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American Family Physician Jul 2016Acute shoulder injuries in adults are often initially managed by family physicians. Common acute shoulder injuries include acromioclavicular joint injuries, clavicle... (Review)
Review
Acute shoulder injuries in adults are often initially managed by family physicians. Common acute shoulder injuries include acromioclavicular joint injuries, clavicle fractures, glenohumeral dislocations, proximal humerus fractures, and rotator cuff tears. Acromioclavicular joint injuries and clavicle fractures mostly occur in young adults as the result of a sports injury or direct trauma. Most nondisplaced or minimally displaced injuries can be treated conservatively. Treatment includes pain management, short-term use of a sling for comfort, and physical therapy as needed. Glenohumeral dislocations can result from contact sports, falls, bicycle accidents, and similar high-impact trauma. Patients will usually hold the affected arm in their contralateral hand and have pain with motion and decreased motion at the shoulder. Physical findings may include a palpable humeral head in the axilla or a dimple inferior to the acromion laterally. Reduction maneuvers usually require intra-articular lidocaine or intravenous analgesia. Proximal humerus fractures often occur in older patients after a low-energy fall. Radiography of the shoulder should include a true anteroposterior view of the glenoid, scapular Y view, and axillary view. Most of these fractures can be managed nonoperatively, using a sling, early range-of-motion exercises, and strength training. Rotator cuff tears can cause difficulty with overhead activities or pain that awakens the patient from sleep. On physical examination, patients may be unable to hold the affected arm in an elevated position. It is important to recognize the sometimes subtle signs and symptoms of acute shoulder injuries to ensure proper management and timely referral if necessary.
Topics: Acromioclavicular Joint; Clavicle; Conservative Treatment; Fractures, Bone; Humans; Immobilization; Joint Dislocations; Pain Management; Physical Examination; Physical Therapy Modalities; Radiography; Range of Motion, Articular; Rotator Cuff Injuries; Shoulder Dislocation; Shoulder Injuries
PubMed: 27419328
DOI: No ID Found -
Orthopaedics & Traumatology, Surgery &... Feb 2017Management of clavicle fracture has progressed over the last decade, notably with wider use of surgery in midshaft fracture, and new techniques for lateral fracture.... (Review)
Review
Management of clavicle fracture has progressed over the last decade, notably with wider use of surgery in midshaft fracture, and new techniques for lateral fracture. Midshaft clavicle fracture treatment needs to be personalized and adapted to the patient's activity level. Whichever the segment involved, treatment for non-displaced fracture is functional; elbow-to-body sling immobilization seems the best tolerated. Apart from regular surgical indications (shoulder impaction, floating shoulder, open fracture or fracture with neurovascular complications), surgery is recommended in case of bone shortening exceeding 1.5cm in young active patients. The technique needs to take account of clavicle anatomy: notably periosteal vascularization in midshaft fracture and acromioclavicular ligament integrity and location in case of lateral fracture. Plate osteosynthesis should take account of bone diameter and 3D curvature; intramedullary fixation should take account of intramedullary canal morphology. Although iatrogenic vascular complications are rare, vessel relations and variants need to be known, especially in the medial end of the clavicle and midshaft. Lateral segment fractures are a particular entity. Large-scale randomized studies are needed to assess indications and results for the various possible internal fixation techniques: isolated or associated to ligament reconstruction, rigid or flexible, and open or arthroscopic.
Topics: Bone Plates; Clavicle; Decision Support Techniques; Fracture Fixation, Internal; Fractures, Bone; Humans
PubMed: 28043849
DOI: 10.1016/j.otsr.2016.11.007 -
Clinics in Orthopedic Surgery Jun 2020Distal clavicle fractures are less common than mid-shaft fractures in adults and there is no consensus on the best classification system or the ideal treatment approach... (Review)
Review
Distal clavicle fractures are less common than mid-shaft fractures in adults and there is no consensus on the best classification system or the ideal treatment approach considering that high nonunion rates have been reported. Although there are numerous treatment options for distal clavicle fractures, a gold standard treatment has not yet been established. Each surgical technique has its pros and cons. In this review article, we provide an overview of classification systems and treatment methods for distal clavicle fractures.
