Statistical analysis was performed with STATA software (version 13.1; STATACORP, College Station, Texas). A power calculation had been made before the study with a power of 80% and an alpha of 0.05. The needed patients were 63 patients. The local ethical committee recom- mended that a further seven patients should be included for a total of 70 patients. Standard descriptive statistics were done for fracture type, age and gender. Mixed linear model regression analysis was used after the recommendation from an out of study statistician as multiple measurements were done at various time points after the fracture. Further- more the use of mixed linear models allowed to adjust for gender and left/right length differences on the individual level. The length measurement performed on injured clavi- cles was used as the continuous response variable. Time was used as a continuous variable. Explanatory variables (covariates) were type of fracture, displaced fracture y/n, side and gender. These were chosen on their apparent con- nection to the pre-fracture length of the clavicle. During the model building phase the interaction terms of displace- ment versus days was added into the model as it was found to be statistically significant for the fit of the model.
while the GCS score of CF group was .13 points. Callus volume was preoperatively measured with length, width, and height obtained from CT scan images. The follow- ing formula was used to calculate the callus volume: volume = length × width × height × π /6. The width and height in the formula were subtracted from the width and height of clavicle bone, respectively. The brain injuries were clinically defined as loss of consciousness, post-traumatic amnesia, disorientation, confusion and/or neurological deficit after injuries including cerebral concussion, cerebral contusion, laceration, subarachnoid hemorrhage, subdural hemorrhage, and intracerebral hemorrhage. Participants with any forms of prior nervous system or bone-related diseases, malignant disease, multiple fractures, diabetes, autoimmune disease, rheumatoid arthritis, other chronic inflammation diseases as well as nonsteroidal antiinflammatory drugs, immunosup- pressant, history of long-time steroid, survived ,1 year after surgery or bisphosphonate therapy were excluded.
clinical results, with an increased risk of evolution to pseudoarthrosis ; in our study, the mean reduction of the clavicular length in dissatisfied patients was 15.2 mm, but discordant data are reported in literature. Eskola et al. identified 15 mm as the threshold value above which pain was likely to be present , whereas Hill et al. reported unsatisfactory results with a bone shortening of more than 20 mm  but underlined that this situation is not certain to lead to pseudoarthro- sis. Postacchini et al. determined the cut-off for surgical treatment as a bone length reduction of more than 2.3 cm . However, these different values do not take into account the constitutional variations in clavicle length that are present in the population. In fact, we believe that a 2 cm reduction in length of a long clavicle bone will be better compensated for than the same reduction in a short bone. For this reason, rather than adopting an absolute shortening value as previously done in the literature, we have calculated the percentage shortening value as compared to the original length. We found a correlation between a reduction by more than 9.7% and the onset of scapulohumeral dysfunction as demonstrated by a lower Constant Score. In their recent work, Postacchini et al. also recognised the utility of the percentage reduction value to assess the prognosis of conservative treatment of clavicle fractures . They observed a greater statistical incidence of
The clavicle is a long bone with an epiphysisat either end that permits growth of the bone. It is the first fetal bone to undergo primary ossification, and its medialepiphysis is the last to fuse with the diaphysis (Cardoso et al., 2013). However, other long bones ossify by end ochondral ossification, the clavicle ossifies via both intramembranous and endochondral ossification (Kreitner et al., 1998). The two primary ossification centres of the clavicle appear on the medial and lateral side by the sixth week of development and fuse together about one week later (Cameriere et al., 2012). After the bone matrix is laid down, cartilage appears at the acromial sternal (medial) end of the developing clavicle while mesenchymal cells proliferates at the lateral (Acromial end). Therefore, at this stage, growth continues by a combination of endochondral and membranous ossification in the acromial end and the sternal end of the clavicle, respectively. The medial cartilaginous mass contributes about 80% or more of the clavicular length (Scheuer and Black 2000). The combination of the spatial location of the two ossification centres at either end of the bone and endochondral ossification at these sites gives the clavicle its unique S-shape by the eighth to ninth week of gestation. The bone finally attains its adult form by the eleventh intrauterine week (Krogman and Iscan 1986), and after birth, growth slows down untill puberty (11 to 14 years). From this point, the medial epiphysis starts growing until complete fusion around 30 years (Black and Scheuer 1996). Therefore it is difficult to use the clavicles of children before adolescent period in age estimation, but much easier and more accurate during the adolescent and post-adolescent periods. Little attention has been given to the lateral
depth and angle dimensions. Finally, a further 4.2 per- cent of variation is attributed to the change in width and thickness. Although these four modes attribute to almost 87 percent of clavicular variation, a single mode attributes to 70.5 percent. This, together with the gen- der-specific results evident using k-means clustering, raises the question of how much variation must be accounted for when designing an implant. Although current clavicle fixation devices exist in a range of sizes and shapes (Figure 12), none are gender-based designs. Neither do the widths of current plates vary along their length in order to closer fit the anatomic width variation of clavicles (Figure 13), something previously studied .
