Immediate Weight-bearing as Tolerated has Improved Outcomes Compared to Non–weight-bearing after Surgical Stabilisation of Midshaft Clavicle Fractures in Polytrauma Patients
Clavicle fractures are common injuries in the polytrauma population and frequently limit early mobilisation. This study evaluates the effect of immediate crutch weight-bearing (WB) in polytrauma patients after surgical stabilisation of a displaced midshaft clavicle fracture.
Methods
A retrospective review identified 26 polytrauma patients with operatively managed displaced midshaft clavicle fractures and a non–weight-bearing (NWB) lower extremity injury. Patients were allowed immediate WB after surgery or NWB. The primary outcome was total hospital length of stay. Statistical analysis was done using Mann–Whitney U test.
Results
The WB group had decreased total hospital length of stay (10.4 vs. 17.0 days, p = 0.012) and improved physical therapy score (3.9 vs. 2.9, p = 0.054) and postoperative length of stay (6.8 vs. 12.7 days, p = 0.006) compared with the NWB group.
Conclusions
Our data suggest that an immediate WB as tolerated protocol for polytrauma patients after surgical fixation of displaced clavicle fractures may decrease the overall length of stay.
RobinsonCM. Fractures of the clavicle in the adult. Epidemiology and classification. J Bone Joint Surg Br1998;80:476–84.
2.
NeerC.Fractures of the clavicle. In: Rockwood Jr CA, Green DP, editors. Fractures in adults. 2nd ed. Philadelphia: Lippincott; 1984. p. 707–13.
3.
PostacchiniF, GuminaS, De SantisP, Epidemiology of clavicle fractures. J Shoulder Elbow Surg2002;11:452–6.
4.
MillerME, AdaJR. Injuries to the shoulder girdle. In: Browner BD, Jupiter JB, Levine AM, Trafton PG, editors. Skeletal Trauma.Philadelphia: WB Saunders; 1992. p. 1291–310.
5.
CrosbyLA, BlahaJD, GreenwaldAS, , Canadian Orthopaedic Trauma Society. Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial.) Bone Joint Surg Am2007;89(1):1.
6.
KulshresthaV, RoyT, AudigeL.Operative versus nonoperative management of displaced midshaft clavicle fractures: a prospective cohort study. J Orthop Trauma2011;25(1):31–8.
7.
RobinsonCM, GoudieEB, MurrayIR, Open reduction and plate fixation versus nonoperative treatment for displaced midshaft clavicular fractures: a multicenter, randomized, controlled trial. J Bone Joint Surg Am2013;95(17): 1576–84.
8.
PearsonAM, TostesonAN, KovalKJ, Is surgery for displaced, midshaft clavicle fractures in adults cost effective? Results based on a multi-center randomized, controlled trial. J Orthop Trauma2010;24(7):426–33.
9.
ChengO, ThompsonC, McKeeMD, Canadien Orthopaedic Trauma Society. General health status following clavicle fracture: results of a randomised clinical trial. J Bone Joint Surg Br2012;94(S38). 81–81.
10.
RobinsonCM, Court-BrownCM, McQueenMM, Estimating the risk of nonunion following nonoperative treatment of a clavicular fracture. J Bone Joint Surg Am2004;86(7):1359–65.
11.
BanerjeeM, BouillonB, ShafizadehS, , Trauma Registry Group. Epidemiology of extremity injuries in multiple trauma patients. Injury2013;44(8): 1015–21.
12.
EngelsFT, BeckettAN, RubenfeldGD, Physical rehabilitation of the critically ill trauma patient in the ICU. Crit Care Med2013;41(7):1790–801.
13.
Hans-ChristophP, GiannoudisP, KrettekC.The timing of fracture treatment in polytrauma patients: relevance of damage control orthopedic surgery. Am J Surg2002;183(6):622–9.
14.
KubiakEN, BeebeMJ, NorthK, Early weight bearing after lower extremity fractures in adults. J Am Orthop Assoc2013;21(12):727–38.
15.
TingstadEM, WolinskyPR, ShyrY, Effect of immediate weight bearing on plated fractures of the humeral shaft. J Trauma2000;49:278–80.
16.
SandersR, HaidukewychGJ, MilneT, Minimal versus maximal plate fixation techniques of the ulna: the biomechanical effect of number of screws and plate length. J Orthop Trauma2002;16(3):66–171.
17.
BostmanO, ManninenM, PihlajamakiH.Complications of plate fixation in fresh displaced midclavicular fractures. J Trauma1997;43(5):778–83.
18.
ShinSJ, DoNH, JangKY. Risk factors for postoperative complications of displaced clavicular midshaft fractures. J Trauma Acute Care Surg2012;72(4): 1046–50.
19.
BrumbackRJ, ToalTRJr, Murphy-ZaneMS, Immediate weight-bearing after treatment of a comminuted fracture of the femoral shaft with a statically locked intramedullary nail. J Bone Joint Surg Am1999;81(11):1538–44.
20.
KovalKJ, ChenAL, AharonoffGB, Clinical pathway for hip fractures in the elderly: the Hospital for Joint Diseases experience. Clin Orthop Relat Res2004;425:72–81.
21.
IannottiMR, CrosbyLA, StaffordP, Effects of plate location and selection on the stability of midshaft clavicle osteotomies: a biomechanical study. J Shoulder Elbow Surg2002;11:457–62.
22.
PartalG, MeyersKN, SamaN, Superior versus anteroinferior plating of the clavicle revisited: a mechanical study. J Orthop Trauma2010;24(7):420–5.
23.
DrosdowechDS, ManwellSE, FerreiraLM, Biomechanical analysis of fixation of middle third fractures of the clavicle. J Orthop Trauma2011;25(1): 39–43.
24.
CelestreP, RoberstonC, MaharA, Biomechanical evaluation of clavicle fracture plating techniques: does a locking plate provide improved stability?J Orthop Trauma2008;22(4):241–7.
25.
FavreP, KloenP, HelfetDL, Superior versus anteroinferior plating of the clavicle: a finite element study. J Orthop Trauma2011 Nov;25(11):661–5.
26.
TaylorP, DayRF, NichollsRL, The comminuted midshaft clavicle fracture: a biomechanical evaluation of plating methods. Clin Biomech2011;26:491–6.
27.
SlavensBA, SturmPF, HarrisGF. Upper extremity inverse dynamics model for crutch assisted gait assessment. J Biomech2010;43:2026–31.
28.
CunninghamBP, McLarenA, RobinsonM, Clavicular length: the assumption of symmetry. Orthopedics2013;36(3):343–e347.
29.
TörnkvistH, HearnTC, SchatzkerJ.The strength of plate fixation in relation to the number and spacing of bone screws. J Orthop Trauma1996;10(3):204–8.
30.
McKeeMD, SchemitschEH, StephenD, Functional outcome following clavicle fractures in polytrauma patients. J Trauma Acute Care Surg1999;47(3): 616.
