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At least 379 records · Page 21Linked to original sources
PubMed2007

Physician pain reminder as an intervention to enhance analgesia for extremity and clavicle injuries in pediatric emergency.

UNLABELLED: The purpose of this study was to document analgesic use for limb and clavicle injuries in the pediatric emergency department (ED) and to determine whether a physician-oriented pain scale form on the patient's chart would enhance the administration of analgesia. Patients 3 to 18 years old were recruited prospectively in our tertiary pediatric ED in Toronto. The study included 4 crossover periods, 2 with the pain scale form on the patient's chart and 2 without. A total of 310 patients were recruited, mean age was 10 years, 64% were boys, and 62% had sustained fractures. The mean pain score was 4.4. Only 90 (29%) patients received an analgesic in the ED, and 65 (72%) of them were ordered by a physician. Only 24 (20%) in the study group and 22 (14%) in the control group received sufficient analgesia (P = .13). The median time to physician-initiated analgesia after arrival was 2.0 hours (1.0 to 3.3 hours), without a significant difference between groups. Pain control was 4-fold more appropriate in children receiving opioids versus nonopioids. Physician pain reminders did not enhance, and other measures should be taken to increase the dispensing of analgesia. PERSPECTIVE: This is the first study to evaluate whether the addition of a physician-oriented pain-scale form on the chart of patients with injuries improves administration of analgesia in the ED. We found that physicians do not give sufficient analgesia even with this reminder form.

Analgesics↗
PubMedDate not supplied

Can we predict long-term sequelae after fractures of the clavicle based on initial findings? A prospective study with nine to ten years of follow-up.

The aim of this long-term, prospective study was to identify risk factors associated with the outcome of clavicular fractures. During 1989 through 1991, 245 patients aged 15 years or older with a radiographically verified fracture of the clavicle were included. Clinical and radiographic examinations were standardized. Of the 208 patients seen at the 9- to 10-year follow-up, 112 (54%) had recovered completely whereas 96 (46%) still had sequelae. Nonunion occurred in 15 patients (7%). No bony contact was the strongest radiographic predictor for sequelae. Comminuted fractures with transverse fragments had a significantly increased risk for remaining symptoms, as did older patients, whereas there was no significant difference between sexes. Fracture location and shortening did not predict outcome except for cosmetic defects. Angulation of the fracture had no effect on cosmetic defects. Patients with predictive risk factors, such as fractures with no bony contact or displacement, especially if comminuted, and also elderly patients with fractures should be considered for more active treatment options.

Adolescent↗
PubMed1995

Case report: central venous catheter fracture due to compression between the clavicle and first rib.

A central venous catheter inserted via the subclavian route may be compressed by the clavicle and adjacent first rib. This appearance on a radiograph has been previously described as the 'pinch-off sign' and indicates the need to remove the catheter, due to a significant risk of subsequent fracture. A case and its management are presented, followed by discussion of the radiographic appearances and their cause.

Adult↗
PubMed1985

Sclerotic changes of the sternal end of the clavicle.

Five adult females with swelling, tenderness and similar sclerotic changes of the sternal end of the clavicle are presented. They were recognised during a 10-year period, suggesting that the condition is rare and may be misdiagnosed. In three patients strain of the sternoclavicular joint seemed to be an aetiological factor.

Adult↗
PubMed2004

A false negative technetium 99m bone scan in a 53-year-old man with a fractured tibia and fractured clavicles conducted 88 h after the accident.

BACKGROUND: Technetium (Tc) 99m bone scan is used as a diagnostic tool in cases of suspected fractures, and in differentiating between old and acute fracture. The false negative rate 72h after the injury in the under 65-year-old population is less than 5%. CASE PRESENTED: A 53-year-old motorcyclist was admitted to the emergency room after a road accident, suffering fractures of the tibia and both clavicles. A Tc 99m bone scan that was performed more than 72h after the injury, because of suspicion of an undiagnosed hip fracture, did not demonstrate increased uptake at the fracture sites. UNIQUENESS: The person involved was relatively young (53 years old), and the bone scan was performed more than 3 days after the injury. Despite these two facts, the bone scan was negative at the fracture sites.

Accidents, Traffic↗
PubMed1985

[Clavicle osteolysis in MacDuffie's syndrome].

MacDuffie's syndrome emerges from systemic vasculitis as including recurrent urticaria-like skin lesions, episodic angio-oedemas, articular manifestations and abdominal pains, with a tendency to affect women. Renal involvement may burden the prognosis. Hypocomplementemia is usual by deficiency of the classical pathway. Corticosteroid therapy is habitual. The case reported, fitting to this nosological entity offers two new features: in the first place, the osteolysis of the distal part of the clavicle whereas the joints are not affected by destroying lesions; then the non steroidal anti-inflammatory drugs was effective within a period of one year without complication.

Adult↗
PubMed1991

Late lesions of the brachial plexus after fracture of the clavicle.

Fractures of the clavicle, particularly those which are markedly displaced, may, in rare instances cause injury to the subclavian vessels and the brachial plexus which manifest progressively days or weeks after the initial trauma. More often than not, however, a costo-clavicular compression syndrome appears months or years after the clavicular fracture as a result of constriction by scar which invests the neuro-vascular bundle, by a secondary aneurysm or by hypertrophic callus. The authors report 16 such cases, one of which was treated conservatively, thirteen treated by surgical intervention while two cases are awaiting operation. These patients represent just over 1% of brachial plexus lesions seen over a period of twenty years in two surgical centres. Operative treatment consists of reduction of the clavicular deformity, possibly first rib resection, liberation of the plexus and correction of a vascular lesion as required. The outcome is usually good.

Adolescent↗
PubMedDate not supplied

Type 2 fractures of the distal clavicle: a new surgical technique.

