Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Professor Lars Adolfsson, Linköping University
- Second opponent: Associate Professor Kjell Matre, University of Bergen
- Third member and chair of the evaluation committee: Associate Professor Jarlis Wesche, University of Oslo
Chair of the Defence
Professor Magne Røkkum, University of Oslo
Principal Supervisor
Associate Professor Stein-Erik Utvåg, University of Oslo
Summary
A fracture of the clavicle is a common occurrence in both children and adults, and occurs usually in the middle third of the shaft. While these fractures traditionally were treated conservatively with a sling, a recent growth of interest has led to more fractures being managed operatively although strong evidence for this approach is lacking.
Paper I and II in this thesis aim to assess the patient reported outcomes after non-operative treatment of midshaft clavicle fractures in adolescents and adults to evaluate to what extent the fracture affects the patient´s shoulder function after several years. The first paper in this thesis finds that good to excellent functional outcomes are to be expected after non-operative treatment after clavicle fractures in 10 – 18-year-old patients, whereas the second paper focused only on adults with displaced fractures. Most adult patients have a favorable outcome, but about 25% have functional deficits after treatment with a sling. However, as more patients are being surgically treated: what is the optimal method of fracture fixation?
We randomized 123 adult patients with completely displaced midshaft clavicle fractures to either plate fixation (PF) or elastic stabile intramedullary nailing (ESIN) (paper III and IV). After one year, there was no difference between the methods and most patients returned to their pre-injury shoulder function. In fractures with comminution, PF provided a faster return of shoulder function than ESIN. About half of the ESIN patients were treated with closed reduction, and this group had a better functional outcome the first six months, but had also less pain after 5 years compared to open ESIN and PF. This suggests that if the fracture does not lend itself to closed reduction end ESIN the surgeon should convert to PF. About 1/3rd of the plates were removed during the first five years, mostly due to pain over the implant, compared to 2/3rd of the Nails.
Additional information
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