The Egyptian Journal of Hospital Medicine (October 2018) Vol. 73 (4), Page

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1 Th Egyptian Journal of Hospital Mdicin (Octobr 2018) Vol. 73 (4), Pag Comparing non-oprativ managmnt surgical fixation in tratmnt of clavicl fracturs Mohammad Abdallah Yahya Alhakamy (1), Ahmad Samr Ahmad Alrfai (1), Alhassan, Mahdi Ali Kariri (1), Ali Mahdi Ali Kariri (1), Ndaa Samr Abdo Jlan (1), Mohammd Bahkali Ali Althrwi (1), Alaa Ahmad Hassan Allayl (1), Asim Bishi Mohammd Hakami (1), Hiba Salah Abdlgadir (2) (1)Faculty of Mdicin, Jazan Univrsity, Saudi Arabia, (2) Family Mdicin, Public Tropical Halth Program, Univrsity of Mdical Scincs Tchnology, Khartoum, Sudan Corrsponding author: Mohammad Abdallah Yahya Alhakamy, Abstract: Background: Clavicl fracturs ar common among mals from sport injuris th non-oprativ tratmnt has bn indicatd as tratmnt of choic. Rcntly, dlayd haling, pain shouldr waknss hav rportd as frqunt complications of non-oprativ tratmnt many studis found bttr outcoms with surgical tratmnt. This rviw aimd at valuating vidnc that compard nonoprativ tratmnt surgical intrvntion in managmnt of clavicl fracturs to provid vidncbasd data about th bst modality of tratmnt aiming to improv patints outcom. Mthods: A wb-basd sarch was achivd in MEDLINE rsultd in 40 ligibl studis. Th rfrnc lists of th articls rviws wr scrnd for rlvant articls. Aftr xclusion of irrlvant, duplicatd rviw studis, 7 studis wr includd in this rviw. Rsults: Th outcom succss aftr surgical intrvntion compard to non-oprativ tratmnts was rportd in all of th includd studis. Most of th intrvntional studis found significant improvmnt in th surgical in tratmnt, whil th majority of th non-oprativ group showd no improvmnt. Conclusions: Th rviw of th vidnc suggstd that us of surgical fixation in tratmnt of clavicular fractur is suprior to th non-oprativ tratmnt if thr ar no contraindications to th surgry. Kywords: Clavicl, Fractur, Managmnt, Surgical, Haling Background: Th clavicl fracturs ar common fracturs in th uppr limb, accounting for 2.6 to 10% of all fracturs about 44.1% of th uppr limb fracturs (1, 2). Clavicl fracturs ar common among mals from sport injuris. Th most common caus of clavicl fractur in adults is falling down, whil sport injuris is th most common caus in young tnagrs (3). Majority of th clavicular fracturs occur in th mid shaft, most of ths fracturs ar displacd (4, 5). Th mid shaft fracturs is thought to occur as a rsult of dirct trauma (3). Habitually, non-oprativ tratmnt is a tratmnt of choic in mid shaft clavicl fracturs (6, 7). Th non-oprativ tratmnt for th clavicl fracturs has good outcom (8). Rcntly it was notd that; th non-oprativ managmnt of clavicular fracturs rsult in high nonunion rats, spcially in displacd fracturs. Furthrmor, th non-oprativ tratmnt is found to b associatd with dlayd haling, pain shouldr waknss (9, 10). Surgical tratmnt in th past is indicatd in prsnc of opn fracturs or fragmnts dislocation (11, 12). Rcntly, many studis found th surgical tratmnt for clavicl fracturs has bttr outcoms (1, 13, 14). This rviw aimd at valuating all th studis that compard non-oprativ tratmnt surgical intrvntion in managmnt of clavicl fracturs to provid vidnc-basd data about th bst modality of tratmnt aiming to improv patints outcom. Mthods: A wb-basd sarch was achivd in MEDLINE using th following sarch stratgy clavicl fractur" AND ("thradd Kirschnr wir " OR opn fixation OR fixation) AND (non-oprativ OR nonoprativ OR nonsurgical OR nonsurgical) AND (failur OR brakag OR succss OR cur OR haling OR union OR complications OR ostomylitis) which rsultd in 40 studis. Th rfrnc lists of th articls rviws wr scrnd for rlvant articls. Aftr xclusion of irrlvant, duplicatd rviw studis, 7 studis wr includd in th rviw as thy mt th inclusion critria, Figur (1). Includd studis aimd at comparing th surgical tratmnt of clavicl fractur with th nonoprativ managmnt. Rcivd: 30/7/2018 Accptd: 10/8/

