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Does Positioning Matter In Radiographs Of Clavicle Fractures?

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If you suffer a shoulder fracture, you´ll probably feel a pain in your shoulder and it will feel like it´s grinding if you try to move it. There may well be swelling and bruising, and a clavicle (collarbone) fracture may result in a distinct lump.

Radiographs are commonly used to help understand the problem in detail and these can be performed when the patient is in an upright or a supine position (lying on their back). A new study has examined the differences between these two approaches, in an effort to establish whether positioning matters.

The researchers identified 46 patients with an acute unilateral clavicle fracture and asked the patients to undergo radiographs in both supine and upright positions. They then measured displacement and shortening and compared them between the two positions.

Results showed that fracture displacement was significantly greater when measured from upright radiographs than from supine ones. There was an 89% increase in fracture displacement when measured from upright radiographs compared with supine radiographs. It was also found that 41% of patients had greater than 100% displacement on upright radiographs, but not on supine ones.

Compared with the uninjured side, 3 mm of shortening was noted on upright radiographs and 1.3 mm of lengthening on supine radiographs.

The researchers concluded that the increased fracture displacement and shortening seen when the patient is upright suggest that upright radiographs may better demonstrate clavicle displacement and predict the position at healing if non-operative treatment is selected.

The findings have been published in the Journal of Orthopaedic Trauma.