CLINICAL EVALUATION OF THE TREATMENT OF CLAVICLE FRACTURES: INTRAMEDULLARY NAIL × PLATE

ABSTRACT Objective: Studies confirm the benefit of surgical treatment for fixation of displaced midshaft clavicle fractures. Plate fixation and intramedullary nail are the two most used techniques. Our study seeks to compare these two surgical techniques. Methods: This is a retrospective study, conducted by the evaluation of patients treated for displaced midshaft clavicle fracture with intramedullary nail, and plate and screws. Socioeconomic variables were collected, a visual pain scale questionnaire was applied, the shoulder function was measured using CONSTANT and UCLA scores, and radiography was performed to verify the consolidation and evaluation of the final clavicle shortening. Results: Sixty-five patients were evaluated, 36 (55.4%) of which were subjected to clavicle fixation with plate and screws and 29 (44.6%) with intramedullary nail. The median shortening was 0.1mm for plate and 5.8mm for nail (p = 0.001). The UCLA score shows an average of 35 in the plate group and 35 in the intramedullary group. The median CONSTANT scores were 96.5 for plate and 95 for nail, without significance. In all groups, 13 (20%) complications were registered, 9 fixed with plate and 4 fixed with intramedullary nail. The most common complication was skin erosion with exposure of the synthetic material. Conclusion: The two techniques present satisfactory results for the treatment of displaced midshaft clavicle fractures. Level of Evidence III, Therapeutic Studies Investigating the Results of Treatment.

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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.

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Plating versus intramedullary fixation for mid-shaft clavicle fractures: a systemic review and meta-analysis

PeerJ ◽

10.7717/peerj.1540 ◽

2016 ◽

Vol 4 ◽

pp. e1540 ◽

Cited By ~ 9

Author(s):

Yan Gao ◽

Wei Chen ◽

Yue-Jv Liu ◽

Xu Li ◽

Hai-Li Wang ◽

...

Keyword(s):

Plate Fixation ◽

Meta Analysis ◽

Clavicle Fracture ◽

Shoulder Function ◽

Intramedullary Fixation ◽

Systemic Review ◽

Cochrane Library ◽

Union Rate ◽

Fixation Group ◽

Clavicle Fractures

Background.Plate fixation and intramedullary fixation are the most commonly used surgical treatment options for mid-shaft clavicle fractures; the latter method has demonstrated better performance in some studies.Objectives.Our aim was to critically review and summarize the literature comparing the outcomes of mid-shaft clavicle fracture treatment with plate fixation or intramedullary fixation to identify the better approach.Search Methods.Potential academic articles were identified from the Cochrane Library, MEDLINE (1966-2015.5), PubMed (1966-2015.5), EMBASE (1980-2015.5) and ScienceDirect (1966-2015.5). Gray studies were identified from the references of the included literature.Selection Criteria.Randomized controlled trials (RCTs) and non-RCTs comparing plate fixation and intramedullary fixation for mid-shaft clavicle fracture were included.Data Collection and Analysis.Two reviewers performed independent data abstraction. TheI2statistic was used to assess heterogeneity. A fixed- or random-effects model was used for the meta-analysis.Results.Six RCTs and nine non-RCTs were retrieved, including 513 patients in the intramedullary fixation group and 521 patients in the plating group. No significant differences in terms of the union rate and shoulder function were found between the groups. Patients in the intramedullary fixation group had a shorter operative time, less blood loss, smaller wound size, and shorter union time than those in the plating group. With respect to complications, significant differences were identified for all complications and major complications (wound infection, nonunion, implant failures, transient brachial plexopathy, and pain after 6 months). Similar secondary complications (symptomatic hardware, hardware irritation, prominence, numbness, hypertrophic callus) were observed in both groups.Conclusions.Intramedullary fixation may be superior to plate fixation in the treatment of mid-shaft clavicle fractures, with similar performance in terms of the union rate and shoulder function, better operative parameters and fewer complications.

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A novel surgical technique for arthroscopic fixation of lateral end clavicle fracture using FiberWire and FiberTape

10.25259/jassm_27_2020 ◽

2020 ◽

Vol 1 ◽

pp. 199-206 ◽

Cited By ~ 2

Author(s):

Ketansinh Pramodsinh Solanki ◽

Ravi Subramaniam Soundarapandian ◽

Sarvanan Manoharan

Keyword(s):