Neer type 2 fractures of the distal clavicle have a high rate of nonunion and delayed union. In this series nine cases of coracoclavicular ligament reconstruction with Dacron graft material led to union at the fracture site. All patients had no symptoms and returned to full activity. This technique allows for stable fixation with early mobilization and return to work and sports.

Activities of Daily Living↗
PubMed2000

Vanishing distal clavicle after arthroscopic acromioplasty.

Arthroscopic subacromial decompression is gaining wide acceptance. There are several reports on its technique, its limitations, and its efficacy. However, papers describing complications are rare. We describe a case of osteolysis of the distal clavicle after overenthusiastic arthroscopic subacromial decompression.

Acromioclavicular Joint↗
PubMed1978

[Complications due to migration of a Kirschner wire from the clavicle (author's transl)].

The complications due to migration of a Kirschner wire from the clavicle are described. The major complication of a vascular and pulmonary kind were found in five cases. Migration of the wire into major vessels (aorta, subclavian artery) were seen twice and in three cases, the wire entered the lung. Removal of the wire from the aorta had a fatal result. Before removing displaced fixation wires, accurate localisation is necessary, if necessary using angiography in order to plan the subsequent operation. To avoid migration of the wire, one end should be bent to form a walking-stick shape, and the arm should be immobilised.

Adolescent↗
PubMed2001

[Luxation of the clavicle as rare cause of monstrous thrombus formation of the internal jugular vein].

Summary.A 55-year-old female with massive painless swelling of the right cervical soft tissue was admitted for surgical exploration. The operation revealed an ectasia of the internal jugular vein with a diameter up to 7 cm which was obliterated by thrombotic material. We discussed a retrosternal dislocation of the clavicle proved by chest X-ray. We resected the internal jugular vein from the basis of the skull to the upper thoracic aperture. The postoperative course was uneventful.

Clavicle↗
PubMed2002

[Surgical treatment of fractures of the clavicle--Indication, surgical technique and results].

UNLABELLED: 46 cases of clavicular fracture (25 of the middle third and 21 of the distal third) are reviewed concerning indications for surgery, surgical technique and postoperative results. In 32 cases surgery was necessary due to dislocation (in 7 cases with a rupture of the coracoclavicular ligaments), 3 times due to a complex trauma of the shoulder joint, 3 times due to a local neurovascular involvement, 3 times due to a delayed fracture healing and 3 times due to a pathological fracture. In two cases an open fracture required osteosynthesis. The most frequent surgical procedure was plate osteosynthesis using the following materials: 3.5 mm LCDC plate, the so called "Balser plate" and the "Ulrich plate", 3.5 mm reconstruction plate, 3.5 mm T-plate and compound plate. In 14 cases autogenous bone grafting was performed. Additional suture of the coracoclavicular ligaments was indicated in 7 patients. In every case early physiotherapy followed the surgical procedure. COMPLICATIONS: in 2 cases an avascular pseudarthrosis emerged after plate osteosynthesis without autogenous bone grafting. In one case a non-union developed due to infection. Moreover we found a loosening of a "Balser plate" and in one patient the development of keloid tissue. The functional outcome according to the Constant score was good. 32 patients achieved 89 out of 100 possible points (average follow up 31 months). In distal clavicle fractures we prefer the use of the "Balser plate" combined with a suture of the coracoclavicular ligaments. Due to the occurrance of delayed fracture healing with pseudarthrosis (2/25) in fractures of the middle third, the indication for surgical treatment has to be discussed. In case of local soft tissue trauma and damage of the periostal blood supply, plate osteosynthesis in combination with autogenous bone grafting should be performed.

Adolescent↗
PubMedDate not supplied

[Chronic osteomyelitis of the clavicle].

From 1978 to 1987, 139 children were treated for osteomyelitis at our institution, among them 6 with osteomyelitis of the clavicle. All six patients presented with a primary chronic osteomyelitis. Three children sustained a trauma anamnestically. Pathohistological examinations revealed a chronic, unspecific inflammation in all cases. Immobilisation was achieved by means of a DESAULT-cast or an abduction splint for 7 to 36 weeks, antibiotics (clindamycin) were given for 6 to 55 weeks, starting with intravenous administration for 1 weeks maximally. All patients were primarily operated on, mostly undergoing curettage of affected regions or partial resection. After 4 to 10 years, 4 children are well and without evidence of recurrence, 2 children are still under treatment for recurrences.

Adolescent↗
PubMed1982

[Morphometry and determination of corticodiaphyseal indices of the clavicles in the conventional chest x-ray in healthy humans and in bone diseases].

The cortical width of both clavicles was measured in 400 chest x-rays of normal people aged 20 to 70 years, and normal values for three so-called cortico-diaphyseal indeces have been established: 1) "combined cortical thickness" (CCT), 2) the "Barnett-Nordin index" (DNI), 3) "the bone areas index" (IBA). The results are in good agreement with those of other authors, eg. Virtama, Helelä, Kocian et al. This indicates that there are no significant variations amongst different European populations. In order to test the clinical usefulness of the method, the results were compared with measurements from 50 patients with secondary osteoporosis. Measurements of cortical thickness on the chest x-ray proved a simple and reliable method. Finally, brief reference is made to the possibility, and the problems, of measuring bone mineral content by computed tomography.

Adrenal Cortex Hormones↗
PubMed1981

[Friedrich's disease--aseptic necrosis of the sternal end of the clavicle (author's transl)].

Six examples of aseptic necrosis of the epiphyseal end of the clavicle in adults are described. The radiological appearances are highly characteristic, allowing a definite diagnosis and exclusion of other conditions. The histological changes could be established by the examination of material obtained during resection and arthroplasty. The radiological differential diagnosis is discussed.

Adult↗