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Superior plating versus anteroinferior plating for treating middle-third clavicle fractures.

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Title: Superior plating versus anteroinferior plating for treating middle-third clavicle fractures.
Alternate Title: Fijación con placa superior versus fijación con placa antero-inferior para el tratamiento de fracturas del tercio medio de la clavícula.
Authors: Martínez Suárez, José Ignacio1, Ariza Moreno, Carlos Alberto1, Liliana Muñoz, Daissy1, Ernesto Chilito, Carlos1, Cortés Neira, Ana Xiomara1,2, Acosta Martínez, Julián Andrés1 joseimartinezs1977@hotmail.com
Source: Revista Facultad de Medicina de la Universidad Nacional de Colombia. abr-jun2021, Vol. 69 Issue 2, p77-101. 25p.
Subjects: CLAVICLE fractures, SHOULDER injuries, FUNCTIONAL assessment, OPERATIVE surgery, ADULTS
Abstract (English): Introduction: Clavicle fractures represent 2.6% of all fractures and 35% of all shoulder injuries in the adult population. Multiple surgical techniques are available to treat these fractures, including superior and anteroinferior plating. Objective: To determine the most effective and safest surgical technique for treating middle-third clavicle fractures: superior plating or anteroinferior plating. Materials and methods: Analytical observational cohort study carried out on 96 patients with middle-third clavicle fractures treated by one of these two surgical techniques in a secondary care hospital in Huila, Colombia. Different outcomes of interest were measured for each technique. The degree of satisfaction and functional outcome were assessed by means of the DASH and the Constant Score questionnaires, respectively. Univariate, bivariate, and multivariate analyses were performed to characterize the relationship between the outcomes measured. Results: The superior plating technique was used in 52 patients, while the anteroinferior plating technique was used in 44. The outcomes of interest that were measured behaved as a protective factor for the anteroinferior plating method: intraoperative bleeding (RR 0.60), surgical time (RR 0.53), consolidation time (RR 0.56), irritation caused by osteosynthesis materials (RR 0.12) and removal of the material (RR 0.25). Differences regarding functional outcomes and degree of satisfaction were also statistically significant (Constant score, p=0.000; DASH, p=0.000, respectively). Conclusion: The anteroinferior plating technique proved to be safer and more effective for the treatment of these fractures, achieving both a better functional outcome and a better degree of satisfaction. Consequently its use is recommended for treating patients with middle-third clavicle fractures. [ABSTRACT FROM AUTHOR]
Abstract (Spanish): Introducción. En población adulta, las fracturas de clavícula constituyen el 2.6% de todas las fracturas y el 35% de todas las lesiones del hombro. Existen varias técnicas quirúrgicas para el tratamiento de estas fracturas, entre ellas la fijación con placa antero-inferior y con placa superior. Objetivo. Determinar cuál es la técnica quirúrgica más efectiva y segura para el tratamiento de fracturas del tercio medio de la clavícula: fijación con placa superior o con placa antero-inferior. Materiales y métodos. Estudio observacional analítico de cohorte realizado en 96 pacientes con fracturas del tercio medio de la clavícula tratadas mediante una de estas dos técnicas quirúrgicas en un hospital de segundo nivel de Huila, Colombia. Se midieron distintos desenlaces de interés para cada técnica. El grado de satisfacción y el resultado funcional fueron evaluados mediante los cuestionarios DASH y Constant Score, respectivamente. Además, se realizó un análisis univariado, uno bivariado, y uno multivariado para caracterizar la relación entre los desenlaces medidos. Resultados. la técnica de fijación de placa superior se utilizó en 52 pacientes, y la de placa antero-inferior, en 44. Los desenlaces de interés medidos se comportaron como factor protector para el método de placa antero-inferior: sangrado intraoperatorio (RR 0.60), tiempo quirúrgico (RR 0.53), tiempo de consolidación (RR 0.56, irritación del material de osteosíntesis (RR 0.12) y retiro del material (RR 0.25). Las diferencias respecto a resultados funcionales y grado de satisfacción también fueron estadísticamente significativas (Constant Score, p=0.000; DASH, p=0.000, respectivamente). Conclusión. La técnica de fijación con placa antero-inferior demostró ser más segura y efectiva para el tratamiento de estas fracturas, logrando un mejor resultado funcional y grado de satisfacción, por lo que se recomienda su uso en estos pacientes. [ABSTRACT FROM AUTHOR]
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Database: MedicLatina
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Abstract:Introduction: Clavicle fractures represent 2.6% of all fractures and 35% of all shoulder injuries in the adult population. Multiple surgical techniques are available to treat these fractures, including superior and anteroinferior plating. Objective: To determine the most effective and safest surgical technique for treating middle-third clavicle fractures: superior plating or anteroinferior plating. Materials and methods: Analytical observational cohort study carried out on 96 patients with middle-third clavicle fractures treated by one of these two surgical techniques in a secondary care hospital in Huila, Colombia. Different outcomes of interest were measured for each technique. The degree of satisfaction and functional outcome were assessed by means of the DASH and the Constant Score questionnaires, respectively. Univariate, bivariate, and multivariate analyses were performed to characterize the relationship between the outcomes measured. Results: The superior plating technique was used in 52 patients, while the anteroinferior plating technique was used in 44. The outcomes of interest that were measured behaved as a protective factor for the anteroinferior plating method: intraoperative bleeding (RR 0.60), surgical time (RR 0.53), consolidation time (RR 0.56), irritation caused by osteosynthesis materials (RR 0.12) and removal of the material (RR 0.25). Differences regarding functional outcomes and degree of satisfaction were also statistically significant (Constant score, p=0.000; DASH, p=0.000, respectively). Conclusion: The anteroinferior plating technique proved to be safer and more effective for the treatment of these fractures, achieving both a better functional outcome and a better degree of satisfaction. Consequently its use is recommended for treating patients with middle-third clavicle fractures. [ABSTRACT FROM AUTHOR]
ISSN:01200011
DOI:10.15446/revfacmed.v69n2.80176