fractures plating is the ideal choice. |
| format | Article |
| id | doaj-art-8fb89199de9445b18c060383480176de |
| institution | Kabale University |
| issn | 2582-7863 |
| language | English |
| publishDate | 2024-01-01 |
| publisher | Jaypee Brothers Medical Publisher |
| record_format | Article |
| series | Journal of Orthopedics and Joint Surgery |
| spelling | doaj-art-8fb89199de9445b18c060383480176de2025-02-07T11:17:47ZengJaypee Brothers Medical PublisherJournal of Orthopedics and Joint Surgery2582-78632024-01-0161556010.5005/jojs-10079-113310Assessment of Clavicular Shortening in Displaced Midshaft Clavicular Fractures Treated by Nonoperative Method, Plating, and Elastic Nailing: Comparative Functional Analysis—A Case SeriesMakesh Ram Sriraghavan0https://orcid.org/0000-0001-9161-1672Poornima Kumararaja1https://orcid.org/0009-0008-5139-8131Balakannan Jeyabalan2https://orcid.org/0009-0004-4578-0255Makesh Ram Sriraghavan, Department of Orthopaedics, Government Thoothukudi Medical College Hospital, Thoothukudi, Tamil Nadu, India, Phone: +91 9841617765Department of Pathology, ACS Medical College and Hospital, Chennai, Tamil Nadu, IndiaDepartment of Orthopaedics, Government Thoothukudi Medical College Hospital, Thoothukudi, Tamil Nadu, IndiaIntroduction: Clavicular shortening can occur after midshaft clavicular fractures, and its impact on functional outcomes has been a subject of interest in orthopedic research. Some studies have reported that clavicular shortening is associated with worse functional effects, while others have not found a significant correlation. Our series aims to equate the outcomes between nonoperative management and surgical interventions using two different techniques—plating and elastic nailing. Materials and methods: A cohort of 60 patients with displaced middle-third fracture of clavicle managed by three procedures—nonoperative, elastic nailing, and plating each of 20 cases, respectively were reviewed after a mean follow-up of 2 years. The primary outcome variables were assessed. Results: The mean shortening observed was 1 ± 0.75 cm. Patients with clavicular length shortening of >2 cm had distinct differences in their clinical outcomes compared to patients with less severe shortening (<1 cm), as it's associated with discomfort or pain, which can negatively impact a patient's quality of life and functional ability. Severe shortening, greater than 2 cm, can result in functional impairment similar to nonunion. Those cases operated by elastic nailing have shortening of <0.5 mm, with plating of <0.75 cm. Conclusion: When the clavicle is shortened, it can alter the balance of muscles and ligaments around the shoulder joint, leading to functional impairment. The treatment choice is not solely based on fracture configuration but also considers other factors, including the patient's age, activity level, and the surgeon's judgment. There can be variations in the threshold for surgery among different surgeons and institutions. Elastic nailing to be used in displaced midshaft fractures and comminuted fractures plating is the ideal choice.https://www.jojs.in/doi/JOJS/pdf/10.5005/jojs-10079-1133case reportclavicle fractureconstant–murley scoreelastic nailfunctional outcomenonoperative method |
| spellingShingle | Makesh Ram Sriraghavan Poornima Kumararaja Balakannan Jeyabalan Assessment of Clavicular Shortening in Displaced Midshaft Clavicular Fractures Treated by Nonoperative Method, Plating, and Elastic Nailing: Comparative Functional Analysis—A Case Series Journal of Orthopedics and Joint Surgery case report clavicle fracture constant–murley score elastic nail functional outcome nonoperative method |
| title | Assessment of Clavicular Shortening in Displaced Midshaft Clavicular Fractures Treated by Nonoperative Method, Plating, and Elastic Nailing: Comparative Functional Analysis—A Case Series |
| title_full | Assessment of Clavicular Shortening in Displaced Midshaft Clavicular Fractures Treated by Nonoperative Method, Plating, and Elastic Nailing: Comparative Functional Analysis—A Case Series |
| title_fullStr | Assessment of Clavicular Shortening in Displaced Midshaft Clavicular Fractures Treated by Nonoperative Method, Plating, and Elastic Nailing: Comparative Functional Analysis—A Case Series |
| title_full_unstemmed | Assessment of Clavicular Shortening in Displaced Midshaft Clavicular Fractures Treated by Nonoperative Method, Plating, and Elastic Nailing: Comparative Functional Analysis—A Case Series |
| title_short | Assessment of Clavicular Shortening in Displaced Midshaft Clavicular Fractures Treated by Nonoperative Method, Plating, and Elastic Nailing: Comparative Functional Analysis—A Case Series |
| title_sort | assessment of clavicular shortening in displaced midshaft clavicular fractures treated by nonoperative method plating and elastic nailing comparative functional analysis a case series |
| topic | case report clavicle fracture constant–murley score elastic nail functional outcome nonoperative method |
| url | https://www.jojs.in/doi/JOJS/pdf/10.5005/jojs-10079-1133 |
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