scholarly journals Fractures of the Clavicle: An Overview

2013 ◽  
Vol 7 (1) ◽  
pp. 329-333 ◽  
Author(s):  
Thomas D Donnelly ◽  
Robert J MacFarlane ◽  
Mathias Thomas Nagy ◽  
Peter Ralte ◽  
Mohammad Waseem
Keyword(s):  
Surgical Treatment ◽  
Operative Treatment ◽  
Functional Outcomes ◽  
Surgical Approaches ◽  
High Grade ◽  
Non Union ◽  
The Past ◽  
Clavicle Fractures ◽  
Surgical Treatments

Fractures of the clavicle are a common injury and most often occur in younger individuals. For the most part, they have been historically treated conservatively with acceptable results. However, over recent years, more and more research is showing that operative treatment may decrease the rates of fracture complications and increase functional outcomes. This article first describes the classification of clavicle fractures and then reviews the literature over the past decades to form a conclusion regarding the appropriate management.A thorough literature review was performed on assessment of fractures of the clavicle, their classification and the outcomes following conservative treatment. Further literature was gathered regarding the surgical treatment of these fractures, including the methods of fixation and the surgical approaches used. Both conservative and surgical treatments were then compared and contrasted.The majority of recent data suggests that operative treatment may be more appropriate as it improves functional outcome and reduces the risk of complications such as non-union. This is particularly evident in mid shaft fractures, although more high grade evidence is needed to fully recommend this, especially regarding certain fractures of the medial and lateral clavicle.

scholarly journals Midshaft clavicle fractures

2018 ◽  
Vol 3 (6) ◽  
pp. 374-380 ◽  
Author(s):  
Paul Hoogervorst ◽  
Peter van Schie ◽  
Michel PJ van den Bekerom
Keyword(s):  
Operative Treatment ◽  
Treatment Strategy ◽  
Functional Outcomes ◽  
Optimal Treatment ◽  
Return To Sports ◽  
Non Union ◽  
Increased Risk ◽  
Clavicle Fractures ◽  
Decision Making Model ◽  
Optimal Treatment Strategy

Clavicle fractures are common fractures and the optimal treatment strategy remains debatable. The present paper reviews the available literature and current concepts in the management of displaced and/or shortened midshaft clavicle fractures. Operative treatment leads to improved short-term functional outcomes, increased patient satisfaction, an earlier return to sports and lower rates of non-union compared with conservative treatment. In terms of cost-effectiveness, operative treatment also seems to be advantageous. However, operative treatment is associated with an increased risk of complications and re-operations, while long-term shoulder functional outcomes are similar. The optimal treatment strategy should be one tailor-made to the patient and his/her specific needs and expectations by utilizing a shared decision-making model. Cite this article: EFORT Open Rev 2018;3:374-380. DOI: 10.1302/2058-5241.3.170033

Energy Sources for the Surgical Treatment of Atrial Fibrillation

2019 ◽  
Vol 14 (6) ◽  
pp. 503-508
Author(s):  
Robert M. MacGregor ◽  
Spencer J. Melby ◽  
Richard B. Schuessler ◽  
Ralph J. Damiano
Keyword(s):  
Atrial Fibrillation ◽  
Surgical Treatment ◽  
Tissue Injury ◽  
Surgical Techniques ◽  
Maze Procedure ◽  
Energy Sources ◽  
Surgical Approaches ◽  
Surgical Ablation ◽  
The Past ◽  
Minimally Invasive Surgical

The surgical treatment of atrial fibrillation has evolved over the past 2 decades due to the advent of ablation technology, and the introduction of less invasive surgical approaches. Current devices produce ablation lines that aim to replace the incisions of traditional surgical ablation strategies, such as the Cox-Maze procedure. This has helped to simplify and shorten surgical ablation procedures and has allowed for the development of minimally invasive surgical techniques. This review discusses surgical ablation energy sources and devices, providing background on device characteristics, mechanism of tissue injury, and success in creating transmural lesions.

Other surgical approaches in the management of osteoarthritis

2016 ◽  
Author(s):  
Jonas Bloch Thorlund ◽  
L. Stefan Lohmander
Keyword(s):  
Stem Cells ◽  
Surgical Treatment ◽  
Adverse Events ◽  
Surgical Procedures ◽  
Joint Replacement ◽  
Hip Arthroscopy ◽  
Surgical Techniques ◽  
Risk Of Bias ◽  
Surgical Approaches ◽  
Surgical Treatments

Joint replacement is often considered the surgical treatment for patients with osteoarthritis (OA). However, several other surgical treatments, of which some are more frequently performed, have been advocated for patients with OA in order to relieve symptoms, stall progression, and avoid or postpone joint replacement. This chapter briefly describes the most common procedures such as knee and hip arthroscopy and knee and hip osteotomy. It also reviews the evidence for the efficacy of these treatments compared with non-surgical alternatives, which is frequently insufficient due to lack of controlled low-risk-of-bias studies. The risk of adverse events is also reported when data is available. Some of the more recent surgical techniques such as implantation of chondrocytes or stem cells are also described and discussed but their utility for treating osteoarthritis remains uncertain. There is a great need for continued innovation and development of surgical techniques for managing in particular the earlier stages of osteoarthritis. To reduce the risk of future costly failures, a stepwise introduction of new surgical procedures and devices must be encouraged.

scholarly journals Functional outcomes following non-operative versus operative treatment of clavicle fractures in adolescents

2017 ◽  
Vol 11 (4) ◽  
pp. 310-317 ◽  
Author(s):  
M. M. Herzog ◽  
R. C. Whitesell ◽  
L. M. Mac ◽  
M. L. Jackson ◽  
B. A. Culotta ◽  
...  
Keyword(s):  
Operative Treatment ◽  
Functional Outcomes ◽  
Clavicle Fractures

scholarly journals Protocol of BRICS: Brazilian multicentric pragmatic randomised trial of surgical interventions for displaced diaphyseal clavicle fracture study: MIPO versus ORIF for the treatment of displaced midshaft clavicle fractures

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e052966
Author(s):  
Adriano Fernando Mendes Jr. ◽  
Rodrigo Fleury Curado ◽  
Jair Moreira Dias Jr. ◽  
José Da Mota Neto ◽  
Oreste Lemos Carrazzone ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Minimally Invasive ◽  
Internal Fixation ◽  
Open Reduction ◽  
Skin Irritation ◽  
Randomised Trial ◽  
Implant Failure ◽  
Minimally Invasive Osteosynthesis ◽  
Non Union ◽  
Clavicle Fractures

IntroductionFractures of the diaphysis of the clavicle are common; however, treatment guidelines for this condition are lacking. Surgery is associated with a lower risk of non-union and better functional outcomes but a higher risk of complications. Open reduction and internal fixation with