Operative treatment of displaced mid-shaft fractures of the clavicle reduces complications .
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OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2014;2(12):58 J Bone Joint Surg Am. 2012 Apr 18;94(8):675-84This meta-analysis identified 6 randomized clinical trials that compared operative and non-operative treatment of acute, displaced mid-shaft clavicle fractures. Results from this analysis indicate that there was a reduced complication rate in the operatively treated patients, with a decrease in non-unions and symptomatic malunions. A greater number of patients treated operatively were able to return to moderate activity 16 days following the injury, demonstrating that operative treatment provides superior early outcomes.
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Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
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Pourquoi cette étude était-elle nécessaire maintenant ?
The non-union rate of acute, displaced mid shaft fractures treated non-operatively has been reported to be as high as 15-20% and has detrimental effects on shoulder muscle strength. Based on these suboptimal outcomes for non-operative management, primary operative care has increased in popularity. The meta-analysis was conducted to evaluate treatment effects, potential harm and patient outcomes of these differing methods.
Quelle était la principale question de recherche ?
Which treatment, operative or nonoperative, provides the best clinical and functional results, and what are the complications associated with these procedures for patients presenting with displaced mid-shaft fracture of the clavicle?
- Non-union rate was significantly higher in the non-operative patients (29/200), than in the patients treated operatively (3/212) (p=0.001)
- The rate of patients with a symptomatic malunion was signficantly greater in the non-operative group (17/200), compared to the operative group (0/200) (p<0.001)
- The overall complication rate was significantly greater in the non-operative group (84/200), compared to the operative group (62/212) (p=0.0075)
- Three studies reported Constant Shoulder scores at one year weighted operative average was 94.3 compared to the non-operative average of 90.2
- DASH scores appeared to favor the operative group, but only reported numerically in 2 studies and graphically in one
- Early return to moderate activity on the 16th day was possible in 80% of the operatively treated patients, compared to 55% in the non-operative patients
De quoi dois-je me souvenir en priorité ?
The results from this meta-analysis indicate that operative treatment of acute, displaced mid-shaft fractures of the clavicle provides a reduced rate of complication with fewer patients suffering non-union or symptomatic malunions. A greater number of operatively treated patients also were able to return to function earlier than the conservative treatment.
Comment cela affectera-t-il les soins prodigués à mes patients ?
The results from this meta-analysis support the use of primary operative treatment of acute, displaced mid shaft fractures of the clavicle.
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