2 Comparing non-oprativ managmnt surgical fixation. Rsults: Out of th 7 studis 2 wr prospctiv nonromi comparativ trials 15), on (14, rtrospctiv cohort (1), on prospctiv cohort trial (13), on Rtrospctiv obsrvational (16) th two wr prospctiv romi controlld clinical trials (17, 18). Th total sampl siz was 439 patints with clavicular fracturs. Th minimum ag was 12 yars th maximum ag was 70 yars old. Rgarding th location of th fractur, all of th includd studis involvd patints with mid shaft clavicl fractur (1, 13-18). A rcruitd 60 patints with compltly displacd midshaft clavicl fractur (14), whil two studis includd patints diagnosd with displacd mid shaft clavicl fractur (13, 15). Only 4 of th includd studis rportd th mthods that wr usd in th n of th fractur (1, 14, 17, 18). Th causs of th clavicl fractur includ RTA, fall sports injury wr th mchanisms of th trauma that lad to clavicl fractur (14). In addition to RTA falls injuris, studis rportd bicycling skiing as a causs of clavicl fracturs (13). Also, dirct trauma wr th mchanisms of th trauma in on includd (15). Main sport injuris accrud in football, wrstling, skatboard, soccr, bicycl, hocky (16). Rlvant articls idntifid in Mdlin (n = 40) By scrning of rfrncs list of rviws (n = 7) Excludd Articls by scrning th titl abstract (n = 34): irrlvant articls (n = 33) rviws (n = 1) Articls xcludd (n = 5): No full txt (n=2) Languag (n=2) Inconsistnt mthod or outcom (n=1) Articls for which full txt rtrivd (n = 6) Articls xcludd (n = 1): 1= inconsistnt mthods or outcoms Articls includd in th rviw (n = 5) Articls includd (n=2) Final articls includd (n=7) 6402

3 Mohammad Alhakamy t al. Rfrnc (author yar) by End Coppa t al. (1) Navn t al, (14) van dr Vn Dnis t al. (13) Khorami t al. (15) Vr Hav t al. (16) Judd t al. (18) Smkal t al. (17 Tabl (1): Th findings of th includd studis rgarding managmnt of clavicl fractur Study dsign Rtrosp ctiv cohort iv nonromi compara tiv trial iv cohort trial iv nonromi clinical trial Rtrosp ctiv obsrvat ional iv, romi iv romi Controll d Clinical Trial Sa mpl siz Ag of patint Man ag yars yars yars Man ag / yars Man ag 15.4 (12 18) yars yars Typ location of fractur clavicl fractur Complt ly displacd mid-shaft clavicl fractur Displac d mid shaft clavicl Displac d clavicl mid-shaft fracturs Midshaft Clavicl Fracturs clavicl fracturs Clavicl Fracturs Classificati on of th fractur Allman s radiographi c n systm (1b & 1c) Allman s radiographi c n systm (Robinson typ 2b) rportd rportd rportd Singl Assssmnt Numric Evaluation (SANE)17 L Insalata1 8 shouldr scors OTA n systm Mchanis m of trauma lad to clavicl fractur rportd RTA, fall, Sports injury RTA, fall, sport, Bicycling & skiing Traffic accidnts, dirct trauma, falling down. Skatboard, Wrstling, Football, Bicycl, Fll off bik, motor vhicl accidnt, Hocky, Soccr. Motorcycl or motor vhicl accidnt, contactsports injury, bicycl accidnt, fall. Fall, Traffic accidnt, Bicycl accidnt, Sports accidnt. Surgical intrvntion Kirschnr wir Plat fixation Applying th VA-LCP antrior locking comprssion plat, sling post oprativly Plat fixation (3-5 mm DCP plat with at last six cortical scrws) Plat fixation Opn rduction intrnal fixation (ORIF) ESIN Dtails of nonoprativ manag mnt Figurof-ight bag Figurof-ight bag a sling Us of stard sling for two wks figur-ofight bag Sling or figur-of- 8 brac Sling rstrictd activity Simpl shouldr sling Follow -up priod man followup of yars 6 rport d 1 yar 2-yar Succss aftr surgical intrvntion Rduction in Displacmnt in 25 (89.29%) & only 3 (10.71%) cass not improvd (p = 0.032) 100% (all patints had fractur union) DASH Constant Scors at six wks wr significant bttr (90.9 +/ /- 17.2) Avrag durations of union 19.3 wks. with non-union rat= 5.7% Man tim to radiographic union 7.4 wks Alignmnt with haling aftr 1 yar 86% 100 % (union was achivd in all patints) Succss of nonoprativ 6 cass (20.69% ) improv d, 23 cass (76.67% ) not improv d (p = 0.464) 93% DASH Constant Scors at six wks ( ) Avrag duration s of union 24.4 wks with nonunion rat= 13.3% Man tim to radiogra phic union 8.7 wks Alignm nt with haling aftr 1 yar 11% Union in 70 %, 30% nonunio n 6403

