Modi Nihar, Mishra Shaswat, Mhatre Jayesh, Kambli Mrinal, Dave Harshit, Gandbhir Viraj
Grant Govt. Medical College and Sir J.J. Group of Hospitals, 300 Resident Hostel, JJ Hospital, Byculla, Mumbai, India.
Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, India.
Indian J Orthop. 2022 Jun 11;56(8):1394-1402. doi: 10.1007/s43465-022-00652-1. eCollection 2022 Aug.
A prospective randomised trial was conducted to compare the results of conservative management of middle-third clavicular fracture using the figure of 8 bandage and broad-arm sling.
296 patients with middle-third clavicle fracture were included in the study conducted between March 2017 and January 2020. 152 patients were managed with figure of 8 bandage and 144 patients were managed with a broad arm sling. Results were evaluated based on clinical, radiological and functional outcomes. Visual analogue scale (VAS) for pain was used to evaluate the clinical outcomes, whereas radiological outcomes were assessed with non-union, malunion, clavicle shortening and time to union. Disability of Arm, Shoulder and Hand score (DASH), Constant score and Nottingham Clavicle Score were used to assess functional outcomes.
The broad arm sling group showed a significantly better VAS score in the first 4 weeks. DASH score was significantly superior in the broad arm sling group in the initial 4 weeks, but with similar outcome thereafter. Constant scores showed a good outcome for both groups at the final follow-up, whereas the Nottingham Clavicle Score was significantly superior in the broad arm sling group at the 2 year follow-up. A satisfactory outcome was achieved with respect to the radiological parameters, without any significant difference between the 2 groups. Incidence of malunion was significantly higher in figure of 8 bandage group.
Broad-arm sling proves to be a better modality of management for middle-third clavicular fractures in terms of ease of application, pain relief, incidence of malunion, and functional outcomes.
开展了一项前瞻性随机试验，以比较使用8字绷带和宽臂吊带对中段锁骨骨折进行保守治疗的效果。
纳入2017年3月至2020年1月期间进行的一项研究中的296例中段锁骨骨折患者。152例患者采用8字绷带治疗，144例患者采用宽臂吊带治疗。根据临床、影像学和功能结果对疗效进行评估。采用视觉模拟评分法（VAS）评估疼痛的临床结果，而影像学结果则通过骨不连、畸形愈合、锁骨缩短和愈合时间进行评估。采用上肢、肩部和手部功能障碍评分（DASH）、Constant评分和诺丁汉锁骨评分评估功能结果。
宽臂吊带组在前4周的VAS评分明显更好。宽臂吊带组在最初4周的DASH评分明显更高，但此后结果相似。两组在最终随访时的Constant评分均显示出良好的结果，而在2年随访时，宽臂吊带组的诺丁汉锁骨评分明显更高。在影像学参数方面取得了满意的结果，两组之间无任何显著差异。8字绷带组的畸形愈合发生率明显更高。
就应用的简便性、疼痛缓解、畸形愈合发生率和功能结果而言，宽臂吊带被证明是中段锁骨骨折更好的治疗方式。
