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      Densitometric study of the clavicle: bone mineral density explains the laterality of the fractures ☆☆ Translated title: Estudo densitométrico da clavícula: a densidade mineral óssea explica a lateralidade das fraturas

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          Abstract

          Introduction

          Epidemiological studies have shown laterality in clavicle fractures, such that the left side is more frequently fractured. The present study had the aim of evaluating whether the clavicle on the dominant side is denser and thus explaining the greater incidence of fractures on the non-dominant side.

          Materials and methods

          This was a descriptive study on 52 healthy patients, who were classified according to age, sex and whether the dominant or non-dominant side was affected.

          Results

          The participants comprised 28 women (53.8%) and 24 men (46.2%). Regarding the dominant side, 30 were right-handed (57.7%) and 22 were left-handed (42.3%). The mean age was 25 years. In this study, it could be seen that the non-dominant side had greater bone mass than the dominant side. It was also observed that the bone density was greater in the middle and distal thirds on the non-dominant side, with a statistically significant difference. In the women, the density was also greater on the non-dominant side; this difference was not significant in relation to the dominant side, but there were significant differences between the middle thirds ( p < 0.001) and the distal thirds ( p < 0.006).

          Conclusion

          Variations in bone density, toward higher and lower bone mass, may have been responsible for the fractures. According to the findings from this study, fractures occur more in the middle third of the non-dominant clavicle, as a result of greater bone mineral mass, which gives rise to lower flexibility and fractures in the region.

          Resumo

          Introdução

          Estudos epidemiológicos mostram uma lateralidade nas fraturas da clavícula, com o lado esquerdo mais frequentemente fraturado. O presente estudo tem como finalidade avaliar se a clavícula do lado dominante é mais densa e explicar, dessa forma, a maior incidência de fraturas no lado não dominante.

          Material e métodos

          Estudo descritivo de 52 pacientes hígidos, classificados quanto a idade, sexo e lado dominante ou não.

          Resultados

          Fizeram parte deste estudo 28 mulheres (53,8%) e 24 homens (46,2%); em relação ao lado dominante, 30 eram destros (57,7%) e 22, canhotos (42,3%); a idade média foi de 25 anos. Neste estudo, foi possível constatar que o lado não dominante teve maior massa óssea quando comparado ao lado dominante. Também observamos que a densidade óssea foi maior nos terços médios e distais no lado não dominante, com diferença estatisticamente significativa. Nas mulheres, a densidade também foi maior no lado não dominante; essa diferença não foi significativa quando comparado com o lado dominante, porém foi significativamente diferente entre os terços médio (p < 0,001) e distal (p < 0,006).

          Conclusão

          As variações da densidade óssea, tanto com maior como com menor massa óssea, podem ser responsáveis pelas fraturas. De acordo com os achados deste estudo, as fraturas ocorrem mais no terço médio da clavícula não dominante, em decorrência de uma maior massa mineral óssea, o que acarretaria uma menor flexibilidade da região e as fraturas.

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          Most cited references21

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          Fractures of the clavicle in the adult. Epidemiology and classification.

          From 1988 to 1994 a consecutive series of 1000 fractures of the adult clavicle was treated in the Orthopaedic Trauma Clinic of the Royal Infirmary of Edinburgh. In males, the annual incidence was highest under 20 years of age, decreasing in each subsequent cohort until the seventh decade. In females, the incidence was more constant, but relatively frequent in teenagers and the elderly. In young patients, fractures usually resulted from road-traffic accidents or sport and most were diaphyseal. Fractures in the outer fifth were produced by simple domestic falls and were more common in the elderly. A new classification was developed based on radiological review of the anatomical site and the extent of displacement, comminution and articular extension. There were satisfactory levels of inter- and intraobserver variation for reliability and reproducibility. Fractures of the medial fifth (type 1), undisplaced diaphyseal fractures (type 2A) and fractures of the outer fifth (type 3A) usually had a benign prognosis. The incidence of complications of union was higher in displaced diaphyseal (type 2B) and displaced outer-fifth (type 3B) fractures. In addition to displacement, the extent of comminution in type-2B fractures was a risk factor for delayed and nonunion.
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            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.
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              Epidemiology of clavicle fractures.

              An epidemiologic study of 535 isolated clavicle fractures treated in a hospital of a large metropolis during an 11-year period was performed. Data regarding patient's age and sex, side involved, mechanism of injury, and season in which the fracture occurred were obtained from the clinical records. Radiographic classification was performed with the Allman system. Clavicle fractures represented 2.6% of all fractures and 44% of those in the shoulder girdle. Most patients were men (68%), and the left side was involved in 61% of cases. Fractures of the middle third of the clavicle, which were the most common (81%), were displaced in 48% of cases and comminuted in 19%. Fractures of the medial third were the least common (2%). The prevalence of midclavicular fractures was found to decrease progressively with age, starting from the first decade of life when they represented 88.2% of all clavicle fractures and were undisplaced in 55.5% of cases. In adults, the incidence of displaced fractures, independent of location, was higher than that of undisplaced fractures. Traffic accidents were the most common cause of the injury. In the period under study, the incidence of fractures showed no significant change over time and no seasonal variation.
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                Author and article information

                Contributors
                Journal
                Rev Bras Ortop
                Rev Bras Ortop
                Revista Brasileira de Ortopedia
                Elsevier
                2255-4971
                16 July 2014
                Sep-Oct 2014
                16 July 2014
                : 49
                : 5
                : 468-472
                Affiliations
                [a ]Serviço de Ortopedia, Hospital Universitário, Universidade Luterana do Brasil (ULBRA), Canoas, RS, Brazil
                [b ]Grupo do Ombro e Cotovelo, Hospital Universitário, Universidade Luterana do Brasil (ULBRA), Canoas, RS, Brazil
                [c ]Hospital Universitário, Universidade Luterana do Brasil (ULBRA), Canoas, RS, Brazil
                Author notes
                [* ] Corresponding author. gabibusin@ 123456hotmail.com
                Article
                S2255-4971(14)00111-6
                10.1016/j.rboe.2014.07.002
                4487471
                26229846
                e0528bc7-9b1b-4d97-916a-1dac6a8c19b9
                © 2014 Sociedade Brasileira de Ortopedia e Traumatologia. Published by Elsevier Editora Ltda.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 13 June 2013
                : 19 July 2013
                Categories
                Original Article

                densitometry,bone fracture,physiopathology,clavicle,densitometria,fratura óssea,fisiopatologia,clavícula

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