Claes J. Petersson

The incidence of fractures of the clavicle.

The age- and gender-specific incidences were calculated in 2035 cases of fracture of the clavicle. The fractures were classified in three groups according to the Allman system. Each group was further divided into undisplaced and displaced fracture subgroups, with an extra subgroup of comminuted midclavicular fractures in Group I. Seventy-six percent of the fractures were classified as Allman Group I. The median age in this group was 13 years. There were significant differences in age- and gender-specific incidence between the undisplaced, displaced, and comminuted fracture subgroups. Twenty-one percent were classified as Allman Group II. The median age of the patients was 47 years, and there was no difference in age between the undisplaced and displaced fracture subgroups. Three percent were classified as Allman Group III, and the median age of the patients in this group was 59 years. All three groups were characterized by a significant preponderance of men, and there was a significant increase in the incidence of clavicular fracture, both overall and sports-related, between 1952 and 1987.

Mid-clavicle fractures in adults: end result study after conservative treatment.

OBJECTIVE The aim of the present study was to analyze the long-term outcome of mid-clavicle fractures in adults and to evaluate the clinical importance of displacement and fracture comminution. DESIGN Two hundred twenty-five mid-clavicular fractures that had been nonsurgically treated at Malmö University Hospital were retrospectively evaluated, both clinically and radiographically, an average of seventeen years after injury. There were seventy-one undisplaced fractures, sixty-nine displaced two-fragment fractures, and eighty-five displaced and comminuted fractures. The average patient age at the time of trauma was thirty-three years (range 15 to 70 years). Patients were interviewed, and careful clinical and radiological examination of their shoulders was performed. Two patients had experienced transient neuritis, and another two underwent operative treatment because of progressive neuropathy. SETTING All 225 consecutive patients were treated primarily at the Malmö University Hospital, which serves the Malmö city population (250,000). PATIENTS/PARTICIPANTS Since the beginning of this century, all radiographs taken at the Malmö University Hospital have been classified and filed for easy retrieval. In this retrospective study, all patients treated between 1970 and 1979 were identified, and those still living were called for follow-up examination. INTERVENTION Of the 225 fractures reviewed, 197 fractures were originally treated with a figure-of-eight splint for an average period of three weeks without any attempt to reduce the displaced fractures; twenty-four patients were allowed immediate free shoulder mobilization. MAIN OUTCOME MEASUREMENTS Clinical rating and healing were the main outcome measurements. RESULTS At follow-up, 185 shoulders were asymptomatic. Thirty-nine shoulders had moderate pain and were rated as fair, and one patient was rated as poor. One hundred twenty-five of the fractures had healed normally, fifty-three were malunited with persistent fracture displacement, and seven were nonunions; nonunion was significantly more prevalent in cases with displaced fractures. Forty malunited fractures and three nonunions were rated as good. CONCLUSIONS This review demonstrates that few patients with fractures of the mid-part of the clavicle require operative treatment.

Incidence and causes of shoulder girdle injuries in an urban population

In a prospective population-based study of all shoulder injuries seen at Malmö General Hospital during 1987, the incidence and causes of major injuries involving fractures of the clavicle, scapula, or proximal humerus and glenohumeral or acromioclavicular dislocations were investigated in children, adults, and the elderly. Seventy-five shoulder injuries occurred in children. Sixty-five of them were fractures of the clavicle. In this age group no sex-related differences were seen in incidence, and 37 of 73 injuries were related to sports or playing. One hundred eighty-one injuries occurred in adults. Sixty fractures of the proximal humerus, 67 fractures of the clavicle, and 31 primary glenohumeral dislocations were seen. The injuries in this group were significantly more frequent in men, with most of them caused by traffic and sport injuries. Two hundred forty-eight injuries occurred in elderly people. Two hundred one were fractures of the proximal humerus. The incidence was significantly higher in women; 147 of 247 injuries were caused by an indoor fall. The variations among age groups are probably attributable to age-related differences in activity, mobility, and fragility.

The subacromial space in normal shoulder radiographs

The subacromial space in standard anteroposterior radiographs of 175 normal shoulders was between 9 and 10 mm. The space was significantly greater in men, with a slight reduction with age. In middle age, a subacromial space less than 6 mm is pathological, possibly indicating supraspinatus tendon rupture.

