Can Only Fix Sternoclavicular Joint to Treat Bipolar Clavicle Injury?

2021 ◽  
Author(s):  
Dongxu Feng ◽  
Yong Liu ◽  
Zijun Li ◽  
Jie Huang ◽  
Mei Fan ◽  
...  
Keyword(s):  
Plate Fixation ◽  
Clavicle Fracture ◽  
Early Mobilization ◽  
Recurrent Dislocation ◽  
Sternoclavicular Joint ◽  
Dash Score ◽  
Distal Clavicle Fracture ◽  
The Mean ◽  
Internal Plate Fixation

Abstract Background: Owing to the rarity of bipolar clavicle injury, treatment remains controversial. The purpose of this study is to report treatment of bipolar clavicle injury with internal plate fixation.Methods: We present our experience of clavicle hook plating for sternoclavicular joint dislocation and anatomical plating for distal clavicle fracture for the treatment of three consecutive bipolar clavicle injuries with different injury patterns. At follow up, radiographs were assessed for joint congruity, fracture union, and implant failure. Clinical evaluation included Disability of the Arm, Shoulder, and Hand (DASH), Constant and Murley Score, Visual Analog Scale (VAS), and complications.Results：All patients had a minimum follow-up of six months. Each fracture had solid union, and each dislocation showed no sign of recurrent dislocation, the mean shoulder forward flexion was 153.3°±10.4°, the mean DASH score was 13.9±9.2 points. The mean Constant and Murley score was 82.3±12.3 points, and, the mean VAS score was 2.2±2.0 point. No complications were encountered, and each patient was highly satisfied with their treatments.Conclusion: Our experience of using internal plating for bipolar clavicle injury is positive, as it allows early mobilization and resulted in good joint function. Also, only sternoclavicular joint fixation might be sufficient for some part of bipolar clavicle injury, acromioclavicular joint fixation is not necessary unless residual instability existence.

scholarly journals Midterm Results of Four-Corner Fusion Using Dorsal Circular Plate Fixation

2017 ◽  
Vol 07 (03) ◽  
pp. 262-266 ◽  
Author(s):  
Claus Deglmann ◽  
Vanja Celigoj ◽  
Bernhard Lukas ◽  
Ahmed Elgammal
Keyword(s):  
Circular Plate ◽  
Plate Fixation ◽  
Fixation Method ◽  
Dash Score ◽  
Level Of Evidence ◽  
Plate Removal ◽  
Level Ii ◽  
The Mean ◽  
K Wires

Purpose The purpose of this prospective study was to evaluate the results of four-corner fusion using dorsal circular plate. Methods We operated on 20 patients between 2009 and 2011. Results At a mean follow-up period of 30 months (range: 14–62, SD: 16), the mean VAS improved from 8 (range: 4–10, SD: 2) preoperatively to 4 (range: 0–8, SD: 2). Function measured with the DASH score improved from 37 (range: 10–75, SD: 18) to 26 (range: 2.5–64, SD: 19). Eighteen patients in our series showed full consolidation and two patients showed persistent nonunion. Three cases required plate removal due to dorsal impingement. Conclusion  Four-corner fusion using dorsal circular plate showed satisfactory results in this study, but it did not show superior results compared with simpler fixation methods mentioned in the literature, such as K-wires or screw fixation. Currently, we are principally using K-wires as a fixation method of choice in our four-corner fusion procedures. Level of Evidence  Level II.

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

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
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.

scholarly journals Temporary spanning plate across the elbow for complex fractures of the distal humerus

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ashraf N. Moharram ◽  
Mostafa Mahmoud ◽  
Ahmed Lymona ◽  
Ahmed Afifi ◽  
Mostafa Ezzat ◽  
...  
Keyword(s):  
Bone Loss ◽  
Internal Fixation ◽  
Early Mobilization ◽  
Distal Humerus ◽  
Open Reduction Internal Fixation ◽  
Dash Score ◽  
Level Of Evidence ◽  
The Mean ◽  
Therapeutic Study

Abstract Background Open reduction internal fixation (ORIF) is the gold standard management of fractures of the distal humerus. Stable fixation to allow early mobilization is not always possible in cases with comminuted fracture patterns and bone loss, with a high failure rate. We propose augmentation of internal fixation in these unstable situations with a spanning plate across the elbow to protect the fixation construct temporarily until bone union. Methods Eighteen patients with complex distal humeral fractures were managed with standard ORIF technique augmented with a temporary plate spanning across the elbow as an internal fixator. Cases included were either very distal, comminuted (6 cases) or insufficiency fractures (4 cases) or revision fixation cases (8 cases). The temporary spanning plate was removed as soon as signs of early radiographic union were detected. Results Seventeen patients were available for final follow up at a mean 28.3 months. The spanning plate was removed after 3.4 months on average. At the final follow-up, the mean elbow total arc of motion was 86.3°. The mean Mayo Elbow Performance Score (MEPS) was 80, and the mean Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) score was 27. Conclusion Spanning the elbow temporarily with a plate in adjunct to standard ORIF technique is both simple and effective in achieving fracture stability and union and minimizes failure rates after fixation of comminuted, very distal fractures, osteoporotic cases, or revision fixation cases with bone loss. Level of evidence Level IV, Therapeutic study

scholarly journals Clinical outcomes of doubled-suture Nice knot augmented plate fixation in the treatment of comminuted midshaft clavicle fracture