We used contralateral computed tomography images and preferred to maintain clavicle length rather than its proper anatomical shape for our surgical reconstruction. While clavicular length has been linked with improved functional outcome in clavicle fractures, there is limited evidence concerning the importance of its shape. Furthermore, this choice spared osteotomy of the peroneal graft and thus eliminated the risk of nonunion and symptomatic metal hardware [22, 23]. The improvement in the Constant- Murley score noted in our case might indicate that clavicular length is sufficient to improve or maintain shoulder function after total clavicle excision, even though the ROM returned to its preoperative level but did not surpass it.
Introduction: Fractures of the clavicle are common and make up 5% - 10% of all fractures. Treat- ment options in part depend on the location of the fracture along the bone and degree of dis- placement. These two parameters are best determined by good quality, standardized radiographs of the clavicle. We reviewed the literature to determine the optimal radiographs of clavicle frac- tures and their influence on the treatment plan. Methods: A comprehensive search of Medline™ database was undertaken with the following search terms and MeSH headings: clavicle, fractures, bone, radiography, and X-ray. We included articles in English published from 1950 to present. We ruled out fractures in children, fracture dislocations, open fractures, those with neurological and vascular injuries and fractures involving the acromioclavicular or sternoclavicular joints. Findings: Of the 821 citations obtained, only four studies proved eligible. In the most pertinent, four ortho- paedic surgeons were shown standard views (antero-posterior and 20˚ cephalic tilt) of 50 clavicle fractures and then additional two views (45˚ cephalic and caudal tilt), and found that alternative views influenced their decision making, with more surgeons opting for surgical fixation. In a dif- ferent study, it was shown that orthogonal views of the clavicle increased surgeons’ understanding and improved their treatment of these fractures. The third paper was a case series on clavicle fractures that were missed on the initial antero-posterior radiograph, and the fourth paper post- ulated that postero-anterior views of the thorax were most accurate in determining length of the clavicle. Conclusion: Studies showing an optimal view for assessment of clavicle fractures with a decision to then progressing to operative fixation are few, but the evidence points towards surgic- al fixation when alternative views of mid-shaft clavicle fractures are present.
Similarly, Chibba and Bidmos(28) concluded that fragmentary tibia may be useful for estimating stature in the absence of long bones. Based on measurements of maximum skull length of a Central Indian population, Patil and Mody(29) determined that height could be estimated from the skull using separate regression formulae for males and females. They took measurements from lateral cephalograms and adjusted the cephalograms accordingly to account for the percent of magnification from the x-rays. This technique proved highly reliable for both males and females in the sample population.
