Non-union of a clavicle fracture: lateral fragment excision for brachial artery embolism

Background: Clavicle Fractures is one of the common fractures of upper limb accounting for approximately 40 % of all shoulder fractures. Till recently all clavicle fracture were treated conservatively, but now interest in surgical management is rising. This study was carried out to see if Surgical management outweighs the conservative treatment of Fractures Of Clavicle. Methods: A total of 40 cases satisfying inclusion and exclusion criteria were included in the study. Alternate patients were allocated to operative and conservation groups. In total 20 patients were operated operatively and 20 patients were treated conservatively. Outcome was analysed in terms of radiological union and functional outcome of the patient. Constant and Murley score was used as a score to evaluate final outcome. Results: In this study, the 20 patients who were operated upon had an average union time of 7.8 weeks; 1 patient had delayed fracture union by 12 wks. 20 patients in conservative group had normal union of fractures with 1 patient going into non-union. Average union time in the conservative group was 9.4 weeks, which was more than the 7.8 weeks seen in the group treated operatively. Mal-union was present in 7 of the 20 patients treated conservatively, and 5 of these 7 had a visible deformity. Out of these patients with mal-union 1 had poor functional outcome, 3 had good to excellent outcome and 3 had satisfactory functional outcome. 4 of these had restricted movements terminally and 2 had pain on movement. Conclusions: From our study based on patients of clavicle fractures, it can be concluded that the operative group had significantly higher excellent outcomes as compared to the conservatively- managed group, based on the Constant and Murley score. Keywords: Clavicle Fractures, Constant and Murley Score, Operative Clavicle Fracture Management, Clavicle Fracture Functional Outcome.

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Late onset venous thoracic outlet syndrome following clavicle non-union fracture: A case report

Vascular ◽

10.1177/1708538114538253 ◽

2014 ◽

Vol 23 (2) ◽

pp. 183-187 ◽

Cited By ~ 2

Author(s):

Daniel J Wong ◽

Tammy M Holm ◽

George SM Dyer ◽

Jonathan D Gates

Keyword(s):

Case Report ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Thoracic Outlet Syndrome ◽

Late Onset ◽

Plate Fixation ◽

Clavicle Fracture ◽

Vascular Complications ◽

Non Union ◽

Clavicle Fractures

A 59-year-old woman was admitted three times over a six-month period with recurrent upper extremity deep venous thrombosis (UEDVT). It was determined that this patient was suffering from an unusual presentation of Paget-Schröetter syndrome secondary to a 20-year-old non-union of a midshaft clavicle fracture. Following thrombolysis the patient underwent resection and plate fixation of the clavicle fracture non-union. Despite the anatomic proximity of the subclavian vessels to the clavicle, vascular complications from fracture are rare. Treatment of midshaft clavicle fractures is often non-operative. Non-union rates are generally less than 10%, and easily treated secondarily without complication. Clavicular pseudo-arthroses from trauma have been implicated in the development of the thoracic outlet syndromes, however, onset 20 years after fracture has never before been reported.

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Late onset acute occlusion of the subclavian artery after clavicle fracture

Vascular ◽

10.1177/1708538114565206 ◽

2014 ◽

Vol 23 (6) ◽

pp. 661-662 ◽

Cited By ~ 2

Author(s):

PM van Schaik ◽

GJ de Borst ◽

FL Moll ◽

RJ Toorop

Keyword(s):

Case Report ◽

Thrombolytic Therapy ◽

Brachial Artery ◽

Late Onset ◽

Clavicle Fracture ◽

Limb Ischemia ◽

Vascular Injuries ◽

Surgical Exploration ◽

Acute Occlusion ◽

Life Threatening

Vascular injuries after a clavicle fracture are rare. The treatment remains, if possible, conservative. In case of life-threatening bleeding or limb ischemia, endovascular treatment is the treatment of choice. In this case report, we describe a patient who suffered a clavicle fracture five years before and now presented with acute invalidating claudication caused by an acute occlusion superimposed on a brachial artery stenosis. After unsuccessful thrombolytic therapy a surgical exploration of the brachial artery was performed.

