Tobacco, in addition to being one of the greatest public health threats facing our world, is believed to have deleterious effects on bone metabolism and especially on bone healing. It has been described in the literature that patients who smoke are approximately twice as likely to develop a nonunion following a non-specific bone fracture. For clavicle fractures, this risk is unclear, as is the impact that such a complication might have on the initial management of these fractures. A systematic review and meta-analysis were performed for conservatively treated displaced midshaft clavicle fractures. Embase, PubMed, and Cochrane Central Register of Controlled Trials (via Cochrane Library) were searched from inception to 12 May 2022, with supplementary searches in Open Grey, ClinicalTrials.gov, ProQuest Dissertations & Theses, and Google Scholar. The searches were performed without limits for publication date or languages.Aims
Methods
They have been evaluated after a mean follow-up of 3,6 years (13 months–15 years). Five patients had grade I sarcoma, 17 grade II, 28 grade III and 1 unstated (FNCLCC classification). All but 5 presented a localised disease at the time of diagnosis. The reason for ILP was extracompartimental location in 10, contiguity to nervous or vascular structures in 10, the size of the lesion alone for 10 (up to 28 cm), and local spread of the tumor at presentation or by former surgical procedures 21. Thirteen patients presented major or longlasting post-operative complications, mostly cutaneous and neurological. Twenty-five percent of patients had a complete response to treatment, 44% a partial response, 17% no change and the remaining 14% a progressive disease. Ten radical (R0), 20 marginal (R1) and 4 intralesional (R2) resections have been performed 5,3 months (1,5–42) after ILP. Seven patients had a primary amputation (14%) and 10 had no operation or refused it. A reconstructive surgery was performed in 32% of the patients, and 27% had a complmentary radio- and/or chemotherapy. With a mean follow-up of 3,6 years (13 months–15 years), 33% patients were free of recurrence, 13% had local recurrence only, 27% distant only, and 27% both local and distant. From the 19 patients (40%) with local recurrence, 12 needed at least one new operation, with 5 more amputations. Overall time to distant recurrence is 27,9 months (2–43), and to local recurrence is 22,3 months (2–78) respectively. Two and 5 years survival are 60,3% and 43,5% respectively.
