Outcome following management of unstable lateral end clavicle fractures with locking plate and coracoid anchor augmentation

Background Management of complex lateral end clavicle fractures with coraco-clavicular ligament disruption can be challenging. Methods We prospectively analysed 19 (17 M:2F) patients from January 2014 to June 2016. Six patients had intra-articular fractures (Edinburgh-3B2) and the remaining were extra-articular (3B1). All patients had open reduction internal fixation with lateral end locking plate augmented with a coracoid anchor. All patients were evaluated at the final follow-up by American Shoulder and Elbow Surgeon score (ASES), Disabilities of the Arm, Shoulder and Hand (DASH), Oxford Shoulder Score (OSS), return to work, sports and radiographs. Results At a mean follow-up of 54 months (range 37–64), 19 patients were available for analysis. Mean age of patients was 34 years (range 24–65). At final follow-up DASH score was 1.66 (range 0–5); ASES score was 98.14 (93.3–100) and OSS was 46.6 (42–48). There was no difference in the functional outcome between 3B1 and 3B2 fractures (DASH – p(0.51); ASES – p(0.44); OSS – p(0.69)). All patients returned to preinjury level of function, sports and work. Five patients needed implant removal and three developed capsulitis that resolved with conservative treatment. Conclusion Locking plate fixation, augmented with coracoid anchor is an effective option in the management of these complex injuries. The need for implant removal is reduced (26%) and there is no difference in the functional outcome between 3B1 and 3B2 fractures.

Download Full-text

A study on the outcome of displaced midshaft non-comminuted clavicle fractures treated with anatomical locking plate versus titanium elastic nail

Journal of Orthopaedics Trauma and Rehabilitation ◽

10.1177/2210491720975189 ◽

2020 ◽

pp. 221049172097518

Author(s):

Vineet Thomas Abraham ◽

Chandrasekaran Marimuthu

Keyword(s):

Functional Outcome ◽

Locking Plate ◽

Plate Versus ◽

Dash Score ◽

Titanium Elastic Nail ◽

Constant Murley Score ◽

Elastic Nail ◽

Clavicle Fractures ◽

The Mean ◽

Quick Dash

Purpose: Fixation of displaced midshaft clavicle is well known to decrease nonunion, malunion and shoulder disability as compared to nonoperative treatment. This study was done to compare the clinical and functional outcome of group 1 clavicle fractures treated with anatomic locking plates (ALP) versus Titanium elastic nail (TEN). Methods: We studied patients presenting with displaced midshaft clavicle fractures treated with ALP or TEN. The study period was from Jan 2013 to Dec 2016. Patients were reviewed and at each visit clinical and radiological progress of union was noted, complications if any were noted, functional assessment was done using the quick Dash score and Constant Murley score. Results: A total of 116 patients met our inclusion criteria. 62 patients were treated with TEN and 54 with ALP. Bony union was achieved at an average of 11.8 weeks in the TENS group and 12.8 weeks in the ALP group post operatively and this was found to be significant. The mean postoperative Constant Murley score in the ALP and the TEN groups were 92.8 (range 80–97), and 93.7 (82–97) respectively. The mean postoperative quick dash score in the ALP and TEN groups were 2.48(range from 0 to 6.8) and 2.1 (range 0–9.1) respectively. Conclusion: Both Anatomical locking plate and TEN are good options for the treatment of non-comminuted mid clavicular fractures as they have a similar functional outcome. TEN nail insertion has the advantage of being minimally invasive, having a faster union time and may be recommended in midshaft clavicle fractures without comminution.

