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Nonoperative Treatment of Ipsilateral Fractures of the Scapula and Clavicle
BackgroundInternal fixation of one or both bones is the recommended treatment for floating shoulder injuries (ipsilateral fractures of the scapula and clavicle). Perceived risks of nonoperative treatment include abduction weakness, decreased range of motion, chronic pain, malunion, and nonunion. Non...
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| Published in: | Journal of bone and joint surgery. American volume 2000-06, Vol.82 (6), p.774-774 |
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| container_title | Journal of bone and joint surgery. American volume |
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| creator | Edwards, Scott G Whittle, A Paige Wood, George W |
| description | BackgroundInternal fixation of one or both bones is the recommended treatment for floating shoulder injuries (ipsilateral fractures of the scapula and clavicle). Perceived risks of nonoperative treatment include abduction weakness, decreased range of motion, chronic pain, malunion, and nonunion. None of these problems, however, have been confirmed by clinical studies. The purpose of this retrospective study was to analyze the clinical and radiographic results of nonoperative treatment of floating shoulder injuries.MethodsTwenty patients with a floating shoulder injury were treated with either a sling or a shoulder immobilizer. Eleven clavicular fractures were displaced ten millimeters or more, and five scapular fractures were displaced more than five millimeters. Physical therapy was begun three days to two weeks after the injury. Patients were evaluated with three separate scoring systemsthose of Herscovici et al., Rowe, and Constant and Murley. Shoulder abduction and flexion were measured, and abduction strength was evaluated by clinical examination and comparison with the uninjured extremity. The duration of follow-up averaged twenty-eight months (range, nine to seventy-nine months).ResultsNineteen of the twenty pairs of fractures united uneventfully. One clavicular nonunion occurred secondary to segmental bone loss from a gunshot wound. On the basis of the Herscovici rating system, seventeen patients had an excellent result and three had a good result. According to the Rowe system, eighteen patients had an excellent result, one had a good result, and one had a fair result. The average Rowe score was 95. The average Constant score was 96. In all twenty patients, the strength of the injured extremity was equal to that of the uninjured extremity. Eighteen patients had a full, symmetrical range of shoulder motion, one lost 15 degrees of flexion, and one lost 20 degrees of abduction.ConclusionsNonoperative treatment of floating shoulder injuries, especially those with less than five millimeters of fracture displacement, can achieve satisfactory results that are probably equal or superior to those reported after operative treatment, without the risk of operative complications. |
| doi_str_mv | 10.2106/00004623-200006000-00003 |
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| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_71193606</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>55109316</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4623-55b663041d21fa25e5977ae12371a30007c7da0cd64918b3f887ac1d427422c93</originalsourceid><addsrcrecordid>eNp1kV9r2zAUxcVoadKsX2GYUfrmVv9lP47QtKVle1j3LG7ka-JOsT3Jbum3r5xkWxlMIHS593cuhyNCMkYvOaP6iqYjNRc5nyqdbj4V4gOZMyVUzkShj8icUs7yUig1I6cxPk0iSc0JmTFaqJKWek7uv3Zt12OAoXnG7DEgDFtsh6yrs7s-Nh6GNPPZKoAbxoBxGgwbzL476EcPGbRVtvTw3DiPH8lxDT7i2eFdkB-r68flbf7w7eZu-eUhdzvPSq21FlSyirMauEJVGgPIuDAMRDJpnKmAukrLkhVrUReFAccqyY3k3JViQS72e_vQ_RoxDnbbRIfeQ4vdGK1hrBSa6gR-_gd86sbQJm-WU8WkkIomqNhDLnQxBqxtH5othFfLqJ3Str_Ttn_S3rVEkn467B_XW6zeCffxJuD8AEB04OsArWviX05qpZVJmNxjL51PeceffnzBYDcIftjY_322eAOmL5PO</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>205143450</pqid></control><display><type>article</type><title>Nonoperative Treatment of Ipsilateral Fractures of the Scapula and Clavicle</title><source>HEAL-Link subscriptions: Lippincott Williams & Wilkins</source><creator>Edwards, Scott G ; Whittle, A Paige ; Wood, George W</creator><creatorcontrib>Edwards, Scott G ; Whittle, A Paige ; Wood, George W</creatorcontrib><description>BackgroundInternal fixation of one or both bones is the recommended treatment for floating shoulder injuries (ipsilateral fractures