Olivier A van der Meijden1, R Marijn Houwert1, Martijn Hulsmans1, Frans-Jasper G Wijdicks1, Marcel G W Dijkgraaf2, Sven A G Meylaerts3, Eric R Hammacher4, Michiel H J Verhofstad5, Egbert J M M Verleisdonk1. 1. Department of Surgery, Diakonessenhuis Utrecht, P.O. Box 80250, 3508 TG Utrecht, the Netherlands. E-mail address for E.J.M.M. Verleisdonk: ejverlei@diakhuis.nl. 2. Clinical Research Unit, Academic Medical Center Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands. 3. Department of Surgery, Medical Center Haaglanden, P.O. Box 432, 2501 CK The Hague, the Netherlands. 4. Department of Surgery, St. Antonius Hospital, P.O. Box 2500, 3430 EM Nieuwegein, the Netherlands. 5. Department of Surgery, Erasmus Medical Center, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
Abstract
BACKGROUND: Over the past decades, the operative treatment of displaced midshaft clavicular fractures has increased. The aim of this study was to compare short and midterm results of open reduction and plate fixation with those of intramedullary nailing for displaced midshaft clavicular fractures. METHODS: A multicenter, randomized controlled trial was performed in four different hospitals. The study included 120 patients, eighteen to sixty-five years of age, treated with eitheropen reduction and plate fixation (n = 58) or intramedullary nailing (n = 62). Preoperative and postoperative shoulder function scores and complications were documented until one year postoperatively. Significance was set at p < 0.05. RESULTS: No significant differences in the Disabilities of the Arm, Shoulder and Hand (DASH) or Constant-Murley score (3.0 and 96.0 points for the plate group and 5.6 and 95.5 points for the nailing group) were noted between the two surgical interventions at six months postoperatively. Until six months after the surgery, the plate-fixation group experienced less disability than the nailing group as indicated by the area under the curve of the DASH scores for this time period (p = 0.02). The mean numbers of complications per patient, irrespective of their severity, were similar between the plate-fixation (0.67) and nailing (0.74) groups (p = 0.65). CONCLUSIONS: The patients in the plate-fixation group recovered faster than the patients in the intramedullary nailing group, but the groups had similar results at six months postoperatively and the time of final follow-up. The rate of complications requiring revision surgery was low. Implant-related complications occurred frequently and could often be treated by implant removal.
RCT Entities:
BACKGROUND: Over the past decades, the operative treatment of displaced midshaft clavicular fractures has increased. The aim of this study was to compare short and midterm results of open reduction and plate fixation with those of intramedullary nailing for displaced midshaft clavicular fractures. METHODS: A multicenter, randomized controlled trial was performed in four different hospitals. The study included 120 patients, eighteen to sixty-five years of age, treated with either open reduction and plate fixation (n = 58) or intramedullary nailing (n = 62). Preoperative and postoperative shoulder function scores and complications were documented until one year postoperatively. Significance was set at p < 0.05. RESULTS: No significant differences in the Disabilities of the Arm, Shoulder and Hand (DASH) or Constant-Murley score (3.0 and 96.0 points for the plate group and 5.6 and 95.5 points for the nailing group) were noted between the two surgical interventions at six months postoperatively. Until six months after the surgery, the plate-fixation group experienced less disability than the nailing group as indicated by the area under the curve of the DASH scores for this time period (p = 0.02). The mean numbers of complications per patient, irrespective of their severity, were similar between the plate-fixation (0.67) and nailing (0.74) groups (p = 0.65). CONCLUSIONS: The patients in the plate-fixation group recovered faster than the patients in the intramedullary nailing group, but the groups had similar results at six months postoperatively and the time of final follow-up. The rate of complications requiring revision surgery was low. Implant-related complications occurred frequently and could often be treated by implant removal.
Authors: H Frima; M H J Hulsmans; R M Houwert; U Ahmed Ali; E J M M Verleisdonk; C Sommer; M van Heijl Journal: Eur J Trauma Emerg Surg Date: 2017-03-17 Impact factor: 3.693
Authors: Martijn H J Hulsmans; Mark van Heijl; R Marijn Houwert; Eric R Hammacher; Sven A G Meylaerts; Michiel H J Verhofstad; Marcel G W Dijkgraaf; Egbert J M M Verleisdonk Journal: Clin Orthop Relat Res Date: 2016-11-09 Impact factor: 4.176
Authors: M H J Hulsmans; M van Heijl; H Frima; O A J van der Meijden; H R van den Berg; A H van der Veen; A C Gunning; R M Houwert; E J M M Verleisdonk Journal: Eur J Trauma Emerg Surg Date: 2017-10-09 Impact factor: 3.693
Authors: Daniel E Axelrod; Seper Ekhtiari; Anthony Bozzo; Mohit Bhandari; Herman Johal Journal: Clin Orthop Relat Res Date: 2020-02 Impact factor: 4.755
Authors: Christopher Vannabouathong; Justin Chiu; Rahil Patel; Shreyas Sreeraman; Elias Mohamed; Mohit Bhandari; Kenneth Koval; Michael D McKee Journal: JSES Int Date: 2020-05-04