Does supine positioning improve the surgical treatment of shaft fractures of the clavicle?
Main Article Content
Abstract
Surgical management of diaphyseal clavicle fractures has increased in recent years. It is well established that upright radiographs more accurately assess fracture displacement compared to those taken in the supine position. This study investigates the influence of the supine position during surgical treatment of these fractures. A retrospective study was conducted on 22 patients: 11 operated in the supine position (Group A) and 11 in the beach chair position (Group B). Demographic data, quality of fracture reduction, surgical time, and operative room occupancy time were analyzed. Patients were comparable in terms of age, sex, and fracture type. The median follow-up was 7 months (range: 3-12). The operative room occupancy time was 120 minutes (range: 85-140) in Group A versus 180 minutes (range: 170-185) in Group B, showing a statistically significant difference (p < 0.01). Surgical time was 80 minutes (range: 58-95) in Group A compared to 100 minutes (range: 90-125) in Group B (p < 0.05). Satisfactory fracture reduction was achieved in all 11 patients in Group A and in 8 patients in Group B (p = 0.0104). Supine positioning for osteosynthesis of diaphyseal clavicle fractures appears to be a favorable option due to advantages in fracture reduction and patient positioning, without an observed increase in complications.
References
Frima H, van Heijl M, Michelitsch C, van der Meijden O, Beeres FJP, Houwert RM, Sommer C. Clavicle fractures in adults: current concepts. Eur J Trauma Emerg Surg. 2020; 46(3): 519-29. https://doi.org/10.1007/s00068-019-01122-4
Hoogervorst P, van Schie P, van den Bekerom MP. Midshaft clavicle fractures: current concepts. EFORT Open Rev. 2018; 3(6): 374-80. https://doi.org/10.1302/2058-5241.3.170033
Ranalletta M. CORR Insights®: What is the best evidence for management of displaced midshaft clavicle fractures? A systematic review and network meta-analysis of 22 randomized controlled trials. Clin Orthop Relat Res. 2020; 478(2): 403-5. https://doi.org/10.1097/CORR.0000000000000986
Larsson S. Clavicle fractures: considerations when plating. Injury. 2018; 49 (Suppl 1): S24-8. https://doi.org/10.1016/S0020-1383(18)30298-5
Onizuka N, Anderson JP, Gilbertson JA, MacCormick LM, Cole PA. Displacement of diaphyseal clavicle fractures related to patient position and progressive displacement in the peri-injury period. J Shoulder Elbow Surg. 2018; 27(4): 667-73. https://doi.org/10.1016/j.jse.2018.01.004
Hoogervorst P, van Geene A, Gundlach U, Wei A, Verdonschot N, Hannink G. Influence of radiographic projection and patient positioning on shortening of the fractured clavicle. JSES Int. 2020; 4(3): 503-7. https://doi.org/10.1016/j.jseint.2020.03.005
Stewart L, Lowe A. The impact of upright radiographs of midshaft clavicle fractures on treatment recommendations. Injury. 2019; 85:8 https://bitly.cx/KJfC
Kongmalai P, Chiaprasert P, Rungsinaporn V. Reliability of the radiographic views in supine position for evaluation of displaced midshaft clavicle fracture length. J Orthop Surg (Hong Kong). 2020; 28(3): 230949902095229. https://doi.org/10.1177/2309499020952295
Backus JD, Merriman DJ, McAndrew CM, Gardner MJ, Ricci WM. Upright versus supine radiographs of clavicle fractures: does positioning matter? J Orthop Trauma. 2014; 28(11): 636-41. https://doi.org/10.1097/BOT.0000000000000129
Malik A, Jazini E, Song X, Johal H, O’Hara N, Slobogean G, Abzug JM. Positional change in displacement of midshaft clavicle fractures: an aid to initial evaluation. J Orthop Trauma. 2017; 31(1): e9-12. https://doi.org/10.1097/BOT.0000000000000727
Vatansever A, Demiryürek D, Erçakmak B, Özsoy H, Hazirolan T, Şentürk YE. Redefining the morphometry of subclavian vessels for clavicle fracture treatments. Surg Radiol Anat. 2019; 41(4): 365-72. https://doi.org/10.1007/s00276-018-2132-z
Robinson L, Persico F, Lorenz E, Seligson D. Clavicular caution: an anatomic study of neurovascular structures. Injury. 2014; 45 (12):1867-9. https://doi.org/10.1016/j.injury.2014.08.031
Mulder FJ, Mellema JJ, Ring D. Proximity of vital structures to the clavicle: comparison of fractured and non-fractured side. Arch Bone Jt Surg. 2016; 4(4): 5. https://bitly.cx/tjVl
Chuaychoosakoon C, Suwanno P, Boonriong T, Suwannaphisit S, Klabklay P, Parinyakhup W, Maliwankul K, Duangnumsawang Y, Tangtrakulwanich B. Patient position is related to the risk of neurovascular injury in clavicular plating: a cadaveric study. Clin Orthop Relat Res. 2019; 477(12): 2761-8. https://doi.org/10.1097/CORR.0000000000000902
Stillwell A, Ioannou C, Daniele L, Tan SLE. Osteosynthesis for clavicle fractures: how close are we to penetration of neurovascular structures? Injury. 2017; 48(2): 460-3. https://doi.org/10.1016/j.injury.2016.10.044