Clavicle Fracture management - what to do
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clavical fractures are most controversial in case of treatment modalities in orthopaedics. it is one of the common fracture of all ages. so we are explaining our point what to do or not?
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Clavicle Fracture management - what to do
- 1. FRACTURE CLAVICLE MIDDLE THIRD DISPLACED CONSERVATIVE TREATMENT ?? By Dr. Ranveer Patel Orthopaedic Surgeon, Shreeji Orthopaedic Care
- 2. INTRODUCTION A clavicle fracture accounts for 3-6% of adult fractures. Fractures in the middle third represent 70 to 80% of all clavicular fractures. There is no consensus among orthopaedic surgeons regarding treatment for these fractures. Many supports conservative treatment even for displaced middle third clavicular fractures while other choose surgical management.
- 3. ..
- 4. OLD STUDIES According to Neer & Rowe’s large series non union rate is <1% in non operative cases non union rate is 4% in operated cases more recently studies have questioned 1. union rates 2. Functional recovery 3. Morbidity of malunions following to conservative treatment.
- 5. STUDY A meta analysis including 2144 cases have been done by Canadian orthopaedic association in which conservative : non union seen in 15% cases in displaced fractures surgery : non union seen in 2% cases in displaced fractures Finally it was concluded that 1. Operative complications were 37% while 2. Conservatively treated had 63%
- 6. WHAT CAMPBELL SAYS Non operative treatment is only a sling for comfort as figure of 8 bandages are inconvenient to the patient.
- 7. EXAMPLES OF CLAVICULAR FRACTURES
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- 10. EXAMPLES OF MALUNION & NON UNION
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- 13. INDICATIONS INDICATION FOR PRIMARY FIXATION OF MID SHAFT CLAVICULAR FRACTURES Absolute 1. Compound injuries, associated neurovascular injuries 2. When used as an “approach” for surgery. Relative 1. Displacement >2 cm 2. Shortening >2 cm 3. Comminution >3 fragments 4. Segmental fractures 5. Ipsilateral upper extremity fractures 6. Upper multiple rib fractures 7. Bilateral clavicular fractures
- 14. .. Fractures have been treated conservatively for many years by all of us & our predecessors. We don’t see “ those many “ complications. Why??
- 15. .. Conservative treatment is a “neglected” “entity”. Sling alone is no treatment. Proper, monitored use of “figure 8” bandages still give us good union rates. Many fractures, even comminuted unite well which may be initially displaced. Regular follow up preferably, weekly & adjusting sling, will go on long way in preventing complications.
- 16. .. Finally I ask myself which treatment I will prefer for myself in this scenario that should decide the outcome.
- 17. CONCLUSION No treatment is full proof. Treat with an open mind & proper supervision. Surgical treatment may be needed. (primary/late : personal choice) Disability/ discomfort of treatment & malunion VS cosmetic scar & other complications should decide the line of management.
- 18. THANK YOU