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Clavicle fractures: epidemiology, classification and treatment of 2 422 fractures in the Swedish Fracture Register; an observational study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
Sahlgrenska Univ Hosp Gothenburg, Dept Orthopaed, SE-43180 Molndal, Sweden..
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
2017 (English)In: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, Vol. 18, p. 1-9, article id 82Article in journal (Refereed) Published
Abstract [en]

Background: Large multi-centre studies of clavicle fractures have so far been missing. The aim of this observational study was to describe the epidemiology, classification and treatment of clavicle fractures in the The Swedish Fracture Register (SFR) that collects national prospective data from large fracture populations. Methods: Data were retrieved from the SFR on all clavicle fractures sustained by patients >= 15 years of age in 2013-2014 (n = 2 422) with regards to date of injury, cause of injury, fracture classification and treatment. Results: Sixty-eight per cent of the clavicle fractures occurred in males. The largest subgroup was males aged 1524 years, representing 21% of clavicle fractures. At the ages of 65 years and above, females sustained more clavicle fractures than males. Same-level falls and bicycle accidents were the most common injury mechanisms. Displaced midshaft fractures constituted 43% of all fractures and were the most frequently operated fractures. Seventeen per cent of the patients underwent operative treatment within 30 days of the injury, where plate fixation was the choice of treatment in 94% of fractures. Conclusion: The largest patient group was young males. Displaced midshaft fractures were the most common type of clavicle fracture as well as the most frequently operated type of fracture.

Place, publisher, year, edition, pages
BIOMED CENTRAL LTD , 2017. Vol. 18, p. 1-9, article id 82
Keywords [en]
Clavicle fracture, Epidemiology, Classification, Treatment, The Swedish Fracture Register
National Category
Orthopaedics Rheumatology and Autoimmunity
Identifiers
URN: urn:nbn:se:uu:diva-319095DOI: 10.1186/s12891-017-1444-1ISI: 000395205600001PubMedID: 28202071OAI: oai:DiVA.org:uu-319095DiVA, id: diva2:1086702
Available from: 2017-04-03 Created: 2017-04-03 Last updated: 2024-01-17Bibliographically approved
In thesis
1. Clavicle Fractures: Epidemiology, classification, treatment and outcome, with emphasis on displaced lateral clavicle fractures
Open this publication in new window or tab >>Clavicle Fractures: Epidemiology, classification, treatment and outcome, with emphasis on displaced lateral clavicle fractures
2023 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The rate of surgical treatment for clavicle fractures has increased dramatically in the past 20 years, but the necessity for this remains obscure, particularly for displaced lateral clavicle fractures. The overall aim of the thesis is to acquire knowledge that may help guide treatment decisions for clavicle fractures, with an emphasis on displaced lateral fractures.

Study I was a register-based observational cohort study of 2 422 clavicle fractures from the Swedish Fracture Register (SFR), describing the epidemiology, classification and initial treatment of clavicle fractures in Sweden from 2013–2014. Patients were often young males. Simple falls and bicycle accidents were the most common injury mechanisms. Displaced midshaft fractures were the most common fracture type. Twenty-nine % of displaced midshaft fractures and 20% of displaced lateral fractures were treated surgically.

Study II was an observational cohort study reviewing local medical records of patients with lateral clavicle fractures treated at Uppsala University Hospital in 2013–2015. Twenty-two of the 58 displaced or potentially unstable lateral clavicle fractures were treated surgically, and half required secondary surgery for implant removal. Only 2 of 36 non-surgically treated fractures required delayed surgery because of symptomatic nonunion. In a subgroup of 30 patients seen at a follow-up visit 3 years post-injury, surgically treated patients had worse Constant scores, complained about infraclavicular sensory deficits and were less satisfied with the cosmetic result than non-surgically treated patients.

Study III was a register-based validation study that evaluated the accuracy of the Robinson classification for clavicle fractures applied in the SFR. Radiographs of 115 randomly selected clavicle fractures were independently classified by three experts on two occasions, creating a gold standard classification that was compared to the classifications in the SFR. The degree of agreement between the two classifications (accuracy), was only fair. However, the inter- and intraobserver agreement among the expert raters was almost perfect, indicating that accuracy may be improved if the classification instructions in the SFR are revised.

Study IV was an observational register study of 113 patients with fully displaced lateral clavicle fractures identified through the SFR and linked to the National Patient Register. Thirty-five of 52 surgically treated patients required secondary surgery, primarily for implant removal. Only 3 of 61 non-surgically treated patients required delayed surgical treatment due to nonunion or malunion. Functional outcome did not differ between treatment groups.

We conclude that patients with displaced lateral clavicle fractures should generally be considered for non-surgical treatment.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2023. p. 73
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1957
Keywords
Clavicle fractures, Displaced lateral clavicle fractures, Epidemiology, Classification, Treatment, Outcome, The Swedish Fracture Register, Validation
National Category
Orthopaedics
Research subject
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-505439 (URN)978-91-513-1839-4 (ISBN)
Public defence
2023-09-15, Gunnesalen, Akademiska Sjukhuset, Psykiatrins hus, Sjukhusvägen, Uppsala, 08:00 (Swedish)
Opponent
Supervisors
Available from: 2023-08-21 Created: 2023-06-20 Last updated: 2023-08-21

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Kihlström, CarolineLönn, KatarinaWolf, Olof

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