Are diaphyseal clavicular fractures still treated traditionally in a non-surgical way?☆

Labronici, Pedro José; Santos, Fernando Claudino dos; Reis, Tales Bregalda; Pires, Robinson Esteves Santos; Mendes, Adriano Fernando; Kojima, Kodi Edson

doi:10.1016/j.rboe.2017.06.012

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Sumário

ORIGINAL ARTICLE • Rev. bras. ortop. 52 (04) • Jul-Aug 2017 • https://doi.org/10.1016/j.rboe.2017.06.012 copy

Are diaphyseal clavicular fractures still treated traditionally in a non-surgical way?^☆ ☆ Study conducted at Hospital Santa Teresa, Petrópolis, RJ, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE:

To evaluate the decision of orthopedics surgeons regarding which cases they would indicate surgery or non-surgical treatment.

METHODS:

20 images of radiographs with fracture in the middle third of the collar bone (AO/OTA 15-B) in anteroposterior view were analyzed, and divided into four groups: group 1 - fracture type AO/OTA 15-B1 without displacement; group 2 - fracture type AO/OTA 15-B1 with displacement; group 3 - fracture type AO/OTA 15-B2; group 4 - fracture type AO/OTA 15-B3. The evaluator was requested to indicate the choice of treatment, surgical or non-surgical.

RESULTS:

There was no strong correlation between the amount of surgical indications and the working experience or age of the medical evaluator. It was observed that the average of surgical indications in the total sample was 52%. When indications were studied in different areas of Brazil, there was no significant difference among them. No pattern for the Brazilian regions studied was observed in the case analysis. Even within a group (cases of the same complexity), no specific pattern of surgical indication was observed.

CONCLUSION:

No association between surgical indication and the length of professional experience was found. The Southern and Southeastern regions were those that most recommended surgeries in groups 2, 3, and 4. In no region the same level of surgical indication for cases of the same complexity rate was kept.

Keywords:
Fractures, bone surgery; Fractures, bone radiography; Clavicule/surgery; Clavicule/radiography; Bone plates

Region	Number of participants	Mean age (years)	Mean time of professional activity (years)	Overall percentage of surgery indications
Brazil	193	43	17.5	52
Mid-West	7	44	13	46
Northeast	19	46	21	48
North	6	41	14	43
Southeast	130	50	23	52
South	31	43	18	55

Group	Case	Time of professional activity
		Up to 2 years	3–6 years	7–10 years	11–20 years	Over 20 years
1	1	9.1	0.0	4.5	1.7	6.0
	2	0.0	4.5	0.0	1.7	1.5
	3	13.6	0.0	4.5	15.0	7.5
	4	18.2	0.0	4.5	18.3	13.4
	5	9.1	13.6	4.5	8.3	9.0
2	1	40.9	50.0	50.0	63.3	59.7
	2	90.9	100	95.5	100	95.5
	3	68.2	63.6	77.3	66.7	80.6
	4	86.4	54.5	86.4	65.0	76.1
	5	100	90.9	95.5	93.3	97.0
3	1	77.3	68.2	68.2	73.3	82.1
	2	27.3	9.1	4.5	23.3	23.9
	3	4.5	4.5	0.0	1.7	0.0
	4	95.5	95.5	90.9	96.7	95.5
	5	36.4	27.3	27.3	31.7	37.3
4	1	86.4	95.5	90.9	90.0	92.5
	2	68.2	40.9	45.5	58.3	56.7
	3	86.4	90.9	86.4	83.3	88.1
	4	77.3	59.1	77.3	78.3	86.6
	5	86.4	54.5	63.6	61.7	71.6

Group	Case	Age range of the evaluators
		Up to 29 years	30–39 years	40–49 years	50–59 years	Over 60 years old
1	1	5.0	4.5	0.0	3.2	13.0
	2	5.0	1.5	0.0	3.2	0.0
	3	10.0	9.1	15.1	3.2	4.3
	4	10.0	12.1	17.0	6.5	17.4
	5	5.0	9.1	7.5	12.9	8.7
2	1	35.0	59.1	54.7	61.3	65.2
	2	90.0	98.5	98.1	93.5	100
	3	75.0	72.7	64.2	74.2	87.0
	4	80.0	74.2	64.2	71.0	82.6
	5	100	95.5	94.3	90.3	100
3	1	65.0	77.3	71.7	80.6	82.6
	2	15.0	16.7	28.3	22.6	13.0
	3	5.0	1.5	1.9	0.0	0.0
	4	90.0	97.0	96.2	90.3	100
	5	25.0	33.3	35.8	35.5	30.4
4	1	85.0	92.4	86.8	93.5	100
	2	60.0	53.0	58.5	58.1	47.8
	3	90.0	86.4	83.0	83.9	95.7
	4	65.0	77.3	77.4	83.9	91.3
	5	60.0	72.7	58.5	71.0	73.9

	Time of operation	Age
Number of indications for group 1 cases	-0.01	0.01
Number of indications for group 2 cases	0.08	0.08
Number of indications for group 3 cases	0.03	0.11
Number of indications for group 4 cases	0.04	0.09
Number of indications in total cases	0.05	0.10

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

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[1] * Corresponding author. E-mail: plabronici@globo.com (P.J. Labronici).

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Are diaphyseal clavicular fractures still treated traditionally in a non-surgical way?☆ ☆ Study conducted at Hospital Santa Teresa, Petrópolis, RJ, Brazil.

ABSTRACT

OBJECTIVE:

METHODS:

RESULTS:

CONCLUSION:

Are diaphyseal clavicular fractures still treated traditionally in a non-surgical way?^☆ ☆ Study conducted at Hospital Santa Teresa, Petrópolis, RJ, Brazil.