115 Read more
Materials and methods: The study material consisted of fragments of shafts of left clavicles taken from 39 males and 25 females (aged 22–86). The clavicles came from autopsies conducted between 2005 and 2011 at the Department of Forensic Medicine of Poznan and the Bialystok Medical University. The following were taken into account while estimating the age of the bone remains: clavicle length (CL), clavicle width (CW), clavicle thickness (CT), number of osteons in the field of vision (ON), number of osteons with the Haversian canal of more than 70 µm (HC > 70 µm), average diameter of the Haversian canals (avg. ØHC), area occupied by interstitial lamellae (ILA %), area occupied by osteons (OA %), area occupied by fragments-remnants of osteons remain as irregular arcs of lamellar fragments (OFA %), average thickness of outer cir- cumferential lamellae (avg. OCL, µm), the relation of osteons with the Haversian canal of more than 70 µm in diameter to the total number of osteons (HC > 70 µm, %), at p < 0.00001. The age of the bone remains was estimated using univariate linear regression function.
11 Read more
In the 55 studied cadavers, 3 of 110 CVs joined the jugular vein beyond the edge of the clavicle (Figs. 1, 2). Furthermore, three other CVs divided into two branches at the deltopectoral triangle. One branch joined the axillary vein and the other joined the external jugular vein beyond the clavicle (Figs. 3–6). A distinctive course was observed on both sides in two of the four cadavers, in which the cephalic vein extended beyond the clavicle. Based on previous reports and the results obtained from this study, we classified the variations in the proximal region of the CV around the clavicle into four patterns (Fig. 7) [1, 3–10, 13, 14, 17–20, 22, 25].
In the last decades, many studies have reported that a shortened clavicle can lead to worse functional out- comes, pain, loss of strength, rapid fatigue, hyperesthesia of the hand and arm, difficulty sleeping on the affected side, and esthetic complications [5 – 14]. Godfrey et al.  reported that the degree of symptomatology and occurrence of mal- and nonunion after MSCF is related to the extent of shortening and displacement of the frac- ture elements. Mean post-traumatic shortening of the fractured clavicle has been reported to be approximately
medium for bacterial adhesion and mucosal irritation. Urinary catheter is the most important risk factor for bacteriuria. In our study, there was a statistically significant associa- tion between duration of catheterization (median 8 days in infected patients versus 3 days in noninfected patients; P-value ,0.05), length of hospital stay for each patient (median 18 days in infected patients versus 10 days in non- infected patients; P-value ,0.05), and number of HA CR UTIs (100 cases versus 250 cases; P = 0.04). This finding was revealed in another study done in June 2013 in the Academic Medical Center, Amsterdam, the Netherlands, where dura- tion of catheterization, rate of unnecessary catheterization, length of hospital stay were reduced, and this in turn reduce the CA UTI rate. 10
Background Closed displaced midshaft clavicle fractures used to be treated nonoperatively, and many studies have reported that nonoperative treatment gave good results. However, more recent studies have reported poorer results following nonoperative treatment, whereas the results of operative treatment have improved considerably. The aim of this paper was to report the results of treating closed displaced midshaft clavicle fractures nonoperatively. Materials and methods One hundred Edinburgh type 2B clavicle fractures (69 type 2B1 and 31 type 2B2) in 100 patients (78 males and 22 females) aged between 18 and 67 years (mean 32 years) were treated. All patients were treated using a figure-of-eight bandage. Clinical and radiographic assessment was performed at the time of trauma, 1, 2 and 3 months after the trauma, and then at an average follow-up of 3 years (range 1–5 years). The out- come was rated at the last follow-up using the DASH score. Results Ninety-seven of the 100 fractures healed. Three nonunions were observed. Average healing time was 9 weeks (range 8–12 weeks). No statistically significant correlation between the type of fracture and the healing time was observed. The average DASH score was 24 (range 0–78) and, based on this score, 81 patients presented excellent results, 12 good, 5 fair, and 2 poor. No statisti- cally significant correlation between the type of the fracture and the score was observed.
