OBJECTIVES: To evaluate different methods of length determination in acute displaced midshaft clavicle fractures. METHODS: To provide static conditions, 30 patients with healed midshaft clavicle fracture were investigated by comparing all measuring methods described in literature. The investigation included a standardized 15-degree tilted radiograph of the clavicle, a 15-degree up-tilted anteroposterior panorama radiograph of the shoulder girdle, and a posteroanterior thorax radiograph. The difference between both clavicles was also measured clinically with a tape. A computed tomography (CT) scan of the shoulder girdle was conducted with two-dimensional reconstructions of the CT scan serving as a reference method. Shortening was determined as proportional length difference. Clinical measuring was performed by 2 observers, and radiological analyses were performed by 4 independent investigators. Investigators were asked to perform repeated measurements to provide intraobserver data. RESULTS: CT measurements, measurements on a posteroanterior thorax radiograph, and 15-degree up-tilted anteroposterior panorama radiograph of the shoulder girdle showed comparable repeatability. Repeatability for clinical measurements and measurements on 15-degree tilted radiographs of the clavicle were markedly lower. Agreement with CT measurements was highest for the measurements on posteroanterior thorax radiographs. CONCLUSION: While shortening in clavicle fractures is considered an important parameter in choosing a treatment modality, a standardized method of measurement is essential. Our results suggest determining proportional length differences by taking a posteroanterior thorax radiograph.
OBJECTIVES: To evaluate different methods of length determination in acute displaced midshaft clavicle fractures. METHODS: To provide static conditions, 30 patients with healed midshaft clavicle fracture were investigated by comparing all measuring methods described in literature. The investigation included a standardized 15-degree tilted radiograph of the clavicle, a 15-degree up-tilted anteroposterior panorama radiograph of the shoulder girdle, and a posteroanterior thorax radiograph. The difference between both clavicles was also measured clinically with a tape. A computed tomography (CT) scan of the shoulder girdle was conducted with two-dimensional reconstructions of the CT scan serving as a reference method. Shortening was determined as proportional length difference. Clinical measuring was performed by 2 observers, and radiological analyses were performed by 4 independent investigators. Investigators were asked to perform repeated measurements to provide intraobserver data. RESULTS: CT measurements, measurements on a posteroanterior thorax radiograph, and 15-degree up-tilted anteroposterior panorama radiograph of the shoulder girdle showed comparable repeatability. Repeatability for clinical measurements and measurements on 15-degree tilted radiographs of the clavicle were markedly lower. Agreement with CT measurements was highest for the measurements on posteroanterior thorax radiographs. CONCLUSION: While shortening in clavicle fractures is considered an important parameter in choosing a treatment modality, a standardized method of measurement is essential. Our results suggest determining proportional length differences by taking a posteroanterior thorax radiograph.
Authors: Lori Anne Archer; Stephen Hunt; Daniel Squire; Carl Moores; Craig Stone; Frank O'Dea; Andrew Furey Journal: Can J Surg Date: 2016-09 Impact factor: 2.089