Abstract
Abstract
Objectives
We aimed to evaluate if union of clavicle fractures can be predicted at six weeks post-injury by the presence of bridging callus detected by ultrasound.
Methods
Adult patients who sustained a displaced midshaft clavicle were recruited prospectively. We assessed patient demographics, functional scores and radiographic predictors with a standardized protocol at six weeks. Ultrasound evaluation of the fracture site was undertaken to determine if sonographic bridging callus was present. Nonunion was determined by CT scanning at six months post-injury. Clinical features at six weeks were used to stratify patients at high risk of nonunion and a QuickDASH ≥40, fracture movement on examination or absence of callus on radiograph.
Results
112 patients completed follow-up at six months with a nonunion incidence of 17% (n=18/112). Sonographic bridging callus was detected in 62.5% (n=70/112) of the cohort at six weeks post-injury. If present, union occurred in 98.6% of the fractures (n=69/70). If absent, nonunion developed in 40.5% of cases (n=17/42). The sensitivity to predict union with sonographic bridging callus at six weeks was 73.4% and the specificity was 94.4%. Regression analysis found failure to detect sonographic bridging callus at six weeks was associated with nonunion, older age, female sex, and greater overall fracture displacement (Nagelkerke R2=0.60). Of the cohort, 30.4% (n=34/112) had absent sonographic bridging callus at six weeks in combination with one or more of the ‘high risk’ clinical features. If one was present the nonunion rate was 47.1%, increasing to 60% with two risk factors and 100% when combined with all three.
Conclusions
Ultrasound can accurately predict fracture healing at six weeks following a displaced midshaft clavicle fracture. When combined with poor clinical recovery this could be used to target patients for early operative intervention.
Declaration of Interest
(b) declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported:I declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