A.D.Tambe et al retrospectively assessed the outcome of clavicle hook plating in 18 patients with Neer type II injury after an average follow up of 25 months. All incisions were sabre shaped over the lateral end of clavicle, they initially transfixed with Kirschner wires followed by fixation with Synthes clavicle hook plate. They noticed nonunions in 2, deep infections requiring plate removal in one, fracture proximal to the plate in one and asymptomatic osteolysis was seen in 5 patients. Plate removal was done in 17 patients at an average duration of 5 months. Using a Constant score on 15 of 18 patients, they scored an averaged 88.5 on the affected side as compared to 100 on the unaffected side. (54)
95 Read more
El Maraghy et al. demonstrated the mismatch between plate and sub acromial space and recommended 12 mm depth of hook for women.  In our study hook plate with smaller depth of 12 mm was used as the average depth between acromion and supraspinatus tendon was 15 mm. Lee et al. performed arthros- copic procedure and hook plate of 12 mm size hook was used and none of the patients suffered impingement.  However 17% of the patients had sub- acromial osteolysis. In a study by Siwei Sun, Minfeng Gan, Han Sun, Guizhong Wu, 26% of patients had sub acromial osteolysis . The important cause for this complication is retaining the implant which resolves after implant removal. However it does not affect functional outcome. Fracture at medial end of plate is a complication reported due to small sized hook. This is due to forcible reduc- tion of clavicle. Hence we did not do forcible reduction of clavicle in our pa- tients.
A ratio of screw diameter to bone diameter of 0.25 leads to a 40% decrease of bone strength [20, 21]. In a Chinese population with a mean age of 37 years old, a computed tomography (CT) scan showed that the diameter of the clavicle at the sternal and acromial ends, and in the middle shaft, were greater in males than in females . Based on these studies, remov- ing a screw from a long bone segment (e.g., the mid- shaft clavicle) with a smaller diameter in a female might lead to a greater reduction in bone strength, which might be associated with refracture. However, only one patient had a refracture at a screw hole. Bone diameters were smaller at the fracture site, and the clavicles were shorter in the refracture group, but neither factor was significant in a multivariate ana- lysis. Female might be a confounder for these two pa- rameters according to a morphometric analysis .
Background: Depression after stroke is one of the most serious complications of stroke. Although many studies have shown that the length of hospital stay (LOHS) is a measurable and important stroke outcome, research has found limited evidence concerning the effect of depression on LOHS among patients who have experienced acute stroke. The objective of this study was to assess the effect of depression on LOHS among patients hospitalized for acute ischemic stroke in Japan.
In this study, surfactant charge, surfactant carbon chain length, and surfactant content directly affected the physicochemical characteristics of vesicles and their skin permeability. The incorporation of a high content (29%) of cationic surfac- tant (CPC) with a long-chain carbon (C16) into the vesicle formulation improved the skin permeability of MX. The optimal formulation comprised PC/Chol/CPC/MX in a 0.77%:0.04%:0.10%:0.07% w/v ratio and is recommended as the optimal liposome for the skin delivery of MX. The possible mechanisms by which these liposomes improved the skin delivery of MX encompassed the penetration-enhancing mechanism and the vesicle adsorption to and/or fusion with the SC. Our findings provide useful fundamental information for the development and design of novel liposome formula- tions for enhancing the TDD of lipophilic drugs.
13 Read more
Based on figure 1, at the 3 dpf the growth chart shows adjacent points in all groups. The result of statistical analysis of length comparison at age 3 dpf got p-value equal to 0247. So it can be concluded that there was no significant difference between all groups. Figure 2 showed that there was significant difference of the body length at 6 dpf among groups (p-value = 0.000). The rotenone
In this prospective study, we obtained excellent initial results with the superior clavicle plate with lateral exten- sion in our patients, although the number of patients included in the study was small. This implant is, in our opinion, the most sophisticated of the many techniques and implants that have been applied to treat such fractures. It does not violate the surrounding structures when used correctly, and it fixes the fracture sufficiently to provide a rigid and stable osteosynthesis, with the possibility of early postoperative mobilization and a short time to union. Conflict of interest None.