J. Andermahr - Academia.edu (original) (raw)
Papers by J. Andermahr
Journal of Shoulder and Elbow Surgery, 2013
Fragestellung: Seit Oktober 2007 nimmt XXX an der strukturierten Schwerverletzten-Versorgung im R... more Fragestellung: Seit Oktober 2007 nimmt XXX an der strukturierten Schwerverletzten-Versorgung im Rahmen des Traumanetzwerkes Köln teil. Ziel der vorgelegten Studie ist die prospektive Erfassung, Analyse und Bewertung der klinikeigenen Patientendaten, die im Rahmen der Teilnahme am Traumaregister[for full text, please go to the a.m. URL]
Der Unfallchirurg, 1998
Candida species have emerged as important pathogens in human infection. Although a variety of dee... more Candida species have emerged as important pathogens in human infection. Although a variety of deep-seated candidal infections have been reported, Candida spondylitis has rarely been described. One patient with candida tropicalis spondylitis L I and L II in combination with candida coxitis is presented, and the 31 adult cases with vertebral involvement previously reported are reviewed. Candida spondylitis is noted as a simultaneous occurrence or late manifestation of hematogenously disseminated candidiasis. Spondylitis may not be prevented by a course of Amphotericin B adequate to control the acute episode of disseminated candidiasis, particularly in immune suppressed patients. Spondylitis does not present as a postoperative wound infection. The insidious progression of infection, the nonspecificity of laboratory data, and the failure to recognise Candida as a potential pathogen may lead to diagnostic delay. Diagnosis can be made by either open biopsy or CT controlled needle aspiration. Successful therapeutic regimes have employed combinations of antifungal therapy (Amphotericin B or fluconazole) with radical surgical debridement. Ventral and facultatively dorsal instrumentation is required to stabilize the spine. It is anticipated that the spondylitis will become a more commonly recognised manifestation of hematogenously disseminated candidiasis. A increasing significance of candida species as etiologic agents of infection immune compromised humans has been recognised in the recent years. In those patients whom an antecedent Candida septicaemia was documented, a striking delay of 3.3 months was found between the septicaemia and the onset of symptoms as well as the time of diagnosis.
Surgical and Radiologic Anatomy, 2012
Journal of Neurotrauma, 2006
Patients with traumatic brain injury (TBI) and skeletal injuries have increased rates of excessiv... more Patients with traumatic brain injury (TBI) and skeletal injuries have increased rates of excessive bone healing (EH = hypertrophic callus formation and/or heterotopic ossification). Polytrauma patients are often attributed higher rates of delayed fracture union. This study compares 182 total fractures in 29 isolated polytrauma patients (POLY) and 48 patients after TBI and polytrauma (TBI+POLY), examining the clinical parameters of EH versus delay. A subset of 28 patients (13 TBI+POLY, 15 POLY) underwent serological testing for the following bone turnover parameters: carboxy-terminal extension peptide of type 1 procollagen (P1CP), pyridinolene cross-linked carboxy-terminal telopeptide (1CTP), insulin-like growth factor-1 (IGF-1), insulin-like growth factor binding protein-3 (IGFBP-3), and basic fibroblast growth factor (bFGF). There were higher rates of delayed union in the POLY patients (45% vs. 23%) and EH in the TBI+POLY patients (33% vs. 17%) (not significant = NS). More delayed unions were observed in diaphyseal fractures suffered by POLY (28%) than in TBI+POLY (15%) patients (NS). EH after pelvic fracture was apparent in 52% TBI+POLY and in 21% POLY fractures (NS). P1CP levels did not differ between the groups, but the collagen breakdown parameter 1CTP was significantly higher in the POLY group (p = 0.01-0.04). IGF-1 levels were below normal in both groups, and did not differ. IGFBP-3, an IGF-1-inhibiting and collagenase-3-activating protein, was significantly higher in POLY patients (p = 0.017-0.037). bFGF levels did not vary between groups. Increased serum levels of 1CTP and IGFBP-3 in POLY patients suggest that EH in TBI patients is secondary to decreased collagen breakdown rather than increased synthesis.
