Influence of radiographic projection and patient positioning on shortening of the fractured clavicle

Paul Hoogervorst; Arnoud van Geene; Udo Gundlach; Abel Wei; Nico Verdonschot; Gerjon Hannink

doi:10.1016/j.jseint.2020.03.005

Influence of radiographic projection and patient positioning on shortening of the fractured clavicle

JSES Int. 2020 May 18;4(3):503-507. doi: 10.1016/j.jseint.2020.03.005. eCollection 2020 Sep.

Authors

Paul Hoogervorst^{1

2}, Arnoud van Geene³, Udo Gundlach⁴, Abel Wei⁵, Nico Verdonschot^{1

6}, Gerjon Hannink⁷

Affiliations

¹ Department of Orthopaedic Surgery, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands.
² Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA.
³ Department of Orthopaedic Surgery, Isala Zwolle, Zwolle, The Netherlands.
⁴ Department of Orthopaedic Surgery, Admiraal De Ruyter Ziekenhuis, Goes, The Netherlands.
⁵ Emergency Department, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands.
⁶ Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands.
⁷ Department of Operating Rooms, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands.

Abstract

Background: Radiographic measurements of shortening and vertical displacement in the fractured clavicle are subject to a variety of factors such as patient positioning and projection. The aims of this study were (1) to quantify differences in shortening and vertical displacement in varying patient positions and X-ray projections, (2) to identify the view and patient positioning indicating the largest amount of shortening and vertical displacement, and (3) to identify and quantify the inter- and intraobserver agreement.

Methods: A prospective clinical measurement study of 22 acute Robinson type 2B1 clavicle fractures was performed. Each patient underwent 8 consecutive standardized and calibrated X-rays in 1 setting.

Results: In the upright patient position, the difference of absolute shortening was 4.5 mm (95% confidence interval [CI]: 3.0-5.9, P < .0001) larger than in the supine patient position. For vertical displacement, the odds of being scored a category higher in the upright patient position were 4.7 (95% CI: 2.2-9.8) times as large as the odds of being scored a category higher in supine position. The odds of being scored a category higher on the caudocranial projection were 5.9 (95% CI: 2.8-12.6) times as large as the odds of being scored a category higher on the craniocaudal projection.

Conclusion: Absolute shortening, relative shortening, and vertical displacement were found to be the greatest in the upright patient positioning with the arm protracted orientation on a 15° caudocranial projection. No statistically significant differences were found for a change in position of the arm between neutral and protracted.

Keywords: Clavicle; displacement; fractures; interrater agreement; intrarater agreement; radiological imaging; shortening.