38823
document
Elastic stable intramedullary nailing versus nonoperative treatment of displaced midshaft clavicular fractures-a randomized , controlled , clinical trial . OBJECTIVE To compare elastic stable intramedullary nailing ( ESIN ) with nonoperative treatment of fully displaced midshaft clavicular fractures in adults . DESIGN The study was a randomized , controlled , clinical trial . SETTING Level 1 trauma center . PATIENTS AND METHODS Sixty patients between 18 and 65 years of age participated and completed the study . They were randomized to either operative or nonoperative treatment with a 2-year follow-up . INTERVENTION Thirty patients were treated with a simple shoulder sling and 30 patients with ESIN within 3 days after trauma . MAIN OUTCOME MEASUREMENT Complications after operative and nonoperative treatments , Disabilities of the Arm , Shoulder and Hand ( DASH ) score and Constant Shoulder Score for outcome measurement , and clavicular shortening . RESULTS Fracture union was achieved in all patients in the operative group , whereas nonunion was observed in 3 of 30 patients of the nonoperative group . Two symptomatic malunions required corrective osteotomy in the nonoperative group . Medial nail protrusion occurred in 7 cases in the operative group . Implant failure with revision surgery was necessary in 2 patients after an additional adequate trauma . DASH scores were lower in the operative group throughout the first 6 months and 2 years after trauma , with a significant difference during the first 18 weeks . Constant scores were significantly higher after 6 months and 2 years after intramedullary stabilization . Patients in the operative group showed a significant improvement of posttraumatic clavicular shortening ; they were also more satisfied with cosmetic appearance and overall outcome . CONCLUSIONS ESIN of displaced midshaft clavicular fractures resulted in a lower rate of nonunion and delayed union , a faster return to daily activities , and a better functional outcome . Clavicular shortening was significantly lower , and overall satisfaction was higher in the operative group .
38824
Intervention_Surgical
Elastic stable intramedullary nailing
38825
Intervention_Physical
nonoperative treatment
38826
Intervention_Surgical
elastic stable intramedullary nailing ( ESIN )
38827
Intervention_Control
nonoperative treatment
38828
Intervention_Physical
simple shoulder sling
38829
Intervention_Surgical
ESIN
38830
Outcome_Adverse-effects
Complications
38831
Outcome_Physical
Disabilities of the Arm
38832
Outcome_Physical
Shoulder and Hand ( DASH ) score
38833
Outcome_Physical
Constant Shoulder Score
38834
Outcome_Physical
clavicular shortening
38835
Outcome_Physical
Fracture union
38836
Outcome_Physical
nonunion
38837
Outcome_Other
symptomatic malunions
38838
Outcome_Other
Medial nail protrusion
38839
Outcome_Other
Implant failure with revision surgery
38840
Outcome_Physical
DASH scores
38841
Outcome_Physical
Constant scores
38842
Outcome_Physical
posttraumatic clavicular shortening
38843
Outcome_Other
satisfied
38844
Outcome_Mental
overall outcome
38845
Outcome_Other
nonunion
38846
Outcome_Other
delayed union
38847
Outcome_Other
return to daily activities
38848
Outcome_Other
functional outcome
38849
Outcome_Physical
Clavicular shortening
38850
Outcome_Other
overall satisfaction
38851
Participant_Condition
displaced midshaft clavicular fractures-a
38852
Participant_Condition
Level 1 trauma
38853
Participant_Sample-size
Sixty
38854
Participant_Age
18 and 65 years