Clavicular osteotomy to assess subclavian vein injury during internal fixation of midshaft clavicle fractures

Midshaft clavicle fractures are commonly fixed with locking plates. The subclavian vein risks injury during this procedure and the consequences can be fatal. The purpose of this present study is to describe a clavicular osteotomy technique in order to equip orthopaedic surgeons with a means of rapidly accessing a subclavian vein injury. The osteotomy should only be performed following an urgent intraoperative vascular surgery assessment. There must be shared consensus from both orthopaedic and vascular surgery that direct repair of the subclavian vein is necessary, and further exposure is required. The results of the technique performed on thirteen embalmed cadaveric specimens are also included. The osteotomy was able to expose 3.16 cm (SD = 0.60) of the subclavian vein and both the fracture and osteotomy site of all clavicles (100%) were able to be reduced and fixed using a single pre-contoured fifteen-hole lateral plate intended for use on the contralateral shoulder. This surgical technique study confirms that in the rare circumstance that the osteotomy is utilized, adequate exposure of the subclavian vein is achieved.

Download Full-text

EVALUATION OF A TRAINING COURSE ON OPEN VASCULAR SURGICAL TECHNIQUES IN AORTOILIAC PATHOLOGY - 5 YEARS OF EXPERIENCE

Medicine and Pharmacy Reports ◽

10.15386/cjmed-415 ◽

2015 ◽

Vol 88 (2) ◽

pp. 196-202

Author(s):

Bogdan Stancu ◽

Florin Beteg ◽

Aurel Mironiuc ◽

Aurel Muste ◽

Claudia Gherman

Keyword(s):

Surgical Technique ◽

Vascular Surgery ◽

Prospective Study ◽

Surgical Techniques ◽

Surgical Skills ◽

Technical Quality ◽

Statistical Association ◽

Abdominal Aortic

Introduction. The aim of this prospective study was to assess the efficacy of a vascular surgery course (2008-2012), and to verify the viability and the feasibility of the vascular anastomoses.Material and method. Vascular surgical techniques performed simultaneously on pigs were: enlargement prosthetic angioplasty, abdominal aortic interposition graft and aortoiliac bypass. Endpoints of the study were the surgical skills and the technical quality, evaluated on a scale ranging from 1 (satisfactory) to 3 (very good) for our participants.Result. A significant improvement in vascular surgical skills tasks was observed during the study years and we also found a semnificative statistical association between the quality of suture and the surgical technique used (Kendall coefficient=0.71, p=0.001<0.05).Conclusions. Our course contributed to the improvement of technical vascular surgical skills of the operator teams, reproducing in vivo, in pigs, the intraoperative environment as in human patients.

Download Full-text

Comparing Locking Screw Direction Among Three Locking Plates for Lateral Clavicle Fractures: A Simulation Study

10.21203/rs.3.rs-80154/v1 ◽

2020 ◽

Author(s):

Shingo Abe ◽

Kota Koizumi ◽

Toshiki Shimada ◽

Tsuyoshi Murase ◽

Kohji Kuriyama

Keyword(s):

Sagittal Plane ◽

Fragment Size ◽

Three Dimensional ◽

Locking Plates ◽

Distal Clavicle ◽

Inferior Surface ◽

Locking Screws ◽

Lateral Clavicle ◽

The Usa ◽

Clavicle Fractures

Abstract BackgroundThe current study aimed to measure screw angles of three locking plates for lateral clavicle fractures and to assess the numbers of screws that could be inserted per fragment size to elucidate the size limitation that could be fixed by locking plates.MethodsThe authors assessed three locking plates for lateral clavicle fractures: distal clavicle plate [Acumed, LLC, Oregon, the USA], LCP clavicle plate lateral extension [Depuy Synthes, LLC, MA, the USA], and HAI clavicle plate [HOMS Engineering, Inc., Nagano, Japan]. Using three-dimensional plate models, the angles between the most medial and lateral locking screws on the coronal plane and between the most anterior and posterior locking screws on the sagittal plane were measured. Two examiners independently performed computer simulation to position the plates as laterally as possible in the ten normal three-dimensional clavicle models. A lateral fragment size of 10, 15, 20, 25, and 30 mm was simulated in the acromioclavicular joint and the number of screws completely inserted in each size of the fragment in the simulation was assessed. Subsequently, the area covered by locking screws on the inferior surface of the clavicle was measured.ResultsThe distal clavicle plate had relatively large screw angles (20° on the coronal plane and 32° on the sagittal plane), and the LCP clavicle lateral extension had a large angle (38°) on the sagittal plane. However, the angle of the HAI clavicle plate was at maximum 13° on the coronal or sagittal plane. The distal clavicle plate indicated the largest numbers of screws that could be inserted in each size of the bone fragment. For all locking plates, all screws could be inserted within 25 mm fragments. Among all locking plates, the distal clavicle plate could cover the largest area on the inferior surface of the clavicle by the screws.ConclusionsScrew angles and the numbers of screws that could be inserted in the lateral fragment differed among products. Other augmented fixation procedures should be considered for fractures with fragment sizes <25 mm that could not be fixed with sufficient number of screws.