Anatomia, Histologia, Embryologia: Journal of Veterinary Medicine Series C, 2005
ABSTRACT Surgeons agree that interrupted peripheral nerves should be reconstructed ‘soon’ to enab... more ABSTRACT Surgeons agree that interrupted peripheral nerves should be reconstructed ‘soon’ to enable neural regeneration. Delayed nerve repair will result in impaired outcome, but experimental data on such detriment due to delay are scarce. In a quantitative study we transected the right sciatic nerve of 80 adult female Lewis rats (LEW/SsNHsd), transflected the proximal nerve stump into a muscle pouch and let the animals wait 0 (immediate repair), 3, 6, 9 and 12 months after axotomy, until reconstruction was performed with a 5-mm long allograft from congenic age-matched donors. All hosts were studied with two different methods. First, the functional outcome of sciatic nerve reconstruction was evaluated 4–12 weeks after transplant by walking track analysis, calculating de Medinaceli's Sciatic Functional Index (SFI). Second, 12 weeks after transplantation the fibular communal nerve and the soleus branch of the tibial nerve close to its muscle entry were cut and the proximal stumps labelled with the retrograde neuronal tracers DiI or Fast-Blue. Fourteen days later the rats were perfused with formaldehyde, and the numbers of fluorescently labelled motoneurons were counted in 50 μm serial vibratome sections of the spinal cord. All measurements were done on coded material and codes broken only at the end of the study. Our results are clear-cut and deeply disappointing. The SFI was around 0 (normal value) in all rats before transection of the sciatic nerve; expectedly dropped to −85 to −125 after denervation, but stayed at −108 to −130 up to 12 weeks after transplantation. No improvement of gait at all occurred after sciatic nerve transplant performed immediately or 3, 6, 9 or 12 months after denervation.This failure of functional recovery is not due to lack of regeneration, as the numbers of labelled motoneurons prove. In normal rats we have labelled 549 ± 83 motoneurons by DiI and Fast-Blue. After immediate nerve repair we counted 533 ± 95 labelled motoneurons; after repair delayed for 12 months we still counted 474 ± 108 motoneurons that had regenerated. In all rats the labelled motoneurons were randomly interspersed with a complete lack of myotopic distribution. This misdirection of reinnervation sadly prevents recovery of motor function.
The American Journal of Sports Medicine, 2008
Background New cell-based treatments for articular cartilage repair are needed. As the optimal sc... more Background New cell-based treatments for articular cartilage repair are needed. As the optimal scaffold for cartilage repair has yet to be developed, scaffold-free cartilage implants may remove the complications caused by suboptimal scaffolds. Hypothesis The implantation of a scaffold-free, autologous de novo cartilage implant into standardized full-thickness cartilage defects of femoral condyles in sheep leads to a qualitatively better regenerative tissue than does periosteal flap alone or no treatment. Study Design Controlled laboratory study. Methods Chondral defects 4 mm in diameter (1 per sheep) were created in the center of 1 medial femoral condyle of 48 sheep. Twelve defects were allowed to heal spontaneously, 16 defects were covered with periosteal flaps alone, and 20 defects were filled with autologous de novo cartilage graft and overlaid with a periosteal flap. Differences were assessed macroscopically using the International Cartilage Repair Society score and microscopica...
Journal of Neurotrauma, 2004
Unfallchirurg, Sep 1, 2005
Aktuelle Traumatologie, 2000
Ruptures of the cruciate ligaments become an increasing clinical problem. The reconstruction of t... more Ruptures of the cruciate ligaments become an increasing clinical problem. The reconstruction of the anterior cruciate ligament is one of the most frequent operations of the knee, The indication and the timing point of surgery is discussed as frequently and controversially as the multiple methods of reconstruction. This article presents a review of the literature of this topic using more than 500 articles of the last years. Surgery is supposed to be performed in cases of complex injuries, of younger patients with high activity level, loose soft tissue and instability of the knee in daily life. The later intervention is preferable after decrease of swelling and lost of pain. Surgical results are obviously not dependant on using mini-arthrotomy or arthroscopy. One-incision-technique is to be performed instead of two-incision-technique when it is proceeded by an experienced surgeon. Primary suture has been left because of the insufficient results. Reconstruction using augmentation is to...
