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Additional bone graft accelerates healing of clavicle non-unions and improves long-term results after 8.9 years: a retrospective study
BACKGROUND: Clavicle non-unions can occur after both conservative and operative treatment failure. Here, we investigated the outcome of patients with delayed fracture healing or non-unions of the clavicle. Patients underwent revision surgery by plate osteosynthesis of the clavicle with or without bo...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2015
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4296679/ https://www.ncbi.nlm.nih.gov/pubmed/25573541 http://dx.doi.org/10.1186/s13018-014-0143-y |
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author | Schnetzke, Marc Morbitzer, Christian Aytac, Sara Erhardt, Matthias Frank, Christian Muenzberg, Matthias Studier-Fischer, Stefan Helbig, Lars Suda, Arnold J Gruetzner, Paul-Alfred Guehring, Thorsten |
author_facet | Schnetzke, Marc Morbitzer, Christian Aytac, Sara Erhardt, Matthias Frank, Christian Muenzberg, Matthias Studier-Fischer, Stefan Helbig, Lars Suda, Arnold J Gruetzner, Paul-Alfred Guehring, Thorsten |
author_sort | Schnetzke, Marc |
collection | PubMed |
description | BACKGROUND: Clavicle non-unions can occur after both conservative and operative treatment failure. Here, we investigated the outcome of patients with delayed fracture healing or non-unions of the clavicle. Patients underwent revision surgery by plate osteosynthesis of the clavicle with or without bone grafting. Our aim was to determine rates of bone healing and the functional long-term outcome. METHODS: The study population of 58 consecutive patients was divided into group 1 (n = 25; no bone graft) and group 2 (n = 33; iliac crest bone graft). Bone consolidation was determined by the Lane-Sandhu score preoperatively and after 2.2 ± 1.8 years, respectively. The functional long-term outcome was determined after 8.9 ± 2.7 years in all available patients (n = 30) by the Constant score, DASH (Disabilities of the Arm, Shoulder and Hand) score and SF-36, and clavicle length was measured by ultrasound as compared to the healthy side. RESULTS: Clavicle consolidation was achieved in 54 out of 58 patients (93.1%) after revision surgeries. The radiographic score and bone consolidation rates were significantly higher in group 2 (93.3%) as compared with 72% in group 1 (p = 0.02), resulting in a significantly shorter time to bone consolidation in group 2. Similarly, the relative risk for additional surgery after the first revision surgery was 4.7-fold higher in group 1 (p = 0.02). The long-term results showed overall very good results in DASH score (14.9 ± 16.5) and good results in Constant scores (77.9 ± 19.9). The group analyses found significantly better Constant scores and better visual analogue pain scale (VAS) numbers in group 2. Clavicle shortening appeared to affect the clinical results, and a mild correlation between shortening and Constant scores (R = −0.31) was found. CONCLUSIONS: This study shows high rates of bone healing and good functional outcomes after surgical revision of clavicle non-unions and further demonstrates that additional bone graft could significantly accelerate bone healing. This indicates that revision surgery of clavicle non-unions might preferably be done with additional bone graft, even if the surgeon considers that bone healing might be achieved without bone grafting. |
format | Online Article Text |
id | pubmed-4296679 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-42966792015-01-17 Additional bone graft accelerates healing of clavicle non-unions and improves long-term results after 8.9 years: a retrospective study Schnetzke, Marc Morbitzer, Christian Aytac, Sara Erhardt, Matthias Frank, Christian Muenzberg, Matthias Studier-Fischer, Stefan Helbig, Lars Suda, Arnold J Gruetzner, Paul-Alfred Guehring, Thorsten J Orthop Surg Res Research Article BACKGROUND: Clavicle non-unions can occur after both conservative and operative treatment failure. Here, we investigated the outcome of patients with delayed fracture healing or non-unions of the clavicle. Patients underwent revision surgery by plate osteosynthesis of the clavicle with or without bone grafting. Our aim was to determine rates of bone healing and the functional long-term outcome. METHODS: The study population of 58 consecutive patients was divided into group 1 (n = 25; no bone graft) and group 2 (n = 33; iliac crest bone graft). Bone consolidation was determined by the Lane-Sandhu score preoperatively and after 2.2 ± 1.8 years, respectively. The functional long-term outcome was determined after 8.9 ± 2.7 years in all available patients (n = 30) by the Constant score, DASH (Disabilities of the Arm, Shoulder and Hand) score and SF-36, and clavicle length was measured by ultrasound as compared to the healthy side. RESULTS: Clavicle consolidation was achieved in 54 out of 58 patients (93.1%) after revision surgeries. The radiographic score and bone consolidation rates were significantly higher in group 2 (93.3%) as compared with 72% in group 1 (p = 0.02), resulting in a significantly shorter time to bone consolidation in group 2. Similarly, the relative risk for additional surgery after the first revision surgery was 4.7-fold higher in group 1 (p = 0.02). The long-term results showed overall very good results in DASH score (14.9 ± 16.5) and good results in Constant scores (77.9 ± 19.9). The group analyses found significantly better Constant scores and better visual analogue pain scale (VAS) numbers in group 2. Clavicle shortening appeared to affect the clinical results, and a mild correlation between shortening and Constant scores (R = −0.31) was found. CONCLUSIONS: This study shows high rates of bone healing and good functional outcomes after surgical revision of clavicle non-unions and further demonstrates that additional bone graft could significantly accelerate bone healing. This indicates that revision surgery of clavicle non-unions might preferably be done with additional bone graft, even if the surgeon considers that bone healing might be achieved without bone grafting. BioMed Central 2015-01-09 /pmc/articles/PMC4296679/ /pubmed/25573541 http://dx.doi.org/10.1186/s13018-014-0143-y Text en © Schnetzke et al.; licensee BioMed Central. 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Schnetzke, Marc Morbitzer, Christian Aytac, Sara Erhardt, Matthias Frank, Christian Muenzberg, Matthias Studier-Fischer, Stefan Helbig, Lars Suda, Arnold J Gruetzner, Paul-Alfred Guehring, Thorsten Additional bone graft accelerates healing of clavicle non-unions and improves long-term results after 8.9 years: a retrospective study |
title | Additional bone graft accelerates healing of clavicle non-unions and improves long-term results after 8.9 years: a retrospective study |
title_full | Additional bone graft accelerates healing of clavicle non-unions and improves long-term results after 8.9 years: a retrospective study |
title_fullStr | Additional bone graft accelerates healing of clavicle non-unions and improves long-term results after 8.9 years: a retrospective study |
title_full_unstemmed | Additional bone graft accelerates healing of clavicle non-unions and improves long-term results after 8.9 years: a retrospective study |
title_short | Additional bone graft accelerates healing of clavicle non-unions and improves long-term results after 8.9 years: a retrospective study |
title_sort | additional bone graft accelerates healing of clavicle non-unions and improves long-term results after 8.9 years: a retrospective study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4296679/ https://www.ncbi.nlm.nih.gov/pubmed/25573541 http://dx.doi.org/10.1186/s13018-014-0143-y |
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