Background: The purpose of this study was to investigate the difference between two nailing approaches of intramedullary screw fixation, the retrograde nailing versus the anterograde nailing, on the radiological and clinical outcomes in patients with clavicle shaft fractures. Methods: From April 200...
Background: The purpose of this study was to investigate the difference between two nailing approaches of intramedullary screw fixation, the retrograde nailing versus the anterograde nailing, on the radiological and clinical outcomes in patients with clavicle shaft fractures. Methods: From April 2002 to August 2014, we enrolled a total of 22 patients with clavicle shaft fractures to participate in this study. Twelve patients received retrograde intramedullary nailing and 10 received anterograde nailing. The average duration of follow-up was 12 months. In all the patients, we took follow-up radiographs of the anteroposterior and the axial views to assess the postoperative radiological outcomes. We measured the visual analogue scale (VAS) score, American Shoulder and Elbow Surgeons (ASES) score, and the range of motion (ROM). Results: Clinically, we did not find a statistically significant difference in the retrograde group and the anterograde group in terms of the duration to bone union, the VAS score the ASES score and the ROMs. Radiologically, we found that the difference in the clavicle shortening of the affected arm and the unaffected arm did not show a statistically significant difference at the immediate postoperative assessment. we found that the difference in the clavicle shortening of the affected arm between the immediate postoperative and the final follow-up value did not show a statistically significant difference. Conclusions: We found that both the retrograde nailing and the anterograde nailing gave a favorable outcome for clavicle shaft fractures. Although we saw evidence of clavicle shortening after intramedullary screw fixation, this was not a factor that influenced clinical outcome.
Background: The purpose of this study was to investigate the difference between two nailing approaches of intramedullary screw fixation, the retrograde nailing versus the anterograde nailing, on the radiological and clinical outcomes in patients with clavicle shaft fractures. Methods: From April 2002 to August 2014, we enrolled a total of 22 patients with clavicle shaft fractures to participate in this study. Twelve patients received retrograde intramedullary nailing and 10 received anterograde nailing. The average duration of follow-up was 12 months. In all the patients, we took follow-up radiographs of the anteroposterior and the axial views to assess the postoperative radiological outcomes. We measured the visual analogue scale (VAS) score, American Shoulder and Elbow Surgeons (ASES) score, and the range of motion (ROM). Results: Clinically, we did not find a statistically significant difference in the retrograde group and the anterograde group in terms of the duration to bone union, the VAS score the ASES score and the ROMs. Radiologically, we found that the difference in the clavicle shortening of the affected arm and the unaffected arm did not show a statistically significant difference at the immediate postoperative assessment. we found that the difference in the clavicle shortening of the affected arm between the immediate postoperative and the final follow-up value did not show a statistically significant difference. Conclusions: We found that both the retrograde nailing and the anterograde nailing gave a favorable outcome for clavicle shaft fractures. Although we saw evidence of clavicle shortening after intramedullary screw fixation, this was not a factor that influenced clinical outcome.
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가설 설정
We made a comparative analysis of the two approaches using the radiological and clinical outcomes. We hypothesized that the anterograde approach is superior to the retrograde approach.
제안 방법
The purpose of this study was to investigate and compare the outcomes of retrograde intramedullary screw fixation and of anterograde intramedullary screw fixation for clavicle shaft fractures. We made a comparative analysis of the two approaches using the radiological and clinical outcomes.
We took radiographs of the preoperative antero-posterior and axial views of the shoulder in every patient to measure the length of the affected and the unaffected clavicle. The same radiographs were taken postoperatively at the following periods:2 weeks, 4 weeks, 6 weeks, 3 months, 6 months, and 1 year. We used the radiographs to assess clavicle length of both arms, the extent of bone union, strength of screw fixation, and bone nonunion.
The surgery was performed with the patients under general anesthesia and in beach chair position. For the anterograde approach (Fig.
대상 데이터
Those with multiple fractures were excluded. A total of 22 patients fulfilled the inclusion criteria and were enrolled into our study. We retrospectively analyzed the patients.
The retrograde group comprised 12 patients and the anterograde group, 10 patients. The average age of the patients in the retrograde group was 33.
The study participants were 16 men and 6 women with an average age of 36.8 years (range, 19–76 years).
데이터처리
, Armonk, NY, USA). The results were analyzed using the Mann-Whitney test. We considered statistical significance at a p-value of less than 0.
이론/모형
The clavicle shortening was measured as the difference between the clavicle length at the immediate postoperative follow-up and at the final follow-up. For the clinical assessment, we analyzed pain at the final follow-up using the visual analogue scale (VAS) score for subjective pain and the American Shoulder and Elbow Surgeons (ASES) score. The ROM for anterior flexion, external rotation, internal rotation, and abduction were assessed.
성능/효과
In this study we found that intramedullary screw fixation for clavicle shaft fractures using either the retrograde or the anterograde approach showed good postoperative clinical outcomes. Conservative treatment is generally recommended for most clavicle shaft fractures.
30) found that clavicle shortening was not an accurate prognostic marker for clinical outcome and that there were other better markers of prognosis. In this study, we found that although clavicle shortening occurred more in the retrograde group than in the anterograde group, the clinical outcomes between two were not statistically different showing that the extent of clavicle shortening were not associated with clinical outcome or were not severe enough to influence it.
Khalil6) found that a better fixation, stability, and clinical outcome can be achieved during intramedullary fixation using a screw over plating. In this study, we found that the average ASES score was 88.4 showing a satisfactory outcome with intramedullary screw fixation. We did not find a statistically significant difference in terms of the clinical scores (VAS score, ASES score, and the ROMs) between patients of the retrograde group and the anterograde group.
참고문헌 (30)
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