Download Full-text

The comparison of Nice knots and traditional methods as an auxiliary reduction-fixation technique in pre-contoured locking plate fixation for comminuted Robinson type 2B clavicle fracture: a retrospective study

10.21203/rs.3.rs-33348/v1 ◽

2020 ◽

Author(s):

Shengkun Hong ◽

Wei Wang ◽

Jinku Guo ◽

Feixiong He ◽

Cong Wang

Keyword(s):

Locking Plate ◽

Plate Fixation ◽

Clavicle Fracture ◽

Operation Time ◽

Locking Plate Fixation ◽

Traditional Methods ◽

Traditional Group ◽

Lag Screw ◽

Clavicle Fractures

Abstract Background: Open reduction and pre-contoured locking plate fixation is a popular treatment option for displaced midshaft clavicle fracture. Lag screw and cerclage are two main intraoperative techniques to reduce and fix fragments. However, both lag screw and metallic cerclage have disadvantages. The doubled-suture Nice knot has been reported in many areas of orthopedic surgery for its effectiveness. This study aims to compare the outcomes of comminuted mid-shaft clavicle fractures reduced by Nice knots versus traditional techniques (lag screw or/and metallic cerclage) when bridged with pre-contoured locking plates.Methods: We retrospectively reviewed 101 patients (65 females and 36 males) diagnosed with midshaft clavicle fractures with at least one wedge fragment reduced by either Nice knots or traditional methods and bridged with pre-contoured locking plates between December 2016 and April 2019. Operation time, functional outcomes, pain, patient satisfaction, fracture healing and complications were assessed at a follow-up of 12 to 40 months.Results: The mean age of all the patients was 50.8 years. There were 52 and 49 patients in Nice knot group and traditional group respectively, and no differences between two groups was found in general patient characteristics, fracture type, follow up and injury-to-surgery duration. The Nice knot group had significant less operation time (p < 0.01) than the traditional group (mean and standard deviation [SD], 78.6±19.0 compared with 94.4±29.9 minutes, respectively). For healing time, functional score, pain, satisfaction and complications, there was no significant differences between groups, despite the Nice knot group had slightly better results.Conclusions: Both Nice knots and traditional methods treated for comminuted Robinson type 2B clavicle fractures were effective and safe. And the Nice knots seemed to be superior with significant less operation time.

Download Full-text

Anatomical plating versus titanium elastic nailing for displaced midshaft clavicle fractures: a prospective comparative study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20210621 ◽

2021 ◽

Vol 7 (2) ◽

pp. 278

Author(s):

Ashish Philip ◽

Shishir Murugharaj Suranigi ◽

Lingaraj . ◽

Kanagasabai Rengasamy ◽

Syed Najimudeen

Keyword(s):

Functional Outcome ◽

Plate Fixation ◽

Minimal Invasive ◽

Dash Score ◽

Randomised Study ◽

Titanium Elastic Nailing ◽

Significant Difference ◽

Prospective Comparative Study ◽

Clavicle Fractures ◽

The Mean

Background: Plate fixation has become the standard operative method for fixing displaced midshaft clavicle fractures. Over the years, TENS has also gained lot of attention due to its minimal invasive nature, smaller scar and reduced operative time. The purpose of this study was to compare the functional outcome of middle third displaced clavicle fractures treated either by plate or intra medullary TENS fixation using Constant Murley score and disability of the arm, shoulder and hand score.Methods: A prospective randomised study was conducted from January 2010 to September 2016 at our institute on patients with displaced midshaft clavicle fractures. A total of 56 patients (TENS; n=25, plating; n=31), classified according to orthopaedic trauma association classification underwent midshaft clavicle fixation. They were followed-up for a minimum period of 1 year.Results: Length of the scar in the TENS group was significantly smaller when compared to the incision in the plating group (1.86±1.23 and 11.01±3.29 cms respectively, p<0.001). The Constant shoulder score measured at the end of 1 year was 90.77±9.01 for the TENS group and 92.63±6.04 for the plating group, not significant statistically (p=0.269). The mean DASH score was also not significantly different (p=0.552) between the TENS group and the plating group, at 6.01±11.09 and 6.32±10.33 respectively.Conclusions: In comparison with plate fixation, the nailing procedure is less invasive, requires smaller incisions and has a shorter duration of hospital stay with no statistically significant difference in terms of functional outcome. Hence, TENS technique is recommended for the fixation of displaced mid-shaft non-/minimal comminuted clavicular fractures, especially for young individuals and can be used as an alternative to plate fixation.