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Surgical Treatment for Non-union of Clavicle Fracture

Orthopedics & Traumatology ◽

10.5035/nishiseisai.57.474 ◽

2008 ◽

Vol 57 (3) ◽

pp. 474-477

Author(s):

Takuya Ikuta ◽

Toshio Kitamura

Keyword(s):

Surgical Treatment ◽

Clavicle Fracture ◽

Non Union

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Iatrogenic postoperative brachial plexus compression secondary to hypertrophic non-union of a clavicle fracture

Annals of The Royal College of Surgeons of England ◽

10.1308/003588413x13511609956174 ◽

2013 ◽

Vol 95 (3) ◽

pp. e1-e3 ◽

Cited By ~ 10

Author(s):

D Thavarajah ◽

J Scadden

Keyword(s):

Internal Fixation ◽

Brachial Plexus ◽

Callus Formation ◽

Clavicle Fracture ◽

Brachial Plexopathy ◽

Rigid Internal Fixation ◽

Non Union

The brachial plexus is related intimately to the clavicle such that injury can occur primarily and most commonly at the time of trauma through traction or it can occur secondarily, mainly owing to hypertrophic non-union with exuberant callus formation, causing compression of the plexus. The movement-dependent rearrangement of the subclavicular space is restricted with rigid internal fixation, thereby placing inappropriate pressure on the plexus from the deep hypertrophic tissue. This case highlights another cause of brachial plexopathy of which to be aware.

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Partial claviculectomy after non-union of proximal clavicle fracture

BMJ Case Reports ◽

10.1136/bcr-2013-008874 ◽

2013 ◽

Vol 2013 (mar29 1) ◽

pp. bcr2013008874-bcr2013008874 ◽

Cited By ~ 1

Author(s):

H.-G. Teng ◽

A. L.-J. Liu

Keyword(s):

Clavicle Fracture ◽

Non Union

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Hybrid approach in patients with recurrent brachial artery embolism: adjunctive tissue plasminogen activator infusion following embolectomy

Turkish Journal of Trauma and Emergency Surgery ◽

10.5505/tjtes.2014.73930 ◽

2014 ◽

Vol 20 (1) ◽

pp. 56-58

Author(s):

Mete Gursoy ◽

Veday Bakuy ◽

Mehmet Atay ◽

Jabir Gulmaliyev ◽

Ahmet Akgul

Keyword(s):

Plasminogen Activator ◽

Tissue Plasminogen Activator ◽

Brachial Artery ◽

Hybrid Approach ◽

Artery Embolism ◽

Tissue Plasminogen

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Additional fixation using a metal plate with bioresorbable screws and wires for robinson type 2B clavicle fracture

Clinics in Shoulder and Elbow ◽

10.5397/cise.2020.00262 ◽

2020 ◽

Vol 23 (4) ◽

pp. 198-202

Author(s):

Woo Jin shin ◽

Young Woo Chung ◽

Seon Do Kim ◽

Ki-Yong An

Keyword(s):

Conservative Treatment ◽

Clavicle Fracture ◽

Shaft Fracture ◽

Metal Plate ◽

Bone Screw ◽

Non Union ◽

Shaft Fractures ◽

Clavicle Fractures ◽

Clavicle Shaft Fracture ◽

Additional Fixation

Simple clavicle shaft fracture typically achieves satisfactory union after treatment and does not result in complication with conservative treatment. Non-union or malunion can occur in displaced clavicle fractures or comminuted shaft fractures. Treatment of displaced comminuted clavicle shaft fractures is performed by holding together the free fragments with interfragmentary screws or wires and fixing them to the clavicle with a plate. Therefore, we performed interfragmentary fixation using open reduction and internal fixation with bioresorbable screws (Mg-Ca alloy, Resomet Bioresorbable bone screw; U&I Corp.) and bioresorbable wires (Mg-Ca alloy, Resomet Bioresorbable K-wire and pin, U&I Corp.) for displaced comminuted clavicle fractures (Robinson type 2B) and additionally used a metal plate. We expected decreased irritation and infection due to absorption after surgery. We report four cases that were treated in this way.

