Mechanical failure of plate breakage after open reduction and plate fixation of displaced midshaft clavicle fracture – a possible new risk factor: a case report

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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Treatment of midshaft clavicle fracture with anatomical contoured clavicular locking plate

Asian Journal of Medical Sciences ◽

10.3126/ajms.v10i1.21329 ◽

2018 ◽

Vol 10 (1) ◽

pp. 92-96

Author(s):

Pratyenta Raj Onta ◽

Krishna Sapkota ◽

Krishna Wahegaonkar ◽

Niraj Ranjeet ◽

Pabin Thapa ◽

...

Keyword(s):

Shoulder Joint ◽

Open Reduction ◽

Locking Plate ◽

Plate Osteosynthesis ◽

Plate Fixation ◽

Clavicle Fracture ◽

Shaft Fracture ◽

Free Movement ◽

Early Return ◽

The Mean

Background: Fracture clavicle is a common fracture around the shoulder joint accounting about 2.6% of all fracture and 44% in shoulder region. Mid shaft clavicle fracture accounts about 81% of total clavicle fracture. Open reduction and plate fixation is a good treatment method for displaced mid shaft clavicle fracture with benefit of early pain free movement of shoulder joint and early return to work. The anatomical contoured clavicular plate maintains mechanical strength and has less soft tissue complications. Aims and Objective: The aim of the study was to evaluate the clinical and radiological outcome, time for fracture union and complications in midshaft clavicle fracture managed with anatomical contoured clavicularlocking plate. Material and Methods: This study was done in Manipal Teaching Hospital, Pokhara, Nepal.There were a total of 30 patients (19 male and 11 female) who had displaced mid shaft fracture. All patients underwent plate osteosynthesis with anatomical contoured locking plate. The patients were followed up at 3 weeks, 6 weeks, 3 month and 6 months’ time. Results: There were 30 patients among whom; one patient had bilateral clavicle fracture. The mean age of the patient was 37.19 (11.96) years. The mean time for clinical and radiological union was 8.77 (1.17) weeks and 17.03 (3.06) weeks. All patients in our study had union of fracture with only one patient having superficial surgical site infection. Conclusion: Open reduction and plate fixation is a good option for displaced mid shaft clavicle fracture which help the patient for early pain-free movement of shoulder. Use of anatomical contoured clavicle plate provides fixation of clavicle to its normal contour and provides better fixation and stability.

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Open reduction and plate fixation compared with non-surgical treatment for displaced midshaft clavicle fracture

Medicine ◽

10.1097/md.0000000000015638 ◽

2019 ◽

Vol 98 (20) ◽

pp. e15638 ◽

Cited By ~ 4

Author(s):

Miao Qin ◽

Shishun Zhao ◽

Wenlai Guo ◽

Li Tang ◽

Hangyu Li ◽

...

Keyword(s):

Surgical Treatment ◽

Open Reduction ◽

Plate Fixation ◽

Clavicle Fracture ◽

Non Surgical Treatment

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Posttraumatic Pseudoarthrosis of a Clavicle Fracture in an 11-Year-Old Girl: A Case Report and Analysis

Case Reports in Orthopedics ◽

10.1155/2020/4069431 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

Marco Odorizzi ◽

Maurice FitzGerald ◽

Jorge Gonzalez ◽

Dario Giunchi ◽

Flurim Hamitaga ◽

...

Keyword(s):

Case Report ◽

Conservative Treatment ◽

Internal Fixation ◽

Open Reduction ◽

Iliac Crest ◽

Clavicle Fracture ◽

Paediatric Population ◽

Iliac Crest Bone Graft ◽

The Right

Clavicular fractures are some of the most common bone injuries in the paediatric population, yet the rates of nonunion are very low under 18 years. To the best of our knowledge, posttraumatic nonunion of the clavicle in a paediatric population is rarely reported. We report the case of an 11-year-old girl who presented with a nondislocated fracture of the midshaft to the proximal third of the right clavicle. Initial conservative treatment by sling immobilization demonstrated radiologically confirmed healing at 3 months. However, at 1-year follow-up, she presented with painful nonunion. Diagnostic MRI and CT exams confirmed a pseudoarthrosis, requiring elective open reduction and internal fixation with the aid of an ipsilateral iliac crest bone graft.

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Successful Treatment of a 15-Year-Old Nonunion of a Midshaft Clavicle Fracture Causing Brachial Plexus Compression

Case Reports in Orthopedics ◽

10.1155/2017/5105670 ◽

2017 ◽

Vol 2017 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Annemarijn Teunis ◽

Rianne M. H. A. Huis In ’t Veld ◽

Vincent E. J. A. de Windt ◽

Sjoerd van Raak ◽

Anne J. H. Vochteloo

Keyword(s):

Brachial Plexus ◽

Successful Treatment ◽

Open Reduction ◽

Plate Fixation ◽

Clavicle Fracture ◽

One Year ◽

Internal Plate Fixation

A 49-year-old man with a 15-year-old nonunion of a midshaft clavicle fracture suffered from progressive tingling in his entire arm and fingers for two years, due to irritation of the brachial plexus in the costoclavicular space, especially upon elevation of the arm. After open reduction and internal plate fixation, all symptoms were resolved and complete consolidation of the fracture was achieved at one-year follow-up. This case demonstrates two things: brachial plexus compression can occur even many years after a nonunion of a clavicle fracture and union can be still achieved, even in a longstanding nonunion.