Spezialgebiete aus der Schulter- und Ellenbogenchirurgie, 2004
Die Stabilitat des Schultergelenkes wird masgeblich durch den statischen labrokapsulo-ligamentare... more Die Stabilitat des Schultergelenkes wird masgeblich durch den statischen labrokapsulo-ligamentaren Komplex, sowie durch den dynamischen Komplex der Rotatorenmanschette und der langen Bizepssehne bestimmt. Zur Sicherung eines grosen Bewegungsumfangs besteht ein Misverhaltnis zwischen Humeruskopfumfang und dem kleinen Glenoid. Die Instabilitat des Schultergelenkes entsteht durch eine Storung zwischen den kapsuloligamentaren Strukturen und den Muskeln. Von der traumatisch hervorgerufenen Instabilitat ist die atraumatische, angeborene Schulterlaxitat zu unterscheiden.
Journal of Pediatric Orthopaedics B, 2005
This prospective study investigated medium-term outcomes for 51 children treated from 1997 to 200... more This prospective study investigated medium-term outcomes for 51 children treated from 1997 to 2001 for displaced diaphyseal forearm fractures with elastic stable intramedullary nailing. Forty-three patients included achieved excellent/good functional results at an average follow-up of 38 months. Four patients required open fracture-manipulation at surgery. Complications included eight cases of soft-tissue irritation at nail-insertion site (three required shortening procedures), two temporary radial nerve branch injuries, four minimal rotational mobility deficits, one 10 degrees elbow extension deficit after splinting, and five small keloid scars. All patients were pain-free, without limitations in activities for daily life or sport/play activities by 12 months after hardware removal. Elastic stable intramedullary nailing is appropriate therapy for these injuries.
Fragestellung: In aktuellen Studien konnte gezeigt werden, dass der venöse Rückstrom des Untersch... more Fragestellung: In aktuellen Studien konnte gezeigt werden, dass der venöse Rückstrom des Unterschenkels durch Bewegung des Grosszehengrundgelenkes unterstützt wird. Im Falle von Sportverletzungen mit Beteiligung des Sprunggelenkes und Ruhigstellung desselben wurde die Frage behandelt,[for full text, please go to the a.m. URL]
![Research paper thumbnail of [ Intramedullary nailing (ESIN) in clavicular pseudoarthroses. Results of a prospective clinical trial]](https://attachments.academia-assets.com/83454242/thumbnails/1.jpg)
](Der Unfallchirurg, 2005
This prospective clinical trial was performed to assess healing, clinical outcome and complicatio... more This prospective clinical trial was performed to assess healing, clinical outcome and complications after intramedullary nailing of midshaft clavicular nonunions. Over 2.5 years, 14 patients were included. Exclusion criteria were pathological fractures, bony defects, previous operative therapy, atrophic and infection pseudarthrosis and the patient's age: <18 years or >70 years. Results were evaluated after 3, 6, 12 and 18 months. Beginning 3 months after the operation, pain (VAS), subjective satisfaction, Constant score and DASH score were significantly better than preoperatively during the follow-up period (p<0.001). There were no infections, no implant displacements or refractures.Intramedullary fixation of midshaft clavicular nonunions with an elastic titanium nail is a safe, minimally invasive surgical technique, producing excellent functional and cosmetic results without additional bone grafting.
Until December 2001 84 midclavicular fractures in 80 patients were treated with intramedullary na... more Until December 2001 84 midclavicular fractures in 80 patients were treated with intramedullary nailing. Postoperatively there was a significant decrease of pain and a significant increase of mobility compared to the situation preoperatively. 6 months after hardware removal the mean Constant-Score was 97.4 points. There was one none union. In one patient there was a loss of reduction with shortening of 1.5 cm. In 5 patients a shortening of the proximal end of the nail had to be performed, due to painful skin irritation. Intramedullary nailing of midclavicular fractures is a safe and minimally invasive operation technique. It should be offered to the patient as an alternative to conservative treatment.
The aim of this study was to compare the results achieved in two groups of 20 patients treated fo... more The aim of this study was to compare the results achieved in two groups of 20 patients treated for midclavicular fracture. The first group (mean age 36 years) was treated non-operatively with a rucksack bandage, whereas the second group (mean age 37 years) underwent intramedullary fixation with a titanium pin using a minimally invasive, unreamed technique. At follow-up, which averaged 3.1+/-0.9 years in group 1 and 2.9+/-0.7 years in group 2, the result of treatment, as indicated by the Constant score, functional outcome and cosmetic outcome, was significantly better in the group undergoing operative treatment. Clavicle shortening was significantly ( P=0.027) higher in patients treated with a rucksack bandage. The absolute Constant score averaged 78+/-23 in group 1 and 97+/-4 in group 2 ( P=0.001). The Constant rating scale showed a significant difference between patients with clavicle shortening of less than 1 cm and 1 cm shortening or more. There were two non-unions in group 1 but...
