Malik Awais, Jazini Ehsan, Song Xuyang, Johal Herman, OʼHara Nathan, Slobogean Gerard, Abzug Joshua M
*Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD; and †Department of Orthopaedics, McMaster University, Hamilton, ON, Canada.
J Orthop Trauma. 2017 Jan;31(1):e9-e12. doi: 10.1097/BOT.0000000000000727.
To determine how change in position affects displacement of midshaft clavicle fractures.
Retrospective review.
Level I Trauma Center.
Eighty patients with displaced midshaft clavicle fractures and presence of supine and semiupright or upright chest radiographs taken within 2 weeks of each other.
Supine, semiupright, and upright chest radiographs.
Fracture shortening and vertical displacement on supine, semiupright, and upright radiographs.
Mean vertical displacement was 9.42 mm [95% confidence interval (95% CI), 8.07-10.77 mm], 11.78 mm (95% CI, 10.25-13.32 mm), and 15.72 mm (95% CI, 13.71-17.72 mm) in supine, semiupright, and upright positions, respectively. Fracture shortening was -0.41 mm (95% CI, -2.53 to 1.70 mm), 2.11 mm (95% CI, -0.84 to 5.07), and 4.86 mm (95% CI, 1.66-8.06 mm) in supine, semiupright, and upright positions, respectively. Change in position from supine to upright significantly increased both vertical displacement and fracture shortening (P < 0.001). In the upright position, the proportion of patients who met operative indications (fracture shortening >20 mm) was 3 times greater when compared with that in the supine position (upright 17.65%; supine 5.88%, P = 0.06). Positional changes in fracture displacement were not associated with body mass index, age, or gender.
Patient position is associated with significant changes in fracture displacement. Over 3 times more patients meet operative indications when placed in the upright versus supine position. An upright chest radiograph should be obtained to evaluate midshaft clavicle fracture displacement, as it represents the physiologic stress across the fracture when considering nonoperative management.
Prognostic level IV. See Instructions for Authors for a complete description of levels of evidence.
确定体位变化如何影响锁骨中段骨折的移位。
回顾性研究。
一级创伤中心。
80例锁骨中段移位骨折患者，且在两周内分别拍摄了仰卧位和半直立位或直立位胸部X线片。
仰卧位、半直立位和直立位胸部X线片。
仰卧位、半直立位和直立位X线片上的骨折短缩和垂直移位情况。
仰卧位、半直立位和直立位时，平均垂直移位分别为9.42mm[95%置信区间（95%CI），8.07 - 10.77mm]、11.78mm（95%CI，10.25 - 13.32mm）和15.72mm（95%CI，13.71 - 17.72mm）。骨折短缩分别为-0.41mm（95%CI，-2.53至1.70mm）、2.11mm（95%CI，-0.84至5.07）和4.86mm（95%CI，1.66 - 8.06mm）。从仰卧位到直立位的体位变化显著增加了垂直移位和骨折短缩（P < 0.001）。在直立位时，符合手术指征（骨折短缩>20mm）的患者比例是仰卧位时的3倍（直立位17.65%；仰卧位5.88%，P = 0.06）。骨折移位的体位变化与体重指数、年龄或性别无关。
患者体位与骨折移位的显著变化相关。与仰卧位相比，直立位时符合手术指征的患者多出3倍以上。应拍摄直立位胸部X线片以评估锁骨中段骨折移位，因为在考虑非手术治疗时，它代表了骨折部位的生理应力。
预后水平IV。有关证据水平的完整描述，请参阅作者指南。