Download Full-text

Functional outcome of displaced mid shaft clavicular fractures treated by plate fixation: a prospective observational study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20213381 ◽

2021 ◽

Vol 7 (5) ◽

pp. 996

Author(s):

Junaid Ebrahim ◽

Abdul Asraf Variyathodi ◽

Mohamed Shakeeb Kannan Thody Uppil Thody ◽

Nithin Chandrasekharan

Keyword(s):

Observational Study ◽

Functional Outcome ◽

Prospective Observational Study ◽

Plate Fixation ◽

Shoulder Girdle ◽

High Energy ◽

Young Males ◽

Clavicle Fractures ◽

Radiological Union

Background: Clavicle fractures are one of the commonest injuries to the shoulder girdle. Traditionally these fractures are treated conservatively. This study was to assess the functional outcome of displaced mid shaft clavicular fractures treated with plate fixation.Methods: This was a single center prospective observational study conducted at department of orthopaedics M.E.S medical college Perinthalmanna between the period January 2018 to December 2018 in patients with displaced mid shaft clavicle fractures treated by plate fixation. Out of 51 patients 35 patients were males and 16 were females with mean age of 37.7 years (range 19-59). All patients included in this study were included under Allman group 1. All Patients were treated with plate fixation. Post op follow done at 1 1/2 ,3 and 6 months. During follow up clinical and radiological union were checked. Final functional outcome was assessed at 6 months follow up by Constant-Murley Score.Results: Out of 51 patients with displaced mid shaft clavicle fractures treated with plate fixation 43 patients (84.3%) showed excellent functional outcome 8 patients (15.7%) showed good functional outcome. None of the patients showed moderate or poor outcome. The radiological union was attained at 9.35 weeks. No complications in 83.4% of patients.Conclusions: Mid shaft clavicle fractures are more common in young males sustaining high energy trauma, and those fractures treated with plate fixation has a better functional outcome in terms of pain relief, activities of daily living and range of motion.

Download Full-text

Mid-term outcome of volar plate fixation for scaphoid nonunion

The Bone & Joint Journal ◽

10.1302/0301-620x.102b12.bjj-2019-1160.r3 ◽

2020 ◽

Vol 102-B (12) ◽

pp. 1697-1702

Author(s):

Philip Marcel Jozef Schormans ◽

Maria A. Kooijman ◽

Jan A. Ten Bosch ◽

Martijn Poeze ◽

Pascal F. W. Hannemann

Keyword(s):

Functional Outcome ◽

Cancellous Bone ◽

Bone Grafting ◽

Locking Plate ◽

Plate Fixation ◽

Ct Scans ◽

Scaphoid Nonunion ◽

Cancellous Bone Grafting ◽

The Mean

Aims Fixation of scaphoid nonunion with a volar locking plate and cancellous bone grafting has been shown to be a successful technique in small series. Few mid- or long-term follow-up studies have been reported. The aim of this study was to report the mid-term radiological and functional outcome of plate fixation for scaphoid nonunion. Methods Patients with a scaphoid nonunion were prospectively enrolled and treated with open reduction using a volar approach, debridement of the nonunion, and fixation using a locking plate and cancellous bone grafting, from the ipsilateral iliac crest. Follow-up included examination, functional assessment using the patient-rated wrist/hand evaluation (PRWHE), and multiplanar reformation CT scans at three-month intervals until union was confirmed. Results A total of 49 patients with a mean age of 31 years (16 to 74) and a mean duration of nonunion of 3.6 years (0.4 to 16) were included. Postoperatively, the nonunion healed in 47 patients (96%) as shown on CT scans. The mean time to union was 4.2 months (3 to 12). Due to impingement of the plate on the volar rim of the radius and functional limitation, the hardware was removed in 18 patients. At a median follow-up of 38 months in 34 patients, the mean active range of motion (ROM) improved significantly from 89° to 124° (SD 44°; p = 0.003). The mean grip strength improved significantly from 52% to 79% (SD 28%; p < 0.001) of the contralateral side. The mean PRWHE score improved significantly from 66 to 17 points (SD 25; p < 0.001). Conclusion Locking plate fixation supplemented with autologous cancellous bone grafting is a successful form of treatment for scaphoid nonunion. Functional outcomes improve with the passage of time, and mid-term results are excellent with a significant improvement in ROM, grip strength, and functional outcome as measured by the PRWHE. Cite this article: Bone Joint J 2020;102-B(12):1697–1702.

