Surgical Treatment of Adolescent Clavicle Fractures

IntroductionFractures of the diaphysis of the clavicle are common; however, treatment guidelines for this condition are lacking. Surgery is associated with a lower risk of non-union and better functional outcomes but a higher risk of complications. Open reduction and internal fixation with plates and screws are the most commonly performed techniques, but they are associated with paraesthesia in the areas of incisions, extensive surgical exposure and high rates of implant removal. Minimally invasive techniques for treating these fractures have a lower rate of complications. The aim of this study is to evaluate which surgical treatment option (minimally invasive osteosynthesis or open reduction and internal fixation) has better prognosis in terms of complications and reoperations.Methods and analysisThe study proposed is a multicentric, pragmatic, randomised, open-label, superiority clinical trial between minimally invasive osteosynthesis and open reduction and internal fixation for surgical treatment of patients with displaced fractures of the clavicle shaft. In the proposed study, 190 individuals with displaced midshaft clavicle fractures, who require surgery as treatment, will be randomised. The assessment will occur at 2, 6, 12, 24 and 48 weeks, respectively. The primary outcome of the study will be the number of complications and reoperations. For sample size calculation, a moderate effective size between the techniques was considered in a two-tailed test, with 95% confidence and 90% power. Complications include cases of infection, hypertrophic scarring, non-union, refracture, implant failure, hypoesthesia, skin irritation and shoulder pain. Reoperations are defined as the number of surgeries for pseudoarthrosis, implant failure, infection and elective removal of the implant.Ethics and disseminationStudy approved by the institutional ethics committee (number 34249120.9.0000.5505—V.3). The results will be disseminated by publications in peer-reviewed journals and presentations in medical meetings.Trial registration numberRBR-3czz68)/UTN U1111-1257-8953.

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Surgical treatment of lateral clavicle fractures associated with complete coracoclavicular ligament disruption: Clinico-radiological outcomes of acromioclavicular joint sparing and spanning implants

International Journal of Shoulder Surgery ◽

10.4103/0973-6042.106224 ◽

2012 ◽

Vol 6 (4) ◽

pp. 116 ◽

Cited By ~ 9

Author(s):

DeepakN Bhatia ◽

RichardS Page

Keyword(s):

Surgical Treatment ◽

Acromioclavicular Joint ◽

Coracoclavicular Ligament ◽

Lateral Clavicle ◽

Clavicle Fractures ◽

Ligament Disruption

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Iatrogenic Supraclavicular Nerve Injuries in Surgical Treatment of Clavicle Fractures

N.N. Priorov Journal of Traumatology and Orthopedics ◽

10.17816/vto201522250-54 ◽

2015 ◽

Vol 22 (2) ◽

pp. 50-54

Author(s):

A. S Zolotov ◽

M. S Feshchenko ◽

O. I Pak

Keyword(s):

Surgical Treatment ◽

Postoperative Period ◽

Surgical Intervention ◽

Early Postoperative Period ◽

Surgical Approaches ◽

Nerve Injuries ◽

Clavicle Fractures ◽

Traumatic Damage

Incidence and pattern of disturbed sensitivity in the zone of surgical intervention was studied in 24 patients with clavicle fractures. Traumatic damage of supraclavicular nerve (not related to surgery) was observed only in 1 case. Disturbance of sensitivity in the zone of surgical intervention was noted in 21 (87.5%) patients. Mean area of anesthesia made up 44.5±29.3 cm2 (from 8.0 to 125.5 cm2). That complication developed at both horizontal and vertical surgical approaches. Intraoperatively supraclavicular nerves were visualized and preserved in 6 patients however disturbed sensitivity in early postoperative period was observed in 4 cases. Preventive isolation of supraclavicular nerves does not always ensure the preservation of sensitivity in early postoperative period.

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Fractures of the Clavicle: An Overview

The Open Orthopaedics Journal ◽

10.2174/1874325001307010329 ◽

2013 ◽

Vol 7 (1) ◽

pp. 329-333 ◽

Cited By ~ 21

Author(s):

Thomas D Donnelly ◽

Robert J MacFarlane ◽

Mathias Thomas Nagy ◽

Peter Ralte ◽

Mohammad Waseem

Keyword(s):

Surgical Treatment ◽

Operative Treatment ◽

Functional Outcomes ◽

Surgical Approaches ◽

High Grade ◽

Non Union ◽

The Past ◽

Clavicle Fractures ◽

Surgical Treatments

Fractures of the clavicle are a common injury and most often occur in younger individuals. For the most part, they have been historically treated conservatively with acceptable results. However, over recent years, more and more research is showing that operative treatment may decrease the rates of fracture complications and increase functional outcomes. This article first describes the classification of clavicle fractures and then reviews the literature over the past decades to form a conclusion regarding the appropriate management.A thorough literature review was performed on assessment of fractures of the clavicle, their classification and the outcomes following conservative treatment. Further literature was gathered regarding the surgical treatment of these fractures, including the methods of fixation and the surgical approaches used. Both conservative and surgical treatments were then compared and contrasted.The majority of recent data suggests that operative treatment may be more appropriate as it improves functional outcome and reduces the risk of complications such as non-union. This is particularly evident in mid shaft fractures, although more high grade evidence is needed to fully recommend this, especially regarding certain fractures of the medial and lateral clavicle.

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