Indications changing for ORIF of clavicle fractures

LAHAINA, Hawaii — The methods of treating clavicle fractures are changing in large part due to advancements in fixation methods as well as more active lifestyle trends, according to an orthopedic surgeon.

Christopher S. Ahmad

"This is exciting. We are looking at new ways of treating a very common injury," Christopher S. Ahmad, MD, said during the Orthopedics Today Hawaii 2008 meeting, here.

He noted that in the literature Neer and Rowe advocated nonoperative treatments for these fractures.

"Then the indications for ORIF (open reduction internal fixation) were things like neurovascular injury, skin tenting, open fracture and floating shoulder. But things have changed since the publication of those classic studies," Ahmad said. Also, the addition of locking and precontoured plates has increased.

The changes are related to more active patients who have more high-energy injuries, and higher expectations, he said.

"We are also more sensitive in how we evaluate patients in that we have more specific questionnaires and instruments to find out if they are doing well or not doing well, and what fractures are problem fractures," he said.

Ahmad said that research by Nowack indicated that 43% of patients treated nonoperatively for clavicle fracture reported pain with activity. Other research indicates that factors for poor outcomes include: 15 mm to 20 mm of shortening; lack of cortical apposition; comminution; and displacement on both 0° and 45° views.

Overall, Ahmad said that current studies have not reproduced the results of Neer and Rowe and that poor results are related to shortening, lack of bony contact, and vertically or transversely displaced fragments.

"Those are the ones that we are indicating for surgery, or at least scheduling lengthy discussion with the patient about options for surgery," he said.

For more information:
Ahmad CS. Clavicle fractures. Presented at Orthopedics Today Hawaii 2008. Jan. 13-16, 2008. Lahaina, Maui, Hawaii.