Los Angeles ◽

Surgical Technique ◽

Intraoperative Complications ◽

Clavicle Fracture ◽

Surgical Techniques ◽

Shoulder Function ◽

Secondary Outcome ◽

Clinical And Radiological Outcome ◽

Clavicle Fractures ◽

Radiographic Union

Objectives: Lateral end of clavicle fractures is associated with coracoclavicular ligament disruption and, hence, poses a surgical challenge for the management. Surgical techniques already described have high failure rates and hardware-related complications. The objective of the study is to assess the clinical and radiological outcome of the novel surgical technique of arthroscopic coracoclavicular stabilization and indirect anatomical reduction of the lateral end of clavicle fracture using FiberWire and FiberTape. Materials and Methods: We conducted a retrospective review of 15 consecutive patients with displaced, unstable Neer Type II and V distal clavicle fractures who underwent this surgical technique from 2016 to 2020. Primary outcome variables were radiographic union, patient satisfaction, and post-operative shoulder function. Pre-operative and post-operative University of California, Los Angeles (UCLA), and American Shoulder and Elbow Surgeons (ASES) scores were compared. Secondary outcome variables included intraoperative complications, post-operative complications, and time to radiographic union. Results: In our study, 12 were male patients and three female patients, with a mean age of 43 years. The mean post-operative follow-up period was 23 months. Results were satisfactory in all 15 cases, all 15 were had excellent as per UCLA and ASES score. All fractures healed within a mean period of 6 weeks. Only one patient had developed malunion due to over-tightening of FiberWire, although his functional outcome was not compromised with this. Conclusion: We present a novel surgical technique for fixing displaced distal lateral clavicle with arthroscopic coracoclavicular stabilization with FiberWire and FiberTape that resulted in a 100% union rate and excellent clinical outcomes with minimal complications.

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A comparison of intramedullary cannulated screws versus miniplates for fixation of unstable metacarpal diaphyseal fractures

Journal of Hand Surgery (European Volume) ◽

10.1177/17531934211021521 ◽

2021 ◽

pp. 175319342110215

Author(s):

Birkan Kibar ◽

Ali Cavit ◽

Abdullah Örs

Keyword(s):

Plate Fixation ◽

Randomized Study ◽

Good Alternative ◽

Active Movement ◽

Cannulated Screws ◽

Level Of Evidence ◽

Visual Analogue Pain ◽

Plate Group ◽

Significant Difference ◽

Diaphyseal Fractures

We carried out a prospective randomized study to compare the clinical and radiological results of metacarpal diaphyseal fractures treated with retrograde intramedullary headless cannulated screws (IHCS) and plates. Fractures were fixed with IHCS in 34 patients (37 metacarpals) and locked miniplates in 35 patients (40 metacarpals). The mean age was 33 years (range 18–61) in the IHCS group and 32 years (range 17–68) in plate group. All patients were followed up for 1 year. All fractures in the IHCS group united but there was one nonunion in the plate group. At final follow-up, there was no significant difference between the groups in total active movement, visual analogue pain score, Disabilities of the Arm, Shoulder, and Hand score and grip strength, although the study was not sufficiently powered to exclude differences with certainty. IHCS is a safe and fast technique that is a good alternative to plate fixation in metacarpal diaphyseal fractures. Level of evidence: I

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Analysis of Contoured Anatomic Plate Fixation versus Intramedullary Rod Fixation for Acute Midshaft Clavicle Fractures

Advances in Orthopedic Surgery ◽

10.1155/2014/518310 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 3

Author(s):

Juliann Kwak-Lee ◽

Elke R. Ahlmann ◽

Lingjun Wang ◽

John M. Itamura

Keyword(s):

Range Of Motion ◽

Plate Fixation ◽

Reoperation Rate ◽

Healing Time ◽

Implant Failure ◽

Fracture Union ◽

Early Results ◽

Plate Group ◽

Pin Fixation ◽

Clavicle Fractures

The recent trend has been toward surgical fixation of displaced clavicle fractures. Several fixation techniques have been reported yet it is unclear which is preferable. We retrospectively reviewed one hundred one consecutive patients with acute midshaft clavicle fractures treated operatively at a level-1 trauma center. Thirty-four patients underwent intramedullary pin fixation and 67 had anatomic plate fixation. The outcomes we assessed were operative time, complications, infection, implant failure, fracture union, range of motion, and reoperation rate. There were 92 males and 9 females with an average age of 30 years (range: 14–68 years). All patients were followed to healing with an average followup of 20 months (range: 15–32 months). While fracture union by six months (P=0.8729) and range of motion at three months (P=0.6139) were similar, the overall healing time for pin fixation was shorter (P=0.0380). The pin group had more infections (P=0.0335) and implant failures (P=0.0245) than the plate group. Intramedullary pin fixation may have improved early results, but there was no long term difference in overall rate of union and achievement of full shoulder motion. The higher rate of implant failure with pin fixation may indicate that not all fracture patterns are amenable to fixation using this device.

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Ipsilateral midshaft clavicle fracture and acromioclavicular joint dislocation: a review of literature and evidence-based diagnosis guidelines

10.21203/rs.3.rs-36221/v1 ◽

2020 ◽

Author(s):

Rongguang Ao ◽

Zhen Jian ◽

Jinhong Chen ◽

Dejian Li ◽

Xu Zhang ◽

...

