Klavikula kırıklarında uygulanan tedavi yöntemlerinin klavikula uzunluğuna ve fonksiyonuna etkisi / The effects of various clavicle fracture treatments on length and functionality
AdvisorDOÇ. DR. TOLGA TÜZÜNER
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ABSTRACT Objectives: We evaluated the results of different treatment modalities in the treatment of clavicle fractures in adults. Methods: Forty patients (mean age 37 y) with closed clavicle fractures (30 midshaft, 9 distal and 1 proksimal) were identified. Twenty-seven patients were treated nonoperatively with a sling or figure of eight brace. Thirteen patients (11 midshaft and 2 distal) were treated operatively. The mean follow-up was 22 months( range, 6-48 months). Outcome measurement was complications, clavicular shortening, Constant shoulder score and Disability of the Arm, shoulder and Hand score (DASH). Clavicle length was measured on a computed tomography scan from the lateral end of the clavicle to the sternoclavicular joint. Clavicular shortening was calculated. Results: The avarage amount of clavicular shortening was measured 9,1±5,6 mm in nonoperative group and 3,2±3,7 mm in operative group in comparison to the uninjured side. The mean Constant score was 85±11,8 in nonoperative group and 87,5±7,8 in operative group. The mean DASH skore was calculated 6,3±7,1 in nonoperative group and 5±5,2 in operative group. In 30 patiensts, union was achieved. Malunion occured in six patients and nonunions occured in four patients ( 3 distal and 1 midshaft). There were no nonunions and malunions in operative group. Three patiens had a complication resulting from the surgical procedure. One patient had signs of brachial plexus lesion before surgery. Conclusion: Most midshaft clavicle fractures are effectively treated nonoperatively. the treatment protocol, therefore, is based more on patient comfort and need for return to activities than it is on rates of healing. Type 1 or 3 distal clavicle fractures are usually treated non-operatively by a simple sling. Type 2 fractures require surgery due to the high rate of non-union if conservative treatment is chosen.