Danish medical journal
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Danish medical journal · Jul 2012
ReviewClavicle fractures may be conservatively treated with acceptable results - a systematic review.
The optimal treatment of acute, displaced midshaft clavicle fractures is controversial. Despite lack of compelling evidence towards superior results after primary surgery, it seems that more and more patients are treated surgically. The aim of this study was to investigate which treatment modality should be preferred in this population according to current literature. ⋯ Surgical treatment of acute, displaced midshaft clavicle fractures with a plate yields a better functional outcome and lower mal- and nonunion rates than conservative treatment. However, the clinical relevance of the observed functional benefits are questionable as is the use of the shoulder outcome scores frequently employed to assess the functional outcome of clavicle fracture treatment. When operative treatment is preferred, the number needed to treat to avoid a nonunion is high.
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Danish medical journal · Jul 2012
ReviewClavicle fractures may be conservatively treated with acceptable results - a systematic review.
The optimal treatment of acute, displaced midshaft clavicle fractures is controversial. Despite lack of compelling evidence towards superior results after primary surgery, it seems that more and more patients are treated surgically. The aim of this study was to investigate which treatment modality should be preferred in this population according to current literature. ⋯ Surgical treatment of acute, displaced midshaft clavicle fractures with a plate yields a better functional outcome and lower mal- and nonunion rates than conservative treatment. However, the clinical relevance of the observed functional benefits are questionable as is the use of the shoulder outcome scores frequently employed to assess the functional outcome of clavicle fracture treatment. When operative treatment is preferred, the number needed to treat to avoid a nonunion is high.
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Danish medical journal · Jul 2012
ReviewStaging of women with breast cancer after introduction of sentinel node guided axillary dissection.
Today, sentinel lymph node dissection (SLND) has replaced axillary lymph node dissection (ALND) as standard procedure for staging of the axilla in the treatment of breast cancer. SLND can accurately stage the axilla by removing on average only two lymph nodes. Only in case of metastatic spread to sentinel nodes an ALND is offered. ⋯ Accordingly, there is a trend towards omission of ALND in breast cancer patients with minimal metastatic disease in sentinel node. As a result, a tool is needed to identify a group of patients with high risk of recurrence, where ALND should still be offered. In our model a small group of patients with micrometastases had a high risk of NSN metastases on nearly 40%, comparable to patients with macrometastases, indicating that ALND may still be recommended in this subgroup in the future.