Download Full-text

LOCKING PALMAR PLATE FIXATION FOR DORSALLY DISPLACED FRACTURES OF THE DISTAL RADIUS: A PRELIMINARY REPORT

Hand Surgery ◽

10.1142/s0218810411005527 ◽

2011 ◽

Vol 16 (03) ◽

pp. 263-269 ◽

Cited By ~ 3

Author(s):

Koji Moriya ◽

Hidehiko Saito ◽

Yuji Takahashi ◽

Hiroyuki Ohi

Keyword(s):

Distal Radius ◽

Locking Plate ◽

Plate Fixation ◽

Functional Results ◽

Wrist Pain ◽

Point System ◽

Articular Fractures ◽

Palmar Plate ◽

Ulnar Wrist Pain

We reviewed a series of 62 consecutive patients with dorsally displaced fractures of the distal radius, including 20 extra-articular and 42 intra-articular fractures. All patients were treated with palmar locking plate systems at our institution between 2002 and 2006. After a minimum follow-up time of 12 weeks, the fractures had healed with satisfactory radiographic and functional results. According to the demerit point system of Gartland and Werley, 35 patients were rated excellent, 26 good, and one fair. In the good and fair groups, the demerit points were almost all for ulnar wrist pain. Our results suggest that palmar locking plate systems enable early functional mobilization with good reproducible radiographic and clinical outcomes. Since nine out of 62 patients had residual ulnar wrist pain at the final follow-up evaluation, further investigation of the pathogenesis of ulnar wrist pain is necessary to obtain better functional outcomes.

Download Full-text

Volar Locking Plating for the Intra- and Extra-articular Distal Radius Fractures With Dorsal Metaphyseal Comminution

10.21203/rs.3.rs-564409/v1 ◽

2021 ◽

Author(s):

Xue-yang Gui ◽

Zhao-hui Cheng ◽

Hongfei Shi ◽

Yi-xin Chen ◽

Jin Xiong ◽

...

Keyword(s):

Distal Radius ◽

Locking Plate ◽

Plate Fixation ◽

Distal Radius Fractures ◽

Volar Locking Plate ◽

Radius Fractures ◽

Locking Plate Fixation ◽

Articular Fractures ◽

Metaphyseal Comminution

Abstract Background: Volar locking plating remains a popular method for the surgical management of distal radius fractures. Dorsal metaphyseal comminution (DMC) is a common fracture pattern which weakens the stability during fracture fixation. In this study, we aimed to compare the radiographic and functional outcome of the intra- and extra-articular distal radius fractures with DMC following volar locking plate fixation.Materials and methods: Patients suffered from a distal radius fracture with DMC were reviewed in the clinical database of the authors’ institution between Jan 2016 and Jan 2020. The included patients were classified into the extra-articular (A3) group or the intra-articular (C2 and C3) group according to the AO/OTA system. The radiological parameters, wrist range of motion, and functional outcomes were evaluated following open reduction and volar locking plate fixation.Results: A total of 130 patients were included in this study with a mean follow-up length of 17.2 months. Compared with the A3 fracture group, no significant fracture re-displacement or reduced wrist ROMs was observed in the C2 fractures after 12-month’s follow-up. However, significantly decreased volar tilt (P = 0.003) as well as the extension/flexion ROMs were observed in the C3 fractures comparing to the A3 fractures. Most of the patients achieved an excellent (n = 75) or good (n = 51) Gartland and Werley wrist score. Four patients with C3 fractures resulted in a fair functional outcome due to a significant loss of volar tilt during follow-up.Conclusions: The volar locking plate fixation provided sufficient stability for distal radius fractures with DMC, and resulted in similar radiological and functional outcomes in the intra-articular distal radius fractures with a simple articular component (C2 fractures) as those in the extra-articular fractures. Considering the intra-articular fractures with multifragmentary articular component (C3 fracture), despite of the subsequent loss of volar tilt, the majority of the patients achieved good to excellent wrist function following volar locking plating.Trial registration: Not applicable because the design of the study is retrospective.