Topics: Clavicle; Fracture Fixation, Internal; Fractures, Bone; Humans; Internal Fixators
PubMed: 32489533
DOI: 10.4055/cios20010 -
TheScientificWorldJournal Apr 2009Effective brachial plexus blockade requires a thorough understanding of the anatomy of the plexus, as well as an appreciation of anatomic variations that may occur. This... (Review)
Review
Effective brachial plexus blockade requires a thorough understanding of the anatomy of the plexus, as well as an appreciation of anatomic variations that may occur. This review summarizes relevant anatomy of the plexus, along with variations and anomalies that may affect nerve blocks conducted at these levels. The Medline, Cochrane Library, and PubMed electronic databases were searched in order to compile reports related to the anatomy of the brachial plexus using the following free terms: "brachial plexus", "median nerve", "ulnar nerve", "radial nerve", "axillary nerve", and "musculocutanous nerve". Each of these was then paired with the MESH terms "anatomy", "nerve block", "anomaly", "variation", and "ultrasound". Resulting articles were hand searched for additional relevant literature. A total of 68 searches were conducted, with a total of 377 possible articles for inclusion. Of these, 57 were found to provide substantive information for this review. The normal anatomy of the brachial plexus is briefly reviewed, with an emphasis on those features revealed by use of imaging technologies. Anomalies of the anatomy that might affect the conduct of the various brachial plexus blocks are noted. Brachial plexus blockade has been effectively utilized as a component of anesthesia for upper extremity surgery for a century. Over that period, our understanding of anatomy and its variations has improved significantly. The ability to explore anatomy at the bedside, with real-time ultrasonography, has improved our appreciation of brachial plexus anatomy as well.
Topics: Anesthesia; Brachial Plexus; Clavicle; Female; Humans; Male; Nerve Block; Ultrasonography
PubMed: 19412559
DOI: 10.1100/tsw.2009.39 -
Medicine May 2019There is no consensus concerning whether surgery or non-surgical treatment is preferred for displaced midshaft clavicle fracture. We performed a meta-analysis of... (Meta-Analysis)
Meta-Analysis
BACKGROUNDS
There is no consensus concerning whether surgery or non-surgical treatment is preferred for displaced midshaft clavicle fracture. We performed a meta-analysis of randomized controlled trials (RCTs) to compare healing effects and cosmetic results between surgery and non-surgery.
METHODS
We retrieved RCTs regarding open reduction and plate fixation (ORPF) and non-surgical method for the treatment of displaced midshaft clavicle fracture published before June 2018 from PubMed, EMBASE and Cochrane Library. The difference between the two treatments was comparatively discussed in aspects of nonunion, malunion, functional outcome, cosmetic results, and complications.
RESULTS
Nine RCTs were included. The results showed that ORPF is advantageous over the non-surgical treatment in terms of nonunion rate (RR, 0.11[95%CI, 0.06-0.23]), malunion rate (RR, 0.16[95%CI, 0.08-0.35]), appearance dissatisfaction rate (RR, 0.35[95%CI 0.23-0.55]), and shoulder appearance defect rate (RR, 0.06[95%CI, 0.02-0.17]). The non-surgical treatment showed lower rate of complication (RR, 1.60[95%CI, 1.02-2.53]) and no significant differences were found between the 2 treatment groups with respect to functional outcome (disabilities of the arm, shoulder and hand (DASH) questionnaire score) (MD, -4.17[95%CI, -9.35 to 1.01]).
CONCLUSIONS
This meta-analysis updated previous results. The current findings suggested that ORPF yielded better efficacy than conservation treatment for displaced midshaft clavicle fracture from perspectives of fracture healing and appearance.
Topics: Bone Plates; Clavicle; Conservative Treatment; Fractures, Bone; Fractures, Ununited; Humans; Open Fracture Reduction; Orthopedic Fixation Devices; Physical Therapy Modalities; Randomized Controlled Trials as Topic; Range of Motion, Articular
PubMed: 31096481
DOI: 10.1097/MD.0000000000015638 -
Medicina (Kaunas, Lithuania) Jul 2022Nearly 1% of all bone cancers are primary clavicular tumors and because of their rarity, treating clinicians are unfamiliar with their diagnosis, classification,... (Review)
Review
Nearly 1% of all bone cancers are primary clavicular tumors and because of their rarity, treating clinicians are unfamiliar with their diagnosis, classification, treatment options, and prognosis. In terms of preserving function and avoiding complications, clavicle reconstruction seems logical; however, further studies are needed to support this measure. Reconstruction techniques are difficult taking into account the anatomical structures surrounding the clavicle. When chest wall defects are present, a multidisciplinary team, including an orthopedist and thoracic and plastic surgeons, is of paramount importance for optimal surgical management. Malignant clavicle tumors may include primary and secondary malignancies and neighboring tumors with clavicular invasion. Surgical resection of complex thoracic tumors invading the clavicles can result in larger defects, requiring chest wall reconstruction, which is a substantial challenge for surgeons. Correct diagnosis with proper preoperative planning is essential for limiting complications. Post-resection reconstruction of the partial or total claviculectomy is important for several reasons, including maintaining the biomechanics of the scapular girdle, protecting the vessels and nerves, reducing pain, and maintaining the anatomical appearance of the shoulder. The chest wall resection and reconstruction techniques can involve either partial or full chest wall thickness, influencing the choice of reconstructive technique and materials. In the present paper, we aimed to synthesize the anatomical and physiopathological aspects and the small number of therapeutic surgical options that are currently available for these patients.