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Comparing functional outcome in lateral end clavicle fracture after conservative and plating

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20172882 ◽

2017 ◽

Vol 3 (4) ◽

pp. 833

Author(s):

Sachin Y. Kale ◽

Prasad Chaudhari ◽

Shikhar D. Singh ◽

Sanjay B. Dhar ◽

Prakash D. Samant ◽

...

Keyword(s):

Functional Outcome ◽

Functional Outcomes ◽

Standard Treatment ◽

Clavicle Fracture ◽

Operative Management ◽

Skin Infections ◽

Non Union ◽

Medical College ◽

Clavicle Fractures ◽

Early Healing

Background: Fractures of the clavicle have been traditionally treated non- operatively but has been associated with various postoperative complications. In this study, we analyzed the outcomes of the operative management and compare its results with conservative treatment considering it as standard treatment option.Methods: The present study was carried out at the Department of Orthopedics, DY Patil Medical College and Hospital, Navi Mumbai. Open fractures, fractures associated with complication like head injury with associated other bone injuries were included in this study. We excluded patients less than 18 years of age, patients with middle third fracture of clavicle and patients with medial end clavicle fracture. The fractures were classified according to Robinson’s classification. Patients were followed up every week for 4 weeks then at 8 weeks, 12 weeks, 6 months and 1 year. The functional outcomes were assessed by Constant and Murley score.Results: We included 48 patients in the study, 34 of which were males, average age of the patients was 37.53±7.64 years. 23 injuries were on the left. There was statistically significant better union times with operative management (p=0.034). Various complications were observed like infection, implant failure, man union, non-union, deformity and skin infections, statistically seen more in patients who underwent conservative management. Overall, patients experienced excellent and good results with operative management in 6 and 12 patients respectively.Conclusions:Operative treatment gave statistically significant functional outcome and early healing compared to conservatively treated in displaced, communited lateral end clavicle fractures.

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Study of surgical outcome of mid third clavicle fractures surgically managed by locking compression plate

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20214965 ◽

2021 ◽

Vol 8 (1) ◽

pp. 72

Author(s):

Potharaju Swetha Rani ◽

M. Zeeshan Vasif

Keyword(s):

Functional Outcome ◽

Road Traffic ◽

Constant Score ◽

Clavicle Fracture ◽

High Energy ◽

Bony Union ◽

Non Union ◽

Fall From Height ◽

Clavicle Fractures ◽

A Prospective Study

Clavicle is one of the most frequently fractured bones in young and active individuals. They account for 2.6-12% of all fractures and for 44-66% of fractures around the shoulder. Majority of clavicle fractures are mid shaft (80-85%). Functional outcome of midshaft fracture not only depends on the union but also on its length which has to be maintained. Thus a displaced or comminuted fracture carries a risk of symptomatic malunion, non-union or poor functional outcome with cosmetic deformity. The recent trend is shifting to internal fixation of these displaced mid shaft clavicle fracture. This was a prospective study of 20 cases of fresh mid third clavicle fracture admitted to MNR medical college and hospital from August 2020 to September 2021. Cases were taken according to inclusion and exclusion criteria. Medically unsuitable and patients not willing for surgery were excluded from the study. There were 17 male patients and 3 female patients with mid 1/3 closed clavicle fracture. 12 patients had right sided clavicle fracture and 8 patients had fracture of the left clavicle. All 20 fractures were closed fractures. Majority of the patients sustained fracture due to road traffic accident (high energy trauma) in 16 cases, fall from height in 3 cases and assault in one case. The mean duration to surgery from the day of presentation and injury was 2.1 days for middle third clavicle fractures. Functional outcome as assessed by constant and Murley scoring was favourable with excellent to good result in 97% cases and fair in 3% cases. The average constant score was 93.35 in one year follow up in middle third group. This study has some limitations. The conclusions drawn from this analysis cannot be generalized because of the small number of cases. In conclusion, for middle third clavicle fractures bony union could be achieved with locking compression plates and the clinical outcomes were satisfactory. All the fractures united and there were no cases of nonunion.

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