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Gui Wu ◽  
Yao-qing Chen ◽  
Chun-yong Chen ◽  
Zhang-xiong Lin ◽  
Qi-yang Xie ◽  
...  
Keyword(s):  
Average Length ◽  
Plate Fixation ◽  
Demographic Data ◽  
Clavicle Fracture ◽  
Bone Fragments ◽  
Comminuted Fractures ◽  
Clavicle Fractures ◽  
The Mean ◽  
The Stability

Abstract Background Free bone fragments were difficult to be fixed in many comminuted midshaft clavicle fractures, and the absence of cortical alignment in comminuted fractures had direct influence on the stability of fixation. This survey was performed to assess the efficacy of doubled-suture Nice knot augmented plate fixation in the treatment of comminuted midshaft clavicle fractures. Methods Between 2013 and 2018, all patients with comminuted midshaft clavicle fractures treated with doubled-suture Nice knot augmented plate fixation were retrospectively reviewed and included in this research. Demographic data of the patients, characteristics of the fractures, intraoperative parameters and follow-up data of the patients were evaluated and summarized. Results A total of 56 patients were included in this study. The mean follow-up time was 25.6 months (range, 12–60 months). The number of male patients was 38 (67.9 %) and of the female patients was 18 (32.1 %). The average age of all patients was 47.89 ± 16.5 years. The mean time of surgery was 85.6 ± 24.0 min. The average length of incision was 9.2 ± 1.9 cm. The number of doubled-suture Nice knot applied ranged from 1 to 5 knots. All the patients reached bone union after the treatment. There was no implant failure or neurovascular injury observed. And most of the patients showed good functional outcome. Conclusions The doubled-suture Nice knot could provide reliable fixation for small bone fragments in comminuted clavicle fractures. Combination of the doubled-suture Nice knot and plate screws fixation was a safe and effective method in comminuted midshaft clavicle fractures treatment.

Analysis of Fracture Midshaft Clavicle Treated by Intramedullary Device Versus Conservative

2021 ◽  
Vol 12 (4) ◽  
pp. 2615-2629
Author(s):  
Swapnil Date ◽  
Kiran Saoji ◽  
Kushal Surana
Keyword(s):  
Clavicle Fracture ◽  
Time Interval ◽  
Dash Score ◽  
Female Ratio ◽  
Conservative Group ◽  
Intramedullary Device ◽  
Male Female Ratio ◽  
Clinical And Radiological Outcome ◽  
The Mean

Clavicle fractures account for about 2.6 to 4 % of all fractures. The best method to treat the displaced midshaft fracture of the clavicle remains a topic of debate. Although there is a large number of studies published about this topic, it is still relatively unknown as to which modality provides better long term functional outcomes and low complications rates. In our study, we have analyzed midshaft clavicle fracture treated with intramedullary device versus conservatively in terms of clinical, functional and radiological outcomes. The mean age of the patients in our study was 35.766 years. Male: Female ratio was 5.0:1.0.  The mean time interval between injury and intervention was 2.1 days. Out of 30 patients, 11 patients (36.666%) had left sided fractures, while 19 patients (63.333%) had right sided fractures. Out of 30 patients, 12 patients (40%) had type 2B1 fracture according to Robinson's classification, followed by type 11 patients (36.666%) type 2B2, 6 patients (20%) type 2A1 and 1 patient (3.333%) type 2A2 fracture. Inoperative group, the mean Constant and Murley score before the intervention, at 1 month follow up, 3 months follow up and at 6 months follow up were 47.46, 76.73, 82.8 and 90.73, while in a conservative group, it was 47.53, 71.66, 79.2 and 89.46 respectively. Inoperative group, the mean Q-DASH score before the intervention, at 1 month follow up, 3 months follow up and at 6 months follow up were 29.33, 19.33, 16.86 and 13.8, while in a conservative group, it was 31.266, 22.533, 18.8 and 15.66 respectively. The final outcome, on the basis of the final Constant and Murley score in 13 patients (43.33%), was excellent, 11 patients (36.66%) was good and 6 patients (20%) was fair. Inoperative group, complications were seen in 6 patients (40%), while in the conservative group, complications were seen in 10 patients (66.66%). Thus, the functional, clinical and radiological outcome of the patients managed surgically with an intramedullary device was significantly better when compared with patients treated conservatively.