Degeneration of the Acromioclavicular Joint: A Morphological Study

One hundred and sixty-eight acromioclavicular joint dissections were performed on 85 cadavera, 46 men and 39 women, with an average age of 69, ranging from 18 to 92. The intra-articular discs and the joint cartilages were scrutinized and degenerative changes were graded macroscopically. An age related disintegration of the disc and the joint cartilages was found. After the age of 70 maximum degeneration was very common.

Radiographic joint space in normal acromioclavicular joints

The acromioclavicular joint space in standard antero-posterior images of 151 normal subjects was measured. The joint space was significantly wider in men. There was a highly significant reduction of the joint space with age in both men and women and in persons past 60 a joint space of 0.5 mm or less is not pathological. A joint space wider than 7 mm in men and 6 mm in women is abnormal. The measuring technique described is useful in population studies. In individual cases a simple measurement with a ruler serves the same purpose.

Degeneration of the Gleno-Humeral Joint: An Anatomical Study

One hundred and fifty-one shoulder dissections were performed on 76 cadavera, 41 men and 35 women, with an average age of 68 (range 18-92). Before the age of 60 no degenerative changes were encountered but after 60, degeneration and full thickness ruptures of the rotator cuff, cartilage degeneration and degeneration and ruptures of the long biceps tendon appeared in an increasing frequency with age. A highly significant relationship between cuff degeneration and cartilage degeneration was found. Measurement of the thickness of normal joint cartilage of the caput humeri did not show any changes with time. Gleno-humeral degeneration was encountered bilaterally in 82 per cent and was more frequent in women, and there is little evidence that occupation is of major importance for the development of shoulder joint degeneration.

Resection of the lateral end of the clavicle : A 3 to 30-year follow-up

Fifty patients, operated on with resection of the clavicle, were evaluated postoperatively after an average of 9 years. There was no significant difference between the traumatic and non-traumatic group. The initial results did not alter significantly with time. Nearly half of the patients with poor outcome had psychiatric or alcoholic problems. Radiographic examination of 30 shoulders showed newly formed bone at the resected clavicle in one third and radio-opaque deposits in the resection gap in another third. These findings were consistent with good outcome.

Spontaneous Medial Dislocation of the Tendon of the Long Biceps Brachii: An Anatomic Study of Prevalence and Pathomechanics

Medial displacement of the tendon of the long biceps brachii muscle was analyzed in a dissection study on autopsy in 77 subjects, 42 men and 35 women. The tendon was found to be medially displaced in five shoulders in five different subjects (6.5%). Medial displacement of the tendon was always found in connection with full-thickness supraspinatus tendon ruptures. It is a common belief that the tendon is always displaced medially to the lesser tubercle riding over the subscapularis tendon. In the present series, this condition was found only in one case; in the other shoulders the tendon had slipped medially to the lesser tubercle under the subscapularis tendon, which was partially internally ruptured. In patients with rotator cuff lesions, medial displacement of the long biceps tendon might be one reason for pain over the front of the shoulder.

Clinical importance of comorbidity in patients with a proximal humerus fracture.

The aim of this prospective study of 100 consecutive patients with a proximal humerus fractures primarily was to investigate the prevalence and importance of poor health and comorbidity. Seventeen men and 83 women with a mean age of 73 years were involved together with 138 age and gender- matched controls. Twenty patients with a mean age of 81 years, were severely ill with a physical and/or mental disorder when they got their proximal humerus fracture. The 1-year mortality of this subgroup was 40% compared with 8% in the control group. Fifty-seven patients with a mean age of 74 years reported concomitant disorders compared with 54 of 78 (69%) controls. Twenty-three patients with a mean age of 67 years, reported no comorbidity compared with 25 of 34 (74%) in the control group. Sixty-seven patients were followed up on for 1 year and were evaluated clinically and radiographically. The Constant-Murley shoulder assessment was used. The 12 surviving severely ill patients were not able to attend the followup evaluation. In the remaining patients there was no significant difference after 1 year in pain, function, Constant-Murley score or radiographic healing of the injured shoulder between individuals with or without comorbidity. Patients with symptomatic shoulders at followup initially had significantly more frequently displaced fractures.Level of Evidence: Prognostic study, Level II (prospective study). See the Guidelines for Authors for a complete description of levels of evidence.