OTA 2008 Posters

Scientific Poster #128 Upper Extremity OTA-2008

The Effect of Radiographic Technique in Visualization of Clavicle Fractures

Timothy G. Weber, MD (n); Steve Shin, MD (n); Palaniswamy Vijay, PhD (n);
OrthoIndy, Indianapolis, Indiana, USA

Purpose: Our objective was to demonstrate discrepancies in radiographic evaluation of clavicle fractures with regard to displacement and shortening.

Methods: Using an adult sawbones human skeleton, a midshaft clavicle osteotomy was created with an oscillating saw. Anterior, posterior, superior, and inferior displacements of 100% (approximately 1 cm) with no shortening were maintained using putty/tape and a series of radiographs were obtained. The three views obtained were anteroposterior (AP) 30° caudad, AP 30° cephalad, and posteroanterior (PA) 30° caudad.

Results: With all four fracture displacements (anterior, posterior, inferior, and superior), the most accurate radiographic view was the PA 30° caudad. The other views demonstrated differing amounts of shortening (1-1.5 cm) despite no actual shortening at the osteotomy site. Most significant changes were with anterior and posterior displacement rather than superior and inferior displacement.

Conclusion: Depending on the angle and projection of the x-ray beam, differing amounts of shortening were observed at the osteotomy site with the AP views. This was seen in a sawbones clavicle fracture that was created with four directions of displacement and no shortening.

Significance: Traditional management of the majority of clavicle fractures has been nonoperative treatment. While this dogma advocates a conservative approach toward clavicle fractures, there has been recent literature detailing that displaced fractures with resultant shortening may lead to permanent shoulder dysfunction. A radiograph is nothing more than a shadow of the bone and the image is affected by the distance the bone is from the cassette. Because of the trajectory that the clavicle traverses from the sternum to the acromion, small displacements may be misinterpreted as distraction or shortening at the fracture site. Suggested radiographic evaluation of clavicle fractures includes an AP shoulder radiograph and a 15° cephalad-oblique radiograph. Other recommendations include a 45° cephalad tilt and/or a 45° caudad tilt. A recent study (Sharr et al) has shown that a PA 15° caudad view may demonstrate a more accurate evaluation of true clavicular length than the standard AP views. The results of this study reinforce the potential of considerable radiographic variability in the imaging of clavicle fractures in the AP plane and the importance of standardized imaging of this injury. The PA 30° caudad view may be considered as one of the more accurate views of clavicle fractures.

If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing. Δ OTA Grant.