scholarly journals Dual Plate Fixation of Mason Type III and IV Radial Neck Fractures: a Mid-term Follow-up of 9 Cases

2021 ◽  
Author(s):  
Kai Ye ◽  
Hui Qin ◽  
Zhiquan An
Keyword(s):  
Radial Head ◽  
Plate Fixation ◽  
Elbow Flexion ◽  
Dash Score ◽  
Type Iii ◽  
Radial Neck ◽  
Radial Neck Fractures ◽  
Dual Plate ◽  
The Mean

Abstract Background: Radial head and neck fractures commonly occur in elbow injuries. The purpose of the present study was to evaluate the effectiveness of the dual plate fixation technique for fractures of the radial neck.Methods: This prospective study included 9 patients who were referred to our department by trauma surgeons between July 2014 and March 2018. 8 patients had a Mason type III fracture, and 1 patient had a Mason type IV fracture. The functional outcomes of dual plate fixation were evaluated via the range of motion (ROM) of the elbow joint, Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, Mayo Elbow Performance Index (MEPI), and the Broberg and Morrey Index. Radiographic images were also reviewed during follow-up.Results: After a mean follow-up period of 50 months (24–69), the mean elbow flexion was 134°, extension was 5°, pronation was 76°, and the mean supination was 78°. The mean DASH score was 6.3. The mean MEPI was 97, and the mean Broberg and Morrey Index was 97. At the time of the last follow-up, the average humeroradial joint space was 2.5 mm, and the average inclination of the radial head relative to the neck was 2.2°. There were no incidences of wound infection, delayed union, nonunion of the fracture, or secondary displacement.Conclusions: Mason type III–IV radial neck fractures can be fixed using the dual plate technique with sufficient midterm results for both fractures that involve the radial head and those that do not. Trial registration: 2020-KY-096(K)

Constrained liners revisited: favourable mid-term results in patients with high-risk of dislocation: technical considerations for the optimal outcome

2021 ◽  
pp. 112070002110107
Author(s):  
Eustathios Kenanidis ◽  
Panagiotis Kakoulidis ◽  
Panagiotis Anagnostis ◽  
Michael Potoupnis ◽  
Eleftherios Tsiridis
Keyword(s):  
High Risk ◽  
Recurrent Dislocation ◽  
Deep Infection ◽  
Consecutive Series ◽  
Revision Thas ◽  
Hip Stability ◽  
Functional Scores ◽  
Revision Tha ◽  
The Mean

Background: The outcomes of constrained liners (CLs) in total hip arthroplasty (THA) remain inconclusive. We evaluated the mid-term performance of CLs in a consecutive series of high-risk dislocation patients undergoing primary or revision THA performed by a single surgeon. The survival, dislocation rate, complications, and functional patients’ scores were assessed. Surgical tips to enhance outcomes were reviewed. Methods: 45 patients who received the Trident Tripolar CL between 2010 to 2019 were retrospectively evaluated from Arthroplasty Registry Thessaloniki. There were 17 primary and 28 revision THAs. The primary indications for using CL were severe abductor insufficiency or comorbidities, increasing the dislocation risk in primary, and recurrent dislocation or abductor insufficiency in revision THAs. The mean patient’s age was 68.5 (±14.5) years, and the mean follow-up 3.81 (±1.66) years. Results: There were 2 dislocations and 1 deep infection in the revision group. For any reason, the cumulative 6-year survival rate was 93.3%, 100% for primary, and 89.3% for revision THAs. The mean overall CL survival was 76.3 months for any reason (95% CI, 68.1–84.5) and 80.5 months for dislocation (95% CI, 75.8–85.2). The mean postoperative functional scores were significantly improved ( p < 0.001) at the latest follow-up. Conclusions: CLs can provide hip stability and durable fixation in selected low-demand patients with high-risk for dislocation after primary and revision THA at mid-term follow-up. Careful patient selection and the refined surgical technique aiming at the neutral liner position and considering the high CLs’ offset relative to stem-neck impingement are necessary to maximise outcomes.