of the scapula and clavicle). Perceived risks of nonoperative treatment include abduction weakness, decreased range of motion, chronic pain, malunion, and nonunion. None of these problems, however, have been confirmed by clinical studies. The purpose of this retrospective study was to analyze the clinical and radiographic results of nonoperative treatment of floating shoulder injuries.MethodsTwenty patients with a floating shoulder injury were treated with either a sling or a shoulder immobilizer. Eleven clavicular fractures were displaced ten millimeters or more, and five scapular fractures were displaced more than five millimeters. Physical therapy was begun three days to two weeks after the injury. Patients were evaluated with three separate scoring systemsthose of Herscovici et al., Rowe, and Constant and Murley. Shoulder abduction and flexion were measured, and abduction strength was evaluated by clinical examination and comparison with the uninjured extremity. The duration of follow-up averaged twenty-eight months (range, nine to seventy-nine months).ResultsNineteen of the twenty pairs of fractures united uneventfully. One clavicular nonunion occurred secondary to segmental bone loss from a gunshot wound. On the basis of the Herscovici rating system, seventeen patients had an excellent result and three had a good result. According to the Rowe system, eighteen patients had an excellent result, one had a good result, and one had a fair result. The average Rowe score was 95. The average Constant score was 96. In all twenty patients, the strength of the injured extremity was equal to that of the uninjured extremity. Eighteen patients had a full, symmetrical range of shoulder motion, one lost 15 degrees of flexion, and one lost 20 degrees of abduction.ConclusionsNonoperative treatment of floating shoulder injuries, especially those with less than five millimeters of fracture displacement, can achieve satisfactory results that are probably equal or superior to those reported after operative treatment, without the risk of operative complications.</description><edition>American volume</edition><identifier>ISSN: 0021-9355</identifier><identifier>EISSN: 1535-1386</identifier><identifier>DOI: 10.2106/00004623-200006000-00003</identifier><identifier>PMID: 10859096</identifier><identifier>CODEN: JBJSA3</identifier><language>eng</language><publisher>Boston, MA: Copyright by The Journal of Bone and Joint Surgery, Incorporated</publisher><subject>Adolescent ; Adult ; Aged ; Biological and medical sciences ; Clavicle - diagnostic imaging ; Clavicle - injuries ; Diseases of the osteoarticular system. Orthopedic treatment ; Fractures, Bone - diagnostic imaging ; Fractures, Bone - therapy ; Humans ; Medical sciences ; Middle Aged ; Radiography ; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) ; Scapula - diagnostic imaging ; Scapula - injuries ; Shoulder - diagnostic imaging ; Shoulder Injuries ; Treatment Outcome</subject><ispartof>Journal of bone and joint surgery. American volume, 2000-06, Vol.82 (6), p.774-774</ispartof><rights>Copyright 2000 by The Journal of Bone and Joint Surgery, Incorporated</rights><rights>2000 INIST-CNRS</rights><rights>Copyright Journal of Bone and Joint Surgery, Inc. Jun 2000</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4623-55b663041d21fa25e5977ae12371a30007c7da0cd64918b3f887ac1d427422c93</citedby><cites>FETCH-LOGICAL-c4623-55b663041d21fa25e5977ae12371a30007c7da0cd64918b3f887ac1d427422c93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,786,790,27957,27958</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=1465657$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/10859096$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Edwards, Scott G</creatorcontrib><creatorcontrib>Whittle, A Paige</creatorcontrib><creatorcontrib>Wood, George W</creatorcontrib><title>Nonoperative Treatment of Ipsilateral Fractures of the Scapula and Clavicle</title><title>Journal of bone and joint surgery. American volume</title><addtitle>J Bone Joint Surg Am</addtitle><description>BackgroundInternal fixation of one or both bones is the recommended treatment for floating shoulder injuries (ipsilateral fractures of the scapula and clavicle). Perceived risks of nonoperative treatment include abduction weakness, decreased range of motion, chronic pain, malunion, and nonunion. None of these problems, however, have been confirmed by clinical studies. The purpose of this retrospective study was to