Topics: Bone Neoplasms; Clavicle; Humans; Prognosis; Plastic Surgery Procedures; Thoracic Wall
PubMed: 35888630
DOI: 10.3390/medicina58070910 -
American Family Physician Jan 2008Clavicle fractures are most common in children and young adults, typically occurring in persons younger than 25 years. Its superficial location, its thin midshaft, and... (Review)
Review
Clavicle fractures are most common in children and young adults, typically occurring in persons younger than 25 years. Its superficial location, its thin midshaft, and the forces transmitted across it make the clavicle a common site for injury. The most common mechanism of injury is a forceful fall with the arm at the side, which commonly occurs during contact sports. Diagnosis can often be made by the history and physical examination, although appropriate radiography should be used to confirm the diagnosis and guide treatment options. Most clavicle fractures occur in the midshaft and can be treated nonoperatively. A prominent callus is common in children, and parents may require reassurance. If a child has no history of trauma, then malignancy, rickets, and physical abuse should be considered. Surgery is an option in fractures that have high potential for nonunion (e.g., displaced or communited fractures, fractures with more than 15 to 20 mm clavicle shortening). Distal fractures are classified based on the relationship to the coracoclavicular ligaments, which determines the likelihood of displacement. Most distal fractures can also be treated nonoperatively; however, certain factors must be considered in children.
Topics: Adult; Child; Clavicle; Fractures, Bone; Humans; Prognosis; Risk Factors
PubMed: 18236824
DOI: No ID Found -
Injury Oct 2023Depending on the severity of the injury and the involvement of the soft tissue envelope, clavicle fractures can be treated operatively or non-operatively. In the past,... (Review)
Review
Depending on the severity of the injury and the involvement of the soft tissue envelope, clavicle fractures can be treated operatively or non-operatively. In the past, displaced fractures of the clavicle shaft in adults have been treated non-operatively. However, the rate of nonunion following non-operative treatment seems to be higher than previously reported. In addition, publications reporting better functional outcomes following operative treatment are increasing. In recent years this has led to a paradigm shift towards an increase of operative fracture treatment. The aim of this review article was to summarize the currently available evidence on the treatment of clavicle fractures. Classifications, indications, and treatment options for different fracture patterns of the medial, midshaft, and lateral clavicles are presented and discussed.
Topics: Adult; Humans; Clavicle; Fracture Fixation, Internal; Treatment Outcome; Bone Plates; Fractures, Bone
PubMed: 37217399
DOI: 10.1016/j.injury.2023.05.049 -
Journal of Orthopaedic Surgery (Hong... Apr 2015
Topics: Acromioclavicular Joint; Athletic Injuries; Clavicle; Female; Humans; Joint Dislocations; Male
PubMed: 26108130
DOI: 10.1177/230949901502300131 -
Chinese Medical Journal Nov 2015Through reviewing the relevant literature from the past decades, to summarize the assessment and management of fractures of the clavicle, and provide an overview of the... (Review)
Review
OBJECTIVE
Through reviewing the relevant literature from the past decades, to summarize the assessment and management of fractures of the clavicle, and provide an overview of the clinical results of a range of treatment options.
DATA SOURCES
The data analyzed in this review are mainly from articles included in PubMed and EMBASE, published from 1960 to 2015.
STUDY SELECTION
Studies involving assessment of fractures of the clavicle were reviewed. Further literatures were gathered regarding the conservative and surgical treatment of these fractures, including the methods of fixation and the surgical approaches used. Both conservative and surgical treatments were then compared and contrasted.
RESULTS
Through retrieving and reading the abstract, a total of 42 representative articles were selected, which covered all aspects of the conservative treatment and surgical treatment, and compared the advantages and disadvantages of different treatment options.
CONCLUSIONS
Although the majority of recent data suggest that surgery may be more appropriate as it improves functional outcome and reduces the risk of complications, we recommend that the treatment should be individually assessed.
Topics: Bone Plates; Clavicle; Fracture Fixation; Fracture Fixation, Internal; Fractures, Bone; Humans
PubMed: 26521795
DOI: 10.4103/0366-6999.168068