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

2017 ◽  
Vol 25 (1) ◽  
pp. 230949901668472 ◽  
Author(s):  
Süleyman Semih Dedeoğlu ◽  
Yunus İmren ◽  
Haluk Çabuk ◽  
Murat Çakar ◽  
Samet Murat Arslan ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Clavicle Fracture ◽  
Rehabilitation Program ◽  
Minimal Invasive ◽  
X Rays ◽  
Distal Clavicle ◽  
Distal Clavicle Fracture ◽  
Shoulder Scores ◽  
Coracoclavicular Fixation

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.

scholarly journals Percutaneous Tennis Elbow Release Under Local Anaesthesia

2012 ◽  
Vol 6 (1) ◽  
pp. 129-132 ◽  
Author(s):  
MA Nazar ◽  
S Lipscombe ◽  
S Morapudi ◽  
G Tuvo ◽  
R Kebrle ◽  
...  
Keyword(s):  
Local Anaesthesia ◽  
Tennis Elbow ◽  
Long Term Results ◽  
Dash Score ◽  
Day Case ◽  
Horse Riding ◽  
Minimal Scarring ◽  
Percutaneous Release ◽  
The Mean

Introduction: When the non-operative treatment of tennis elbow fails to improve the symptoms a surgical procedure can be performed. Many different techniques are available. The percutaneous release of the common extensor origin was first presented by Loose at a meeting in 1962. Despite the simplicity of the operation and its effectiveness in relieving pain with minimal scarring this procedure is still not widely accepted. This study presents the long-term results of percutaneous tennis elbow release in patients when conservative measures including local steroid injections have failed to relieve the symptoms. Patients and Methods: Percutaneous release of the extensor origin was performed in 24 consecutive patients (seven male and seventeen female), providing 30 elbows for this study. The age of the patients ranged from 26 to 71 years with mean age of 55 years. The technique involved a day case procedure in the operating theatre using local anaesthesia without the need for a tourniquet. The lateral elbow was infiltrated with 5mls 1% lignocaine and 5mls 0.5% bupivicaine with 1:200,000 adrenaline. All operations were performed by the senior author. The patients were assessed post operatively by using DASH (disabilities of arm, shoulder and hand) score and Oxford elbow scores. The mean follow up period was 36 months (1-71months). Results: Twenty one patients returned the DASH and Oxford elbow questionnaires. Four patients were lost in the follow up. The post operative outcome was good to excellent in most patients. Eighty seven percent of patients had complete pain relief. The mean post-op DASH score was 8.47 (range 0 to 42.9) and the mean Oxford elbow score was 42.8 (range 16 to 48). There were no complications reported. All the patients returned to their normal jobs, hobbies such as gardening, horse riding and playing musical instruments. Conclusion: In our experience Percutaneous release of the epicondylar muscles for humeral epicondylitis has a high rate of success, is relatively simple to perform, is done as a day case procedure and has been without complications. Percutaneous release is a viable treatment option after failed conservative management of tennis elbow.

Arthroscopic Debridement and Arthrolysis for the Treatment of Advanced Kienböck's Disease: 18-Month and 5-Year Postoperative Results

2021 ◽  
Author(s):  
Omer Ayik ◽  
Mehmet Demirel ◽  
Necmettin Turgut ◽  
Okyar Altas ◽  
Hayati Durmaz
Keyword(s):  
Grip Strength ◽  
Dash Score ◽  
Arthroscopic Debridement ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Hand Grip ◽  
Case Series Study ◽  
The Mean ◽  
Kienbock’S Disease

Abstract Background Salvage procedures, such as proximal row carpectomy, limited or total wrist arthrodesis, and wrist replacement, are generally preferred to treat advanced Kienböck's disease. However, these procedures are particularly aggressive and may have unpredictable results and potentially significant complications. Questions/Purpose This study aimed to present the short- to mid-term clinical and functional results of arthroscopic debridement and arthrolysis in the management of advanced Kienböck's disease. Patients and Methods Fifteen patients in whom Lichtman Stages IIIA to IIIC or IV Kienböck's disease was diagnosed and treated by arthroscopic wrist debridement and arthrolysis were included in this retrospective study. The mean age was 30 years (range: 21–45). The mean follow-up period duration was 36 months (range: 18–60). The Disabilities of the Arm, Shoulder, and Hand (DASH) score, visual analog scale (VAS), wrist range of motion (ROM), and grip strength were measured preoperatively and then again at the final follow-up visit. Results The mean DASH and VAS scores improved from 41 (range: 31–52) and 7.1 (range: 6–8) preoperatively to 13 (range: 8–21) and 2 (range: 0–3; p < 0.001) at the final follow-up visit, respectively. The mean wrist flexion and extension values increased from 32 (range: 20–60 degrees) and 56 degrees (range: 30–70 degrees; p = 0.009) preoperatively to 34 (range: 10–65 degrees; p = 0.218) and 57 degrees (range: 30–70 degrees; p = 0.296) at the final follow-up appointment, respectively, although these findings were statistically insignificant. The mean strength of the hand grip increased from 22.7 (range: 9–33) to 23.3 (range: 10–34; p = 0.372). Conclusion Arthroscopic debridement and arthrolysis may improve wrist function and quality of life due to the preserved ROM and hand grip strength after short- to mid-term follow-up periods despite the radiographic progression of Kienböck's disease. Level of Evidence This is a Level IV, retrospective case series study.

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