Download Full-text

Single-center Experience in the Treatment of Extremely Medial Clavicle Fractures with Vertical Fixation of Double-plate

10.21203/rs.2.15445/v1 ◽

2019 ◽

Author(s):

He Liu ◽

Ziyan Zhang ◽

Baoming Yuan ◽

Guangkai Ren ◽

Junlong Yu ◽

...

Keyword(s):

Fracture Healing ◽

Plate Fixation ◽

Clavicle Fracture ◽

Shoulder Function ◽

Single Center Experience ◽

Clavicle Fractures ◽

Postoperative Fracture ◽

Medial Clavicle ◽

First Time ◽

Contralateral Shoulder

Abstract Background: Patients suffering from medial clavicle fractures combined with displacement need surgical intervention. This research reports the effect of double-plate fixation as an innovative procedure in the treatment of extremely medial clavicle fractures.Methods: Nine patients complaint of extremely medial clavicle fracture were enrolled in this research from Mar 2017 to March 2018. Patients were treated with an open reduction and internal fixation using the double-plate technique. Postoperative X-ray was taken regularly to observe the fracture healing at each visit, and the related complications were also recorded. The rating score systems of Constant Murley score of treated shoulder and contralateral shoulder, Rowe score as well as American Shoulder and Elbow Surgeons (ASES) were questionnaire to evaluate postoperative shoulder joint function.Results: All patients achieved postoperative fracture healing with no complications. Only one patient complained of slight restriction, two patients complained of pain during overhead work, and another patient occurred plate breakage. Meanwhile, the Constant Murley scores of treated and contralateral shoulder were 94.1 and 98.5 points, respectively, indicating the similar shoulder function. Furthermore, the Rowe and ASES scores of the involved shoulder were 96.7 and 96.3 points at average, respectively.Conclusions: It is the first time to introduce the surgical technique of vertical double-plate fixation for stable fixation of extremely medial clavicle fractures, which could provide the surgeons an alternative method for this type of fracture.

Download Full-text

High-energy Comminuted Midshaft Clavicle Fractures: Midterm Clinical and Radiological Results of Operative Treatment Using Assisted Suture Loop Reduction and Internal Fixation With Anatomical Locking Plates

JSES Open Access ◽

10.1016/j.jses.2019.10.090 ◽

2019 ◽

Vol 3 (4) ◽

pp. 257

Author(s):

Andreas Panagopoulos ◽

Ioanna Lianou ◽

Zinon Kokkalis ◽

Antonis Kouzelis ◽

Minos Tyllianakis

Keyword(s):

Internal Fixation ◽

Operative Treatment ◽

High Energy ◽

Locking Plates ◽

Radiological Results ◽

Clavicle Fractures ◽

Clinical And Radiological Results

Download Full-text

Distal Clavicle Fracture Repair: Clinical Outcomes of a Surgical Technique Utilizing a Combination of Cortical Button Fixation and Coracoclavicular Ligament Reconstruction

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119867920 ◽

2019 ◽

Vol 7 (9) ◽

pp. 232596711986792 ◽

Cited By ~ 1

Author(s):

Gautam P. Yagnik ◽

Charles J. Jordan ◽

Raed R. Narvel ◽

Robert J. Hassan ◽

David A. Porter

Keyword(s):

Postoperative Complications ◽

Surgical Technique ◽

Ligament Reconstruction ◽

Distal Clavicle ◽

Sf 36 ◽

Cortical Button ◽

Clavicle Fractures ◽

The Mean ◽

Radiographic Union ◽

Distal Clavicle Fractures

Background: When treated conservatively, unstable distal clavicle fractures demonstrate a high symptomatic nonunion rate. While a variety of surgical techniques have been described, many of these techniques are associated with high failure rates and hardware-related complications. The surgical technique used in this study has shown promising biomechanical results; however, long-term clinical results have not yet been described. Purpose: To assess the clinical and radiological outcomes of a surgical technique for fixing displaced distal clavicle fractures using a combination of cortical button fixation and coracoclavicular (CC) ligament reconstruction. Study Design: Case series; Level of evidence, 4. Methods: We conducted a retrospective review of 22 consecutive patients with displaced, unstable Neer type II or V distal clavicle fractures who underwent this surgical technique from 2012 to 2019. Primary outcome variables were radiographic union, patient satisfaction, and postoperative shoulder function. Preoperative and postoperative University of California, Los Angeles (UCLA), and American Shoulder and Elbow Surgeons (ASES) scores were compared. Secondary outcome variables included intraoperative complications, postoperative complications, time to radiographic union, and preoperative and postoperative CC distance. Quality of life was assessed using preoperative and postoperative 36-Item Short Form Health Survey (SF-36) scores. Results: Nearly all (21/22) patients were available for a final review; 1 patient was lost to follow-up at 2 weeks. All 21 patients achieved radiographic union by 4 months (mean, 60.38 days; range, 41-84 days; 95% CI, 53.80-66.96 days). All patients were satisfied with the surgical procedure and their functional outcome. The mean UCLA score improved from 5.36 (95% CI, 4.14-6.60) preoperatively to 32.52 (95% CI, 30.56-34.48) postoperatively (mean difference, 27.14; P < .001). The mean ASES score improved from 16.23 (95% CI, 9.79-22.67) preoperatively to 88.11 (95% CI, 81.82-94.40) postoperatively (mean difference, 71.91; P < .001). Statistically significant improvements in SF-36 scores were seen in the physical functioning, role limitations due to physical health, pain, social functioning, and emotional well-being categories. There were 3 postoperative complications, including 1 patient with a minor complication secondary to hardware irritation, 1 patient with adhesive capsulitis, and 1 patient with wound dehiscence requiring wound closure. Conclusion: We describe a surgical technique for fixing displaced distal clavicle fractures using a combination of cortical button fixation and CC ligament reconstruction that resulted in a 100% union rate and excellent clinical outcomes with acceptable complications.

Download Full-text

A Minimally Invasive Surgical Technique to Treat Distal Clavicle Fractures

Orthopedics ◽

10.3928/01477447-20090527-19 ◽

2009 ◽

Vol 32 (7) ◽

pp. 509-511 ◽

Cited By ~ 6

Author(s):

Kyle E. Swanson ◽

Britta L. Swanson

Keyword(s):

Surgical Technique ◽

Minimally Invasive ◽

Distal Clavicle ◽

Minimally Invasive Surgical ◽

Clavicle Fractures ◽

Distal Clavicle Fractures

Download Full-text

High-Energy Comminuted Midshaft Clavicle Fractures: Midterm Clinical and Radiological Results of Operative Treatment Using Assisted Suture Loop Reduction and Internal Fixation with Anatomical Locking Plates

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2021.03.019 ◽

2021 ◽

Vol 30 (7) ◽

pp. e423

Author(s):

Andreas Panagopoulos ◽

Anastasia Ampariotou ◽

Ioanna Lianou ◽

Zinon T. Kokkalis ◽

Antonis Kouzelis

Keyword(s):

Internal Fixation ◽

Operative Treatment ◽

High Energy ◽

Locking Plates ◽

Radiological Results ◽

Clavicle Fractures ◽

Clinical And Radiological Results

Download Full-text

Angular stable fixation of displaced distal-third clavicle fractures with superior precontoured locking plates

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2014.09.024 ◽

2015 ◽

Vol 24 (5) ◽

pp. 700-704 ◽

Cited By ~ 23

Author(s):

Mark A. Fleming ◽

Robert Dachs ◽

Sithombo Maqungo ◽

Jean-Pierre du Plessis ◽

Basil C. Vrettos ◽

...

Keyword(s):

Locking Plates ◽

Stable Fixation ◽

Clavicle Fractures

Download Full-text

Extrinsic Subclavian Vein Compression after Osteosynthesis of a Midshaft Clavicular Fracture in an Athlete

Case Reports in Orthopedics ◽

10.1155/2015/981293 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5

Author(s):

Luciano A. Rossi ◽

Nicolas S. Piuzzi ◽

Santiago L. Bongiovanni ◽

Ignacio Tanoira ◽

Gaston Maignon ◽

...

Keyword(s):

Subclavian Vein ◽

Plate Fixation ◽

Clavicle Fracture ◽

Vascular Complications ◽

Vascular Complication ◽

Basketball Player ◽

Safe Procedure ◽

External Compression ◽

Nonsurgical Management ◽

Clavicle Fractures

Clavicle fractures are common injuries. Traditionally, nonsurgical management has been favored; however, recent evidence has emerged indicating that operative fixation produces lower nonunion rates, better functional outcomes, improved cosmesis, and greater patient satisfaction. Although clavicle fixation has been considered a safe procedure, several complications related to plate fixation have been reported. We report a case of a 21-year-old basketball player that had a vascular complication associated with internal fixation of a clavicle fracture. An external compression of the subclavian vein was attributed to a long screw of a precontoured clavicular plate. Although vascular complications associated with clavicle fixation are rare, they may be limb and even life threating. It is advisable that surgeons take measures to avoid them especially when placing the medial screws.

Download Full-text