4 Comparing non-oprativ managmnt surgical fixation. Discussion: Tratmnt of clavicl fracturs can b surgical or non-surgical. This rviw includd all romi non-romi trials that compard surgical non-oprativ tratmnt of clavicular fracturs, aiming to improv th patints outcom by using th bst modality of tratmnt. Rgarding th typ of th surgical intrvntion, plat fixation was usd in thr of th includd studis (14-16). Coppa t al. usd kirschnr wir in thir (1). Van dr Vn Dnis t al. applid in thir th VA- LCP antrior locking comprssion plat, usd sling aftr th opration (13). Judd t al, usd in thir opn rduction intrnal fixation (18). In Smkal t al., lastic stabl intramdullary nailing (ESIN) is th surgical procdur that usd in tratmnt of th mid shaft clavicl fracturs (17). Rgarding th non-oprativ managmnt figur-of-ight bag was usd in four studis (1, 14-16). Vr Hav t al. usd in addition to figur-of-ight, a sling to som patints (16). Th rst of thr includd studis (13, 17, usd sling to thir non-oprativ groups 18). Six of th includd studis rportd th follow up priod of thir includd patints. Two studis followd th patints for 6 (14, 15), on followd th patints for on yar (18) othr on followd th rspondnts for 2 yars (17). Coppa t al. rportd in thir that; th man follow up priod was 48 (1). Van dr Vn Dnis t al, followd th patints for 5 yars (13). Th outcom succss aftr surgical intrvntion compard to non-oprativ tratmnts was rportd in all of th includd studis. In Coppa t al., thr was significant improvmnt in th surgical group, whil th majority of th non-oprativ group showd no improvmnt (1). Navn t al. rportd in thir that; all patints in th surgical group showd rduction th duration of rduction was shortr in this group (14). Van dr Vn Dnis t al. rportd in thir that; oprativ fixation to clavicl fractur has positiv ffcts in rducing th pain arly rduction whn compard to non-oprativ tratmnt (13). In Khorami t al. Vr Hav t al. studis, th non-union rats wr lowr in th oprativ group (15, 16). Vr Hav t al. also rportd fwr complications in th oprativ group (16). Judd t al. rportd in thir that; surgical intrvntion in clavicular fractur rsult in highr functional rat at short trm follow up (18). In Smkal t al., th surgical intrvntion rsultd in fwr nonunion cass, arly rduction rturn to daily activitis highr functional outcom (17). By rviwing th outcom of th includd studis it was notd that; surgical intrvntion in tratmnt of clavicular fracturs rsult in significant improvmnt (1), arly rduction (14, 16, 18), fwr non-union (14, 15, 17), pain rduction (13), arly rturn to daily activity (17), bttr (13) functional outcom fwr complications (16) whn compard to nonoprativ tratmnt. This mans that if thr is no contra indications surgical tratmnt of th clavicl fractur is th prfrrd tratmnt. Th most common typs of surgical intrvntion in tratmnt of clavicular fracturs is plat fixation (14-16). Also opn rduction intrnal fixation (18), kirschnr (1) wir VA-LCP antrior locking (16) comprssion plat lastic stabl intramdullary nailing (ESIN) (17) ar usd in tratmnt of clavicl fracturs. Rgarding th non-oprativ tratmnt of th clavicl fractur, figur-of-ight bag is th most common usd mthod (1, 13-15), followd by sling (13, 16-18) rstrictd activity (18). Road traffic accidnts, fall, sport injuris, bicycling motor vhicl accidnts ar th most common rportd causs of clavicl fracturs (13-18). Many ns ar usd to diagnos clavicl fracturs includ: Allman s radiographic n systm (1, 14), OTA n systm (17), singl assssmnt numric valuation (SANE) 17 L Insalata18 shouldr scors (18). Conclusions: Th rviw of th vidnc suggstd that th us of surgical fixation in tratmnt of clavicular fractur is suprior to th nonoprativ tratmnt if thr ar no contraindications to th surgry. Rfrncs: 1.Coppa V, Di Giudici L, Ccconi S, Marinlli M, Gigant A (2017): Midshaft clavicl fracturs tratmnt: thradd Kirschnr wir vrsus consrvativ approach. Stratgis 6404

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