analyze the clinical and radiographic results of nonoperative treatment of floating shoulder injuries.MethodsTwenty patients with a floating shoulder injury were treated with either a sling or a shoulder immobilizer. Eleven clavicular fractures were displaced ten millimeters or more, and five scapular fractures were displaced more than five millimeters. Physical therapy was begun three days to two weeks after the injury. Patients were evaluated with three separate scoring systemsthose of Herscovici et al., Rowe, and Constant and Murley. Shoulder abduction and flexion were measured, and abduction strength was evaluated by clinical examination and comparison with the uninjured extremity. The duration of follow-up averaged twenty-eight months (range, nine to seventy-nine months).ResultsNineteen of the twenty pairs of fractures united uneventfully. One clavicular nonunion occurred secondary to segmental bone loss from a gunshot wound. On the basis of the Herscovici rating system, seventeen patients had an excellent result and three had a good result. According to the Rowe system, eighteen patients had an excellent result, one had a good result, and one had a fair result. The average Rowe score was 95. The average Constant score was 96. In all twenty patients, the strength of the injured extremity was equal to that of the uninjured extremity. Eighteen patients had a full, symmetrical range of shoulder motion, one lost 15 degrees of flexion, and one lost 20 degrees of abduction.ConclusionsNonoperative treatment of floating shoulder injuries, especially those with less than five millimeters of fracture displacement, can achieve satisfactory results that are probably equal or superior to those reported after operative treatment, without the risk of operative complications.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Clavicle - diagnostic imaging</subject><subject>Clavicle - injuries</subject><subject>Diseases of the osteoarticular system. Orthopedic treatment</subject><subject>Fractures, Bone - diagnostic imaging</subject><subject>Fractures, Bone - therapy</subject><subject>Humans</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Radiography</subject><subject>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)</subject><subject>Scapula - diagnostic imaging</subject><subject>Scapula - injuries</subject><subject>Shoulder - diagnostic imaging</subject><subject>Shoulder Injuries</subject><subject>Treatment Outcome</subject><issn>0021-9355</issn><issn>1535-1386</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2000</creationdate><recordtype>article</recordtype><recordid>eNp1kV9r2zAUxcVoadKsX2GYUfrmVv9lP47QtKVle1j3LG7ka-JOsT3Jbum3r5xkWxlMIHS593cuhyNCMkYvOaP6iqYjNRc5nyqdbj4V4gOZMyVUzkShj8icUs7yUig1I6cxPk0iSc0JmTFaqJKWek7uv3Zt12OAoXnG7DEgDFtsh6yrs7s-Nh6GNPPZKoAbxoBxGgwbzL476EcPGbRVtvTw3DiPH8lxDT7i2eFdkB-r68flbf7w7eZu-eUhdzvPSq21FlSyirMauEJVGgPIuDAMRDJpnKmAukrLkhVrUReFAccqyY3k3JViQS72e_vQ_RoxDnbbRIfeQ4vdGK1hrBSa6gR-_gd86sbQJm-WU8WkkIomqNhDLnQxBqxtH5othFfLqJ3Str_Ttn_S3rVEkn467B_XW6zeCffxJuD8AEB04OsArWviX05qpZVJmNxjL51PeceffnzBYDcIftjY_322eAOmL5PO</recordid><startdate>200006</startdate><enddate>200006</enddate><creator>Edwards, Scott G</creator><creator>Whittle, A Paige</creator><creator>Wood, George W</creator><general>Copyright by The Journal of Bone and Joint Surgery, Incorporated</general><general>Journal of Bone and Joint Surgery Incorporated</general><general>Journal of Bone and Joint Surgery AMERICAN VOLUME</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QL</scope><scope>7QO</scope><scope>7QP</scope><scope>7RV</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AF</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2P</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>200006</creationdate><title>Nonoperative Treatment of Ipsilateral Fractures of the Scapula and Clavicle</title><author>Edwards, Scott G ; Whittle, A Paige ; Wood, George W</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4623-55b663041d21fa25e5977ae12371a30007c7da0cd64918b3f887ac1d427422c93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2000</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Clavicle - diagnostic imaging</topic><topic>Clavicle - injuries</topic><topic>Diseases of the osteoarticular system. Orthopedic treatment</topic><topic>Fractures, Bone - diagnostic imaging</topic><topic>Fractures, Bone - therapy</topic><topic>Humans</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Radiography</topic><topic>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)</topic><topic>Scapula - diagnostic imaging</topic><topic>Scapula - injuries</topic><topic>Shoulder - diagnostic imaging</topic><topic>Shoulder Injuries</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Edwards, Scott G</creatorcontrib><creatorcontrib>Whittle, A Paige</creatorcontrib><creatorcontrib>Wood, George W</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Biotechnology Research Abstracts</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>ProQuest Nursing and Allied Health Journals</collection><collection>Virology and AIDS Abstracts</collection><collection>ProQuest Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>Science Database (ProQuest)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of bone and joint surgery. American volume</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Edwards, Scott G</au><au>Whittle, A Paige</au><au>Wood, George W</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Nonoperative Treatment of Ipsilateral Fractures of the Scapula and Clavicle</atitle><jtitle>Journal of bone and joint surgery. American volume</jtitle><addtitle>J Bone Joint Surg Am</addtitle><date>2000-06</date><risdate>2000</risdate><volume>82</volume><issue>6</issue><spage>774</spage><epage>774</epage><pages>774-774</pages><issn>0021-9355</issn><eissn>1535-1386</eissn><coden>JBJSA3</coden><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>BackgroundInternal fixation of one or both bones is the recommended treatment for floating shoulder injuries (ipsilateral fractures of the scapula and clavicle). Perceived risks of nonoperative treatment include abduction weakness, decreased range of motion, chronic pain, malunion, and nonunion. None of these problems, however, have been confirmed by clinical studies. The purpose of this retrospective study was to analyze the clinical and radiographic results of nonoperative treatment of floating shoulder injuries.MethodsTwenty patients with a floating shoulder injury were treated with either a sling or a shoulder immobilizer. Eleven clavicular fractures were displaced ten millimeters or more, and five scapular fractures were displaced more than five millimeters. Physical therapy was begun three days to two weeks after the injury. Patients were evaluated with three separate scoring systemsthose of Herscovici et al., Rowe, and Constant and Murley. Shoulder abduction and flexion were measured, and abduction strength was evaluated by clinical examination and comparison with the uninjured extremity. The duration of follow-up averaged twenty-eight months (range, nine to seventy-nine months).ResultsNineteen of the twenty pairs of fractures united uneventfully. One clavicular nonunion occurred secondary to segmental bone loss from a gunshot wound. On the basis of the Herscovici rating system, seventeen patients had an excellent result and three had a good result. According to the Rowe system, eighteen patients had an excellent result, one had a good result, and one had a fair result. The average Rowe score was 95. The average Constant score was 96. In all twenty patients, the strength of the injured extremity was equal to that of the uninjured extremity. Eighteen patients had a full, symmetrical range of shoulder motion, one lost 15 degrees of flexion, and one lost 20 degrees of abduction.ConclusionsNonoperative treatment of floating shoulder injuries, especially those with less than five millimeters of fracture displacement, can achieve satisfactory results that are probably equal or superior to those reported after operative treatment, without the risk of operative complications.</abstract><cop>Boston, MA</cop><pub>Copyright by The Journal of Bone and Joint Surgery, Incorporated</pub><pmid>10859096</pmid><doi>10.2106/00004623-200006000-00003</doi><tpages>1</tpages><edition>American volume</edition><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Adult Aged Biological and medical sciences Clavicle - diagnostic imaging Clavicle - injuries Diseases of the osteoarticular system. Orthopedic treatment Fractures, Bone - diagnostic imaging Fractures, Bone - therapy Humans Medical sciences Middle Aged Radiography Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) Scapula - diagnostic imaging Scapula - injuries Shoulder - diagnostic imaging Shoulder Injuries Treatment Outcome |
| title | Nonoperative Treatment of Ipsilateral Fractures of the Scapula and Clavicle |
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