16 Feb 21. Featured Paper

Link to paper on Bone & Joint Research

 

Authors

Jamie A. Nicholson, William M. Oliver, Tom J. MacGillivray, C. Michael Robinson, A. Hamish R. W. Simpson

 

Abstract

Aims: To evaluate if union of clavicle fractures can be predicted at six weeks post-injury by the presence of bridging callus on ultrasound.

Methods: Adult patients managed nonoperatively with a displaced mid-shaft clavicle were recruited prospectively.

Ultrasound evaluation of the fracture was undertaken to determine if sonographic bridging callus was present.

Clinical risk factors at six weeks were used to stratify patients at high risk of nonunion with a combination of Quick Disabilities of the Arm, Shoulder & Hand questionnaire (QuickDASH) ≥ 40, fracture movement on examination, or absence of callus on radiograph.

Results: A total of 112 patients completed follow-up at six months with a nonunion incidence of 16.7% (n = 18/112).

Sonographic bridging callus was detected in 62.5% (n = 70/112) of the cohort at six weeks post-injury.

If present, union occurred in 98.6% of the fractures (n = 69/70).

If absent, nonunion developed in 40.5% of cases (n = 17/42).

The sensitivity to predict union with sonographic bridging callus at six weeks was 73.4% & the specificity was 94.4%.

Regression analysis found that failure to detect sonographic bridging callus at six weeks was associated with older age, female sex, simple fracture pattern, smoking, & greater fracture displacement (Nagelkerke R² = 0.48).

Of the cohort, 30.4% (n = 34/112) had absent sonographic bridging callus in addition to one or more of the clinical risk factors at six weeks that predispose to nonunion.

If one was present the nonunion rate was 35%, 60% with two, & 100% when combined with all three.

Conclusion: Ultrasound combined with clinical risk factors can accurately predict fracture healing at six weeks following a displaced midshaft clavicle fracture.

 

Keywords

• Clavicle

• Nonunion

• Ultrasound