Objectives: To determine whether clavicle fracture
displacement and shortening are different between upright and supine
radiographic examinations.
Picture: Dr Pietsch notfallambulanz.blogspot.com
Design: Combined retrospective and prospective comparative study.
Setting: Level I Trauma Center.
Patients: Forty-six patients (mean age, 49 years; range, 24–89 years) with an acute clavicle fracture were evaluated.
Intervention: Standardized clavicle radiographs were
obtained in both supine and upright positions for each patient.
Displacement and shortening were measured and compared between the 2
positions.
Main Outcomes Measurements: One resident and 3
traumatologists classified the fractures and measured displacement and
shortening. Data were aggregated and compared to ensure reliability with
a 2-way mixed intraclass correlation.
Results: Fracture displacement was significantly
greater when measured from upright radiographs (15.9 ± 8.9 mm) than from
supine radiographs (8.4 ± 6.6 mm, P < 0.001), representing
an 89% increase in displacement with upright positioning. Forty-one
percent of patients had greater than 100% displacement on upright but
not on supine radiographs. Compared with the uninjured side, 3.0 ± 10.7
mm of shortening was noted on upright radiographs and 1.3 ± 9.5 mm of
lengthening on supine radiographs (P < 0.001). The
intraclass correlation was 0.82 [95% confidence interval (CI),
0.73–0.89] for OTA fracture classification, 0.81 (95% CI, 0.75–0.87) for
vertical displacement, and 0.92 (95% CI, 0.88–0.95) for injured
clavicle length, demonstrating very high agreement among evaluators.
Conclusions: Increased fracture displacement and
shortening was observed on upright compared with supine radiographs.
This suggests that upright radiographs may better demonstrate clavicle
displacement and predict the position at healing if nonoperative
treatment is selected.
Keyword: Clavicle fracture, Dr Pietsch, x-ray clavicle fracture and posture
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