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

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.

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

2021 ◽  
Vol 29 (1) ◽  
pp. 34-38
Author(s):  
THIAGO MEDEIROS STORTI ◽  
MAURÍCIO SIQUEIRA CAMILO ◽  
RAFAEL FRANCISCO ALVES SILVA ◽  
RAFAEL SALOMON SILVA FARIA ◽  
CAROLINA LIMA SIMIONATTO ◽  
...  
Keyword(s):  
Intramedullary Nail ◽  
Plate Fixation ◽  
Clavicle Fracture ◽  
Nail Plate ◽  
Surgical Techniques ◽  
Pain Scale ◽  
Shoulder Function ◽  
Level Of Evidence ◽  
Plate Group ◽  
Clavicle Fractures

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.

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

PeerJ ◽  
2016 ◽  
Vol 4 ◽  
pp. e1540 ◽  
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.

Late onset venous thoracic outlet syndrome following clavicle non-union fracture: A case report

Vascular ◽  
2014 ◽  
Vol 23 (2) ◽  
pp. 183-187 ◽  
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.

scholarly journals 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

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.

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

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.

scholarly journals Temporary Sternoclavicular Plating for an Unusual Double Clavicle Fracture (Medial Nonunion, Lateral Acute) Complicated by an Intraoperative Pneumothorax

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
John G. Skedros ◽  
Alex N. Knight ◽  
Chad S. Mears ◽  
Tanner D. Langston
Keyword(s):  
Surgical Complication ◽  
Clavicle Fracture ◽  
Complication Rates ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Clavicle Fractures ◽  
Preoperative Plan ◽  
Medial Clavicle ◽  
Two Stages

Double (segmental) clavicle fractures, involving both the medial and lateral aspects of the clavicle, are very uncommon. Even less common is an asynchronous double fracture with one of the fractures being a nonunion. We report the case of a 30-year-old healthy male patient who had an unusual double clavicle fracture (medial nonunion, lateral acute) that occurred in separate traumatic events during motocross (motorcycle) racing. His fractures were treated surgically in two stages. In the first stage a long reconstruction plate was used that spanned onto the sternum and two transcortical screws were placed into the manubrium to enhance purchase for the deficient bone of the medial clavicle. In accordance with the preoperative plan, the medial one-third of the plate and the medial four screws (of the total 13 used) were removed. Although our patient had an excellent final result, he did have an intraoperative pneumothorax that was treated uneventfully with a chest tube. Medial clavicle fractures are difficult to treat, especially if they are nonunions and surgical complication rates can be high. Our case is one of the few that has been described where temporary sternoclavicular plating was successful in achieving an excellent long-term outcome.

scholarly journals A Biomechanical Study of Various Fixation Strategies for the Treatment of Clavicle Fractures Using Three-Dimensional Upper-Body Musculoskeletal Finite Element Models

2020 ◽  
Vol 10 (16) ◽  
pp. 5651
Author(s):  
Kao-Shang Shih ◽  
Ching-Chi Hsu ◽  
Bo-Yu Shih
Keyword(s):  
Finite Element ◽  
Plate Fixation ◽  
Clavicle Fracture ◽  
Fracture Pattern ◽  
Upper Body ◽  
Fixation Technique ◽  
Skeleton Model ◽  
Fixation Techniques ◽  
Fixation Stability ◽  
Clavicle Fractures

Plate or nail fixations have been applied to the repair of clavicle fractures. However, it is quite difficult to fairly evaluate the different clavicle fixation techniques owing to variations in the bone anatomy, bone quality, and fracture pattern. The purpose of this study was to investigate the biomechanical performances of different fixation techniques applied to a clavicle fracture using the finite element method. A simplified single-clavicle model and a complete human upper-body skeleton model were developed in this study. Three types of plate fixations, namely, superior clavicle plate, anterior clavicle plate, and clavicle anatomic spiral fixations, and one nail fixation, a titanium elastic nail fixation, were investigated and compared. The plate fixation techniques have a better fixation stability compared to the nail fixation technique. However, the nail fixation technique shows lower bone stress and can reduce the risk of a peri-implant fracture compared to the plate fixation techniques. Increasing the number of locking screws for the clavicle plate system can reduce the implant stress. Insertion of the bone plate into the anterior site of the clavicle or a multi-plane fixation is recommended to achieve the required biomechanical performance. A plate fixation revealed a relatively better fixation stability, and a nail fixation showed a lower risk of a peri-implant fracture.

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

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.

scholarly journals Elastic Intramedullary Nailing of a Medial Clavicle Fracture in a Pediatric Patient

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Michael J. Stark ◽  
Michael J. DeFranco
Keyword(s):  
Internal Fixation ◽  
Pediatric Patient ◽  
Intramedullary Nail ◽  
Clavicle Fracture ◽  
Complete Healing ◽  
Sternoclavicular Joint ◽  
Successful Outcome ◽  
Implant Complications ◽  
Clavicle Fractures ◽  
Medial Clavicle

Introduction. Injuries to the medial clavicle in pediatric patients typically involve the physis and/or sternoclavicular joint. Clavicle fractures are one of the most common injuries in children, but ones at its medial end are rare. Most medial clavicle fractures are treated nonoperatively, but surgery is indicated in some cases. This original case report is unique in describing the use of an elastic intramedullary nail for fixation of a completely displaced medial clavicle fracture in a pediatric patient. Case Presentation. A pediatric patient sustained a completely displaced fracture of the medial clavicle. The fracture was lateral to the medial physis of the clavicle and did not involve the sternoclavicular joint. Internal fixation was achieved in an anatomic position with an elastic intramedullary nail. The postoperative course was unremarkable and resulted in complete healing of the fracture in an anatomic position. The patient returned to full activities without any pain or dysfunction. Conclusion. The use of elastic intramedullary nails is a viable option for internal fixation of displaced medial clavicle fractures. Knowledge of the surgical anatomy, potential implant complications, and rehabilitation principles is essential to a successful outcome.

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