%0 Journal Article
%T Superior versus anteroinferior plating for mid-shaft clavicle fractures: a randomized clinical trial.
%A Rivera-Saldívar G
%A Manrique-Ávila JA
%J Cir Cir
%V 92
%N 2
%D 2024
%M 38782391
%F 0.416
%R 10.24875/CIRU.22000562
%X <B>BACKGROUND: </B>Clavicle fractures represent 2.5-4% of all fractures observed in emergency services. 80% occurs in the middle third. Treatment by plating requires a higher level of evidence.<BR><B>OBJECTIVE: </B>To compare the functional outcomes of mid-shaft clavicle fractures managed with superior plating compared to anteroinferior plating.<BR><B>METHODS: </B>A randomized, double-blind, parallel, superiority clinical trial.<BR><B>METHODS: </B>Patients with fractures of the clavicles AO15B1 and AO15B2 were studied. Patients were randomized to be treated with either 3.5 mm superior or anteroinferior plating. A rehabilitation program was designed for both groups. The primary outcome measure was the Disability of Arm, Shoulder, and Hand (DASH) score; secondary outcomes included pain, union rate, and complication rates.<BR><B>RESULTS: </B>Twenty-eight patients were studied and were eligible for analysis. Significant differences were found in the function assessed with the DASH score at 30 days for the superior plating compared with anteroinferior (43.74 vs. 29.26, respectively, p = 0.027), 60 days (23.97 vs. 11.18, p = 0.021), and 90 days (9.52 vs. 3.5, p = 0.016). One loosening with superficial infection was found with superior plating.<BR><B>CONCLUSIONS: </B>Using an anteroinferior reconstruction plate in diaphyseal fractures offers better functional results than the upper plate in patients with fractures of the middle third of the clavicle.<BR><B>BACKGROUND: </B>Las fracturas de clavícula comprenden el 2.5-4% de todas las fracturas observadas en los servicios de emergencia. El 80% se presentan en el tercio medio. La posición de la placa como tratamiento requiere mayor nivel de evidencia.<BR><B>OBJECTIVE: </B>Comparar los resultados funcionales de las fracturas diafisarias de clavícula manejadas con placa superior versus placa anteroinferior.<BR><B>UNASSIGNED: </B>Ensayo clínico aleatorizado, doble ciego, paralelo, de superioridad. Se estudiaron pacientes con fractura diafisaria de clavícula AO15B1 y AO15B2. Se manejaron con placa de reconstrucción de 3.5 mm colocada en forma superior o anteroinferior. Se diseñó un programa de rehabilitación para ambos grupos. El resultado primario fue medido con el cuestionario DASH y los resultados secundarios incluyeron dolor, presencia de consolidación y complicaciones.<BR><B>RESULTS: </B>Fueron elegibles para análisis 28 pacientes. Se encontraron diferencias significativas de la escala DASH a los 30 días para la maniobra superior comparada con la inferior (43.74 vs. 29.26, respectivamente; p = 0.027), a los 60 días (23.97 vs. 11.18; p = 0.021) y a los 90 días (9.52 vs. 3.5; p = 0.016).<BR><B>CONCLUSIONS: </B>El uso de placa de reconstrucción anteroinferior en las fracturas diafisarias ofrece mejores resultados funcionales en comparación con la placa superior en pacientes con fracturas de tercio medio de clavícula.