Journal of Shoulder and Elbow Surgery, 2013
Fragestellung: Seit Oktober 2007 nimmt XXX an der strukturierten Schwerverletzten-Versorgung im R... more Fragestellung: Seit Oktober 2007 nimmt XXX an der strukturierten Schwerverletzten-Versorgung im Rahmen des Traumanetzwerkes Köln teil. Ziel der vorgelegten Studie ist die prospektive Erfassung, Analyse und Bewertung der klinikeigenen Patientendaten, die im Rahmen der Teilnahme am Traumaregister[for full text, please go to the a.m. URL]
Der Unfallchirurg, 1998
Candida species have emerged as important pathogens in human infection. Although a variety of dee... more Candida species have emerged as important pathogens in human infection. Although a variety of deep-seated candidal infections have been reported, Candida spondylitis has rarely been described. One patient with candida tropicalis spondylitis L I and L II in combination with candida coxitis is presented, and the 31 adult cases with vertebral involvement previously reported are reviewed. Candida spondylitis is noted as a simultaneous occurrence or late manifestation of hematogenously disseminated candidiasis. Spondylitis may not be prevented by a course of Amphotericin B adequate to control the acute episode of disseminated candidiasis, particularly in immune suppressed patients. Spondylitis does not present as a postoperative wound infection. The insidious progression of infection, the nonspecificity of laboratory data, and the failure to recognise Candida as a potential pathogen may lead to diagnostic delay. Diagnosis can be made by either open biopsy or CT controlled needle aspiration. Successful therapeutic regimes have employed combinations of antifungal therapy (Amphotericin B or fluconazole) with radical surgical debridement. Ventral and facultatively dorsal instrumentation is required to stabilize the spine. It is anticipated that the spondylitis will become a more commonly recognised manifestation of hematogenously disseminated candidiasis. A increasing significance of candida species as etiologic agents of infection immune compromised humans has been recognised in the recent years. In those patients whom an antecedent Candida septicaemia was documented, a striking delay of 3.3 months was found between the septicaemia and the onset of symptoms as well as the time of diagnosis.
Surgical and Radiologic Anatomy, 2012
Journal of Neurotrauma, 2006
Patients with traumatic brain injury (TBI) and skeletal injuries have increased rates of excessiv... more Patients with traumatic brain injury (TBI) and skeletal injuries have increased rates of excessive bone healing (EH = hypertrophic callus formation and/or heterotopic ossification). Polytrauma patients are often attributed higher rates of delayed fracture union. This study compares 182 total fractures in 29 isolated polytrauma patients (POLY) and 48 patients after TBI and polytrauma (TBI+POLY), examining the clinical parameters of EH versus delay. A subset of 28 patients (13 TBI+POLY, 15 POLY) underwent serological testing for the following bone turnover parameters: carboxy-terminal extension peptide of type 1 procollagen (P1CP), pyridinolene cross-linked carboxy-terminal telopeptide (1CTP), insulin-like growth factor-1 (IGF-1), insulin-like growth factor binding protein-3 (IGFBP-3), and basic fibroblast growth factor (bFGF). There were higher rates of delayed union in the POLY patients (45% vs. 23%) and EH in the TBI+POLY patients (33% vs. 17%) (not significant = NS). More delayed unions were observed in diaphyseal fractures suffered by POLY (28%) than in TBI+POLY (15%) patients (NS). EH after pelvic fracture was apparent in 52% TBI+POLY and in 21% POLY fractures (NS). P1CP levels did not differ between the groups, but the collagen breakdown parameter 1CTP was significantly higher in the POLY group (p = 0.01-0.04). IGF-1 levels were below normal in both groups, and did not differ. IGFBP-3, an IGF-1-inhibiting and collagenase-3-activating protein, was significantly higher in POLY patients (p = 0.017-0.037). bFGF levels did not vary between groups. Increased serum levels of 1CTP and IGFBP-3 in POLY patients suggest that EH in TBI patients is secondary to decreased collagen breakdown rather than increased synthesis.