Download Full-text

Comparison of clinic-radiological and functional outcome of intra articular distal end radius fractures managed by volar locking plate versus external fixation

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20213076 ◽

2021 ◽

Vol 9 (8) ◽

pp. 2324

Author(s):

Pankaj Vir Singh ◽

Gagandeep Singh ◽

Tejpal Singh ◽

Abdul Ghani ◽

Zubair A. Lone

Keyword(s):

Range Of Motion ◽

Functional Outcome ◽

External Fixator ◽

Locking Plate ◽

Plate Versus ◽

Dash Score ◽

Volar Locking Plate ◽

Radius Fractures ◽

Medical College ◽

Articular Fractures

Background: Distal end radius (DER) fractures are most common fractures in upper limb. Intra articular fractures can be managed either by open reduction and internal fixation by volar locking plate or can be managed by closed reduction and external fixator application or by percutaneous pinning. The purpose of our study was to compare the functional outcome of volar locking plate with that of external fixation.Methods: A prospective cohort study was conducted between June 2019 to June 2020 in Government Medical College, Jammu on 46 patients with intra articular distal end radius fractures. Of which 26 were managed by volar locking plate and 20 were managed by external fixator. the results of both groups were compared on the basis of radiological parameter and range of motion achieved post operatively. The functional outcome was evaluated using DASH score and Gartland–Werley scale. Results: Final range of motion, grip strength were better in patients managed with volar locking plate (VLP) as compared to those who were managed with external fixator (EF). Radiographically, volar tilt, radial height were all better in VLP group than EF.Conclusions: We concluded that VLP is superior method to maintain reduction till the union occurs and prevents the fracture collapse in intra articular distal end radius fractures as compared with external fixator. Thus, giving better functional and radiological outcome than the external fixator.

Download Full-text

Treatment of Unstable Distal Clavicle Fractures (Neer type IIb): A Modified System using a Miniature Locking Plate with a Single Button

10.21203/rs.3.rs-129849/v1 ◽

2020 ◽

Author(s):

Hua Ying ◽

Jihuan Wang ◽

Yuehua Sun ◽

Kerong Dai ◽

Chao Yu ◽

...

Keyword(s):

Locking Plate ◽

Surgical Techniques ◽

Dash Score ◽

Shoulder Injuries ◽

Distal Clavicle ◽

Coracoclavicular Ligaments ◽

Clavicle Fractures ◽

Neer Type Iib ◽

Distal Clavicle Fractures

Abstract Background: Distal clavicle fractures were common in shoulder injuries. This study described the novel fixation technique using a miniature locking plate with a single button and reported its clinical outcomes obtained in patients with distal clavicle fractures associated with coracoclavicular ligaments disruption. Methods: Seven patients with distal clavicle fractures were included with a follow-up period of 12 months. All patients were diagnosed type IIb fractures according to the Neer classification. Distal clavicle fracture was fixed with a miniature locking plate and coracoclavicular ligaments were reconstructed using a single button. Functional outcomes were assessed at the final follow-up visit.Results: At 1-year follow-up, all patients had achieved radiographic union. There were no cases of nonunion or osteolysis. Mean Constant score at final follow-up was 88±5.13 (range, 78-93). Mean DASH score was 19.17±7.70 (range, 11.67-25). Mean UCLA score was 30±2.52 (range, 25-33).Conclusions: Internal fixation using a miniature locking plate and coracoclavicular reconstruction with a single button were reliable surgical techniques for restoring stability in patients with Neer type IIb distal clavicle fractures.

Download Full-text