Keyword(s):

Clavicle Fracture ◽

High Energy ◽

Shoulder Function ◽

Acromioclavicular Joint Dislocation ◽

Evidence Based ◽

Ac Joint ◽

Level Of Evidence ◽

Joint Dislocation ◽

Type Iv ◽

Ac Joint Dislocation

Abstract Background: Ipsilateral midshaft clavicle fracture and AC joint dislocation are rare, with very few cases reported. Once the AC joint dislocation were missed diagnosis, the shoulder function may be affected and medical dispute was easy to occur. The aim of this study was to gather data relating to ipsilateral midshaft clavicle fracture and AC joint dislocation to develop evidence-based diagnosis guidelines as none are currently available.Methods: A study was conducted of the PubMed and Google Scholar databases to identify cases of ipsilateral midshaft clavicle fracture and AC joint dislocation. Data collected about each case included age and gender of the patient, mechanism of injury, fracture and dislocation classification. The authors report 2 additional ipsilateral midshaft clavicle fracture and AC joint dislocation cases.Results: 21 cases were identified for inclusion in this research, 19 from the literature and 2 reported by the authors. All the patients were injured by high energy trauma. For the midshaft fracture, 16/21 (76.2%) patients belonged to Type A classification, and 5/21 (23.8%) patients belonged to Type B classification. For AC joint dislocation, 11/21 (47.6%) patients belonged to Type IV classification, 4/21 (19.0%) patients belonged to Type VI classification, 5/21 (23.8%) patients belonged to Type III classification and 1/21 (4.7%) patients belonged to Type V classification.Conclusions: There are limited data available about the diagnosis of ipsilateral midshaft clavicle fracture and AC joint dislocation. From the cases reviewed, we find that simple midshaft clavicle caused by high energy injuries may be associated with ipsilateral AC joint dislocation. Physical examination, careful observation of preoperative X-ray and fluoroscopy including the AC joint during operation were key to diagnose the injury. Level of Evidence Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Plate fixation versus intramedullary nail or Knowles pin fixation for displaced midshaft clavicle fractures

Medicine ◽

10.1097/md.0000000000022284 ◽

2020 ◽

Vol 99 (39) ◽

pp. e22284

Author(s):

Lang Li ◽

Xiaodong Yang ◽

Fei Xing ◽

Jun Jiang ◽

Xueyang Tang

Keyword(s):

Intramedullary Nail ◽

Plate Fixation ◽

Pin Fixation ◽

Clavicle Fractures

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Comparative analysis of a locking plate with an all-suture anchor versus hook plate fixation of Neer IIb distal clavicle fractures

Journal of Orthopaedic Surgery ◽

10.1177/2309499020962260 ◽

2020 ◽

Vol 28 (3) ◽

pp. 230949902096226

Author(s):

Joong-Bae Seo ◽

Kwon-young Kwak ◽

Jae-Sung Yoo

Keyword(s):

Suture Anchor ◽

Constant Score ◽

Plate Fixation ◽

Distal Clavicle ◽

Level Of Evidence ◽

Fixation Group ◽

Clavicle Fractures ◽

Suture Anchor Fixation ◽

Anchor Fixation ◽

Distal Clavicle Fractures

Background: The coracoclavicular fixation with suture anchors adds stability to type IIb distal clavicle fractures fixed with a plate and screws when loaded to failure. The purpose of this study was to compare the clinical and radiological outcomes between the use of a locking compression plate (LCP) with all-suture anchor fixation and hook LCP fixation of Neer IIb distal clavicle fractures. Methods: A total of 82 consecutive patients who underwent plate fixation for Neer IIb distal clavicle fractures were included. The subjects were divided into two groups: an LCP with all-suture anchor fixation group and hook LCP fixation group. For clinical assessments, the American Shoulder and Elbow Surgeons score, Korean shoulder score (KSS), and Constant score were recorded. A percentage of the coracoclavicular distance (CCD%) was used to evaluate fracture reduction. Typical reported complications, such as secondary dislocation, implant failure or loosening, peri-implant fracture, acromion osteolysis, stiffness, peri-anchor osteolysis, postoperative acromioclavicular joint arthrosis, nonunion, or delayed union, were also analyzed. Results: There were no differences in the clinical and radiological outcomes at the final follow-up between the two groups. The period for bone union and CCD% showed no significant differences between groups. Stiffness at 3 months after surgery of LCP with all-suture anchor fixation ( n = 3, 10.7%) was less than that of hook LCP fixation ( n = 17, 31.5%). The complication rate also showed no significant differences between groups. However, LCP with all-suture anchor fixation had anchor-related complications, although it can reduce hook-related complications. Conclusion: LCP with all-suture anchor fixation showed satisfactory outcomes in comparison with hook LCP fixation. In Neer IIb distal clavicle fractures, LCP with all-suture anchor fixation is a useful method for the maintenance of reduction, avoiding implant removal, and hook-related complications. However, anchor fixation should be carefully used, especially in osteoporotic patients or patients with underlying diseases. Level of Evidence: Level III, retrospective study.

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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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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.

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