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Peri-implant distal clavicle fracture: Case report (overlaying plate fixation: Solution for peri-implant clavicle fractures)

International Journal of Surgery Case Reports ◽

10.1016/j.ijscr.2021.106411 ◽

2021 ◽

Vol 87 ◽

pp. 106411

Author(s):

Guilherme Vieira Lima ◽

Nataniel Sousa Santos Filho ◽

Cézar Augusto Pimentel Furlan ◽

Joel Murachovsky ◽

Vitor La Banca ◽

...

Keyword(s):

Case Report ◽

Plate Fixation ◽

Clavicle Fracture ◽

Distal Clavicle ◽

Distal Clavicle Fracture ◽

Clavicle Fractures

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Comparison of union rates and functional outcomes for displaced mid-shaft clavicular fractures at Bhuj-Kutch: a prospective study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20174713 ◽

2017 ◽

Vol 3 (6) ◽

pp. 1195

Author(s):

Chintan Seth ◽

Sangeen Bhundiya

Keyword(s):

Functional Outcomes ◽

Open Reduction ◽

Plate Fixation ◽

Clavicle Fracture ◽

Medical Science ◽

Major Complication ◽

Nonoperative Treatment ◽

Functional Evaluation ◽

Clavicular Fracture ◽

Institutional Ethics

Background: Clavicle fracture usually treated conservatively. There is a rising tendency to treat displaced mid-shaft clavicular fractures with primary open reduction and plate fixation; whether such treatment outcome in enhanced patient outcomes is contentious. The aim of this study was to compare union rates and functional outcomes for displaced mid-shaft clavicular fractures that were treated with either primary open reduction and plate fixation or nonoperative treatment.Methods: Present study was performed at department of orthopedics, Gujarat Adani institute of medical science, Bhuj, Kutch, Gujarat. Ethical clearance was taken from the institutional ethics board and informed consent was obtained from all the participants. In this study, patients who had an acute displaced mid-shaft clavicular fracture were randomized to receive either primary open reduction and plate fixation or nonoperative treatment. Functional evaluation was conducted at 3 months, 6 months, and 1-year with the use of the constant scores. Union was evaluated clinically and radiographically. Complications were recorded and compared.Results: The rate of nonunion was reduced significantly after open reduction and plate fixation as compared with nonoperative treatment. Constant scores were significantly improved after open reduction and plate fixation than after nonoperative treatment; 93.7 versus 85.5. A major complication was found in 34.9% of patients in the conventional group while they were absent in operative group.Conclusions: Open reduction and plate fixation decrease the rate of nonunion after acute displaced mid-shaft clavicular fracture compared with nonoperative treatment and is connected with improved functional outcomes. Open reduction and plate fixation using precontoured locking plate have little implant-related complications.

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Will the Strength of the Clavicle Plate be Increased by Inserting Small Screws into the Empty Holes above the Fracture Site?

10.21203/rs.3.rs-57329/v1 ◽

2020 ◽

Author(s):

Dae-Geun Kim ◽

Soo Min Kim

Keyword(s):

Plate Fixation ◽

Clavicle Fracture ◽

Peak Stress ◽

Fracture Site ◽

Fracture Model ◽

Biomechanical Property ◽

Bending Force ◽

Clavicle Fractures ◽

Cantilever Bending ◽

Plate Breakage

Abstract Background: Open reduction and plate fixation is the standard surgery for displaced midshaft clavicle fractures because of biomechanical stability. Implant failure like plate breakage or deformation is the most serious complication of plate fixation. Several plate designs for midshaft clavicle fractures have been introduced, but traditional superior plate has been mostly used.Methods: We generated the clavicle 3D image using the computed tomography (CT) of the left normal clavicle of a 54-year-old female, and then made the comminuted midshaft clavicle fracture model with 10-mm fracture site gap. The fracture model was fixed with 7-hole superior locking compression plate. Finite element analysis (FEA) was performed between the presence (model B) and absence (model A) of screws above the fracture site.Results: The average peak stress from the cantilever bending force was much greater than the peak stress from the axial compression and axial torsion force. This means that the cantilever loading force is the main force which could cause plate breakage or deformation. The maximal stress of the model B was lower than the one of the model A. Therefore, model B showed superior biomechanical property than model A under all loading conditions, especially cantilever bending force.Conclusions: The peak stress of the superior clavicle plate could be decreased just by inserting a small screw into the screw hole above the fracture site.

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