Results of minimal invasive coracoclavicular fixation by double button lift-up system in Neer type II distal clavicle fractures

Aim: We aimed to evaluate clinical and functional outcomes of indirect fracture reduction performed by coracoclavicular fixation with minimal invasive double button lift-up system in Neer type IIa unstable fractures of distal clavicle. Material and methods: 22 patients with Neer type 2 distal clavicle fracture were enrolled in that prospective study. All patients underwent indirect reduction and osteosynthesis performed by coracoclavicular fixation with minimal invasive double button lift-up system. Postoperative follow-up was carried out clinically and radiologically with plain X-rays and utilization of Constant and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment (ASES) shoulder scores. Mean follow-up time was 15 months. A standard sling was applied for 2 weeks, postoperatively. Rehabilitation program was started on postoperative day 1. Results: Mean age was 39 (range: 21–60), 18 of the patients were male. Right dominant extremity was affected in 14 patients. Mean duration of the surgical intervention was 40 min (range: 30–55 min). Mean union time was found to be 14 weeks (range: 7–21 weeks). Mean postoperative ASES and Constant scores were 79.9 (66.9–88.3) and 82.2 (71–100), respectively. The duration of return to normal daily activities were found to be 4.5 months. Any loss of reduction, AC joint arthrosis, and clavicular shortening were not detected in X-rays. Conclusion: This study has demonstrated that indirect osteosynthesis performed by coracoclavicular fixation with double button lift-up system in the treatment of unstable Neer type IIa fractures of the distal clavicle had successful clinical, radiological, and functional outcomes.

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REHABILITATION OF A CONSERVATIVELY MANAGED CLAVICULAR FRACTURE

Journal of medical pharmaceutical and allied sciences ◽

10.22270/jmpas.v10i4.1245 ◽

2021 ◽

Vol 10 (4) ◽

pp. 3175-3178

Author(s):

Om C Wadhokar

Keyword(s):

Clavicle Fracture ◽

Shoulder Girdle ◽

Pectoral Muscle ◽

Rehabilitation Program ◽

Clavicular Fracture ◽

Distal Clavicle ◽

Distal Clavicle Fracture ◽

Breathing Exercises ◽

Postural Correction ◽

Shoulder Blade

The collarbone, or wishbone, is a thin, S-shaped bone about 6 inches (15 cm) long and serves as a support between the shoulder blade and the sternum (sternum). Clavicle fracture so occur as a result of injury or trauma. The most common site of fracture is the junction between the two curvatures of the bone, which is the weakest point. The displacement post fracture is most common in clavicular fracture because the attachment of the muscle sternocleidomastoid pulls the Sternal head upwards and the pectoral muscle pulls the distal clavicle downwards. After a distal clavicle fracture, radiographic nonunion has been identified in 10% to 44% of patients. Most of clavicular fractures are managed non-surgically by physical therapy which consists of a rehabilitation program without hampering the fracture healing, the rehabilitation consists of pain reduction, improving strength and range of motion of the shoulder, Scapular and neck muscles and postural correction exercises in addition to a brace to support the upper limb as the clavicle is the bone connecting the Axilla to the shoulder girdle. And the patient is started with medical management which usually consist of analgesics. 62 year old male patient with left clavicle fracture was diagnosed on x-ray after a hit from a bullock cart. Following this incident the patient underwent a prompt series of physical rehabilitation which included strengthening exercises, thoracic expansion exercises, breathing exercises. The case report suggests that a physiotherapy treatment procedure led to the improvement of functional goals progressively and significantly.

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Anatomic Locking Plate Fixation and Coracoclavicular Stabilisation with Multistrand Titanium Cable for Unstable Distal Clavicle Fracture

Journal of Medical Imaging and Health Informatics ◽

10.1166/jmihi.2021.3581 ◽

2021 ◽

Vol 11 (5) ◽

pp. 1477-1480

Author(s):

Zhong-Guo Liu ◽

Yue-Wei Yu ◽

Huang-Lin Xie ◽

Qing-Xin Xie

Keyword(s):

Fracture Healing ◽

Locking Plate ◽

Clavicle Fracture ◽

Clinical Effects ◽

Distal Clavicle ◽

Distal Clavicle Fracture ◽

Clavicle Fractures ◽

Anatomic Locking Plate ◽

Distal Clavicle Fractures

Objective: The aim of this study was to introduce a modified surgical procedure using anatomic locking plate (ALP) fixation and coracoclavicular (CC) stabilisation with multistrand titanium cable (MTC) to repair unstable distal clavicle fractures, and to estimate clinical effects of these people. Materials and methods: Between July 2016 and April 2018, we treated 7 patients with unstable distal clavicle fracture by ALP fixation and CC stabilisation with MTC. After the surgery, we followed up every patient for at least 24 months and analysed their clinical results. Results: The average term required for fracture healing was 9.9 (range, 9–12 weeks) and all cases are successful in fracture healing. The average Constant score was 94.6 points (range, 92–100) at the last follow-up; the modified University of California, Los Angeles (UCLA) shoulder rating scale was 33.4 points (range, 31–35) at the last follow-up. There was no infection, hardware failure and iatrogenic fracture in all the cases. Conclusions: ALP fixation and CC stabilisation with MTC is a really good method for the treatment of unstable distal clavicle fractures. This surgical technique can provide stable fixation for early functional exercise, and prevent extra shoulder joint damage.

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Anatomical Locking Plate with Additional K-wire Fixation for Distal Clavicle Fracture

Clinics in Shoulder and Elbow ◽

10.5397/cise.2017.20.4.230 ◽

2017 ◽

Vol 20 (4) ◽

pp. 230-235

Author(s):

Woo Dong Nam ◽

Sung Hoon Moon ◽

Ki Yong Choi

Keyword(s):

Locking Plate ◽

Clavicle Fracture ◽

Clinical Results ◽

Proximal Fragment ◽

Type Ii ◽

Distal Clavicle ◽

Distal Clavicle Fracture ◽

Wire Fixation ◽

Coracoclavicular Distance

BACKGROUND: Neer type II distal clavicle fractures have the drawback of coracoclavicular instability and insufficient distal bony fragment, thereby making it difficult to achieve adequate fixation. Although various surgical treatments have been described for Neer type II fracture, the optimal treatment remains controversial. This study reports the clinical results and usefulness of anatomical locking plate with additional K-wire fixation.METHODS: A totally of 21 patients with type II distal clavicle fracture were included in the study. The surgical procedure reduced the fracture temporarily; it included insertion of one or two K-wire from the lateral margin of the distal fragment to the proximal fragment through the fracture site, followed by application and fixation of the locking plate. The bony union and migration of K-wire was evaluated in the follow-up radiography. The coracoclavicular distance and acromioclavicular joint arthrosis were assessed at the final follow-up. The Constant Score (CS) and Korean Shoulder Score (KSS) were evaluated for clinical scoring.RESULTS: Bone union was achieved in all cases. At the final follow-up, coracoclavicular distance of the injured shoulder was increased, as compared to the intact shoulder (p=0.002), with no accompanying clinical symptoms. No K-wire migration was observed. At the final follow-up, K-wire irritation was observed in two cases and acromioclavicular arthrosis in one case, with no other adverse effects. Pain visual analogue scale, CS, and KSS were improved in all cases.CONCLUSIONS: The method of anatomical locking plate with additional K-wire fixation could be useful in achieving beneficial clinical results.

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Evaluation of Modified CC Stabilization Using LARS Artificial Ligament in Unstable Distal Clavicle Fracture

10.21203/rs.3.rs-27532/v1 ◽

2020 ◽

Author(s):

Yongchuan Li ◽

Nan Lu ◽

Di Shen ◽

Fan Zhang ◽

Jiajia Lu ◽

...

Keyword(s):

Clavicle Fracture ◽

Shoulder Function ◽

Distal Clavicle ◽

Artificial Ligament ◽

Distal Clavicle Fracture ◽

Loss Of Reduction ◽

Clavicle Fractures ◽

Lars Artificial Ligament ◽

Distal Clavicle Fractures

Abstract Background: Unstable distal clavicle fracture is common, and there is no consensus regarding the gold standard treatment. The purpose of this study was to report a new surgical technique for the treatment of unstable distal clavicle fracture with modified coracoclavicular (CC) stabilization using a ligament augmentation and reconstruction system (LARS) artificial ligament, and to evaluate the clinical and radiographic outcomes.Patients and methods: We retrospectively reviewed 18 patients with acute unstable distal clavicle fractures (type Ⅱb) treated between January 2009 and June 2018 with modified CC stabilization using LARS artificial ligament. Indexes for evaluation included fracture healing, quality of reduction, and presence of complications (e.g., infections, nerve injuries, iatrogenic clavicle or coracoid fracture, the fixation loop failure, or loss of reduction). Shoulder function was evaluated using the Constant-Murley score.Results: Patients were assessed at a mean time of 31.8 months follow-up. All 18 patients experienced radiographic union. Follow-up radiographs showed anatomical reduction in 15 patients and slight loss of reduction in 3 patients. There were 2 cases of calcification of the CC ligament, 1 case of degenerative change around the acromioclavicular (AC) joint, and 1 case of clavicular osteolysis around screws noted during the follow-up. At the final follow-up, Constant scores were 91.2 ± 6.9.Conclusions: Treating unstable distal clavicle fractures (type Ⅱb) with modified CC stabilization using LARS artificial ligament resulted in a high union rate, satisfactory fracture reduction, a low complication rate, and excellent shoulder function. We consider this simple surgical technique that naturally restores stability to the distal clavicle fracture is an efficient method for treating the fracture.

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Evaluation of the modified CC stabilization using LARS artificial ligament in unstable distal clavicle fracture

10.21203/rs.2.20317/v1 ◽

2020 ◽

Author(s):

Yongchuan Li ◽

Nan Lu ◽

Di Shen ◽

Fan Zhang ◽

Jiajia Lu ◽

...

Keyword(s):

Clavicle Fracture ◽

Shoulder Function ◽

Distal Clavicle ◽

Artificial Ligament ◽

Distal Clavicle Fracture ◽

Loss Of Reduction ◽

Clavicle Fractures ◽

Lars Artificial Ligament ◽

Distal Clavicle Fractures

Abstract Purpose: Unstable distal clavicle fracture is common, and there is no consensus regarding the gold standard treatment for this fracture. The purpose of this study was to report a new surgical technique for the treatment of unstable distal clavicle fracture with modified coracoclavicular (CC) stabilization using ligament augmentation and reconstruction system (LARS) artificial ligament, and evaluate the clinical and radiographic outcomes. Methods: From January 2009 to June 2018, eighteen patients with acute unstable distal clavicle fractures (type Ⅱb) treated by modified CC stabilization using LARS artificial ligament were retrospectively reviewed. Indexes for evaluation included fracture healing, quality of reduction, and complications (infections, nerve injuries, iatrogenic clavicle or coracoid fracture, the fixation loop failure, loss of reduction, etc.). Shoulder function was evaluated using the Constant-Murley score. Results: The patients were assessed at a mean time of 31.8 months follow-up. All 18 patients experienced radiographic union. Follow-up radiographs showed anatomical reduction in 15 patients and slight loss of reduction in 3 patients. There were 2 cases of calcification of CC ligament, 1 case of degenerative change around the acromioclavicular (AC) joint, and 1 case of clavicular osteolysis around screws noted during the follow-up. The Constant scores were 91.2 ± 6.9 at last. Conclusions: The modified CC stabilization using LARS artificial ligament resulted in a high union rate, satisfactory fracture reduction, a low complication rate, and excellent shoulder function for unstable distal clavicle fractures (type Ⅱb). We consider this simple surgical technique that naturally restores stability to the distal clavicle fracture is an efficient method for treating the fracture.

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