Anatomia, Histologia, Embryologia: Journal of Veterinary Medicine Series C, 2005
ABSTRACT Surgeons agree that interrupted peripheral nerves should be reconstructed ‘soon’ to enab... more ABSTRACT Surgeons agree that interrupted peripheral nerves should be reconstructed ‘soon’ to enable neural regeneration. Delayed nerve repair will result in impaired outcome, but experimental data on such detriment due to delay are scarce. In a quantitative study we transected the right sciatic nerve of 80 adult female Lewis rats (LEW/SsNHsd), transflected the proximal nerve stump into a muscle pouch and let the animals wait 0 (immediate repair), 3, 6, 9 and 12 months after axotomy, until reconstruction was performed with a 5-mm long allograft from congenic age-matched donors. All hosts were studied with two different methods. First, the functional outcome of sciatic nerve reconstruction was evaluated 4–12 weeks after transplant by walking track analysis, calculating de Medinaceli's Sciatic Functional Index (SFI). Second, 12 weeks after transplantation the fibular communal nerve and the soleus branch of the tibial nerve close to its muscle entry were cut and the proximal stumps labelled with the retrograde neuronal tracers DiI or Fast-Blue. Fourteen days later the rats were perfused with formaldehyde, and the numbers of fluorescently labelled motoneurons were counted in 50 μm serial vibratome sections of the spinal cord. All measurements were done on coded material and codes broken only at the end of the study. Our results are clear-cut and deeply disappointing. The SFI was around 0 (normal value) in all rats before transection of the sciatic nerve; expectedly dropped to −85 to −125 after denervation, but stayed at −108 to −130 up to 12 weeks after transplantation. No improvement of gait at all occurred after sciatic nerve transplant performed immediately or 3, 6, 9 or 12 months after denervation.This failure of functional recovery is not due to lack of regeneration, as the numbers of labelled motoneurons prove. In normal rats we have labelled 549 ± 83 motoneurons by DiI and Fast-Blue. After immediate nerve repair we counted 533 ± 95 labelled motoneurons; after repair delayed for 12 months we still counted 474 ± 108 motoneurons that had regenerated. In all rats the labelled motoneurons were randomly interspersed with a complete lack of myotopic distribution. This misdirection of reinnervation sadly prevents recovery of motor function.
The American Journal of Sports Medicine, 2008
Background New cell-based treatments for articular cartilage repair are needed. As the optimal sc... more Background New cell-based treatments for articular cartilage repair are needed. As the optimal scaffold for cartilage repair has yet to be developed, scaffold-free cartilage implants may remove the complications caused by suboptimal scaffolds. Hypothesis The implantation of a scaffold-free, autologous de novo cartilage implant into standardized full-thickness cartilage defects of femoral condyles in sheep leads to a qualitatively better regenerative tissue than does periosteal flap alone or no treatment. Study Design Controlled laboratory study. Methods Chondral defects 4 mm in diameter (1 per sheep) were created in the center of 1 medial femoral condyle of 48 sheep. Twelve defects were allowed to heal spontaneously, 16 defects were covered with periosteal flaps alone, and 20 defects were filled with autologous de novo cartilage graft and overlaid with a periosteal flap. Differences were assessed macroscopically using the International Cartilage Repair Society score and microscopica...
Journal of Neurotrauma, 2004
Unfallchirurg, Sep 1, 2005
Aktuelle Traumatologie, 2000
Ruptures of the cruciate ligaments become an increasing clinical problem. The reconstruction of t... more Ruptures of the cruciate ligaments become an increasing clinical problem. The reconstruction of the anterior cruciate ligament is one of the most frequent operations of the knee, The indication and the timing point of surgery is discussed as frequently and controversially as the multiple methods of reconstruction. This article presents a review of the literature of this topic using more than 500 articles of the last years. Surgery is supposed to be performed in cases of complex injuries, of younger patients with high activity level, loose soft tissue and instability of the knee in daily life. The later intervention is preferable after decrease of swelling and lost of pain. Surgical results are obviously not dependant on using mini-arthrotomy or arthroscopy. One-incision-technique is to be performed instead of two-incision-technique when it is proceeded by an experienced surgeon. Primary suture has been left because of the insufficient results. Reconstruction using augmentation is to...
Spezialgebiete aus der Schulter- und Ellenbogenchirurgie, 2004
Die Stabilitat des Schultergelenkes wird masgeblich durch den statischen labrokapsulo-ligamentare... more Die Stabilitat des Schultergelenkes wird masgeblich durch den statischen labrokapsulo-ligamentaren Komplex, sowie durch den dynamischen Komplex der Rotatorenmanschette und der langen Bizepssehne bestimmt. Zur Sicherung eines grosen Bewegungsumfangs besteht ein Misverhaltnis zwischen Humeruskopfumfang und dem kleinen Glenoid. Die Instabilitat des Schultergelenkes entsteht durch eine Storung zwischen den kapsuloligamentaren Strukturen und den Muskeln. Von der traumatisch hervorgerufenen Instabilitat ist die atraumatische, angeborene Schulterlaxitat zu unterscheiden.
Journal of Pediatric Orthopaedics B, 2005
This prospective study investigated medium-term outcomes for 51 children treated from 1997 to 200... more This prospective study investigated medium-term outcomes for 51 children treated from 1997 to 2001 for displaced diaphyseal forearm fractures with elastic stable intramedullary nailing. Forty-three patients included achieved excellent/good functional results at an average follow-up of 38 months. Four patients required open fracture-manipulation at surgery. Complications included eight cases of soft-tissue irritation at nail-insertion site (three required shortening procedures), two temporary radial nerve branch injuries, four minimal rotational mobility deficits, one 10 degrees elbow extension deficit after splinting, and five small keloid scars. All patients were pain-free, without limitations in activities for daily life or sport/play activities by 12 months after hardware removal. Elastic stable intramedullary nailing is appropriate therapy for these injuries.
Fragestellung: In aktuellen Studien konnte gezeigt werden, dass der venöse Rückstrom des Untersch... more Fragestellung: In aktuellen Studien konnte gezeigt werden, dass der venöse Rückstrom des Unterschenkels durch Bewegung des Grosszehengrundgelenkes unterstützt wird. Im Falle von Sportverletzungen mit Beteiligung des Sprunggelenkes und Ruhigstellung desselben wurde die Frage behandelt,[for full text, please go to the a.m. URL]
Der Unfallchirurg, 2005
This prospective clinical trial was performed to assess healing, clinical outcome and complicatio... more This prospective clinical trial was performed to assess healing, clinical outcome and complications after intramedullary nailing of midshaft clavicular nonunions. Over 2.5 years, 14 patients were included. Exclusion criteria were pathological fractures, bony defects, previous operative therapy, atrophic and infection pseudarthrosis and the patient's age: <18 years or >70 years. Results were evaluated after 3, 6, 12 and 18 months. Beginning 3 months after the operation, pain (VAS), subjective satisfaction, Constant score and DASH score were significantly better than preoperatively during the follow-up period (p<0.001). There were no infections, no implant displacements or refractures.Intramedullary fixation of midshaft clavicular nonunions with an elastic titanium nail is a safe, minimally invasive surgical technique, producing excellent functional and cosmetic results without additional bone grafting.
Until December 2001 84 midclavicular fractures in 80 patients were treated with intramedullary na... more Until December 2001 84 midclavicular fractures in 80 patients were treated with intramedullary nailing. Postoperatively there was a significant decrease of pain and a significant increase of mobility compared to the situation preoperatively. 6 months after hardware removal the mean Constant-Score was 97.4 points. There was one none union. In one patient there was a loss of reduction with shortening of 1.5 cm. In 5 patients a shortening of the proximal end of the nail had to be performed, due to painful skin irritation. Intramedullary nailing of midclavicular fractures is a safe and minimally invasive operation technique. It should be offered to the patient as an alternative to conservative treatment.
The aim of this study was to compare the results achieved in two groups of 20 patients treated fo... more The aim of this study was to compare the results achieved in two groups of 20 patients treated for midclavicular fracture. The first group (mean age 36 years) was treated non-operatively with a rucksack bandage, whereas the second group (mean age 37 years) underwent intramedullary fixation with a titanium pin using a minimally invasive, unreamed technique. At follow-up, which averaged 3.1+/-0.9 years in group 1 and 2.9+/-0.7 years in group 2, the result of treatment, as indicated by the Constant score, functional outcome and cosmetic outcome, was significantly better in the group undergoing operative treatment. Clavicle shortening was significantly ( P=0.027) higher in patients treated with a rucksack bandage. The absolute Constant score averaged 78+/-23 in group 1 and 97+/-4 in group 2 ( P=0.001). The Constant rating scale showed a significant difference between patients with clavicle shortening of less than 1 cm and 1 cm shortening or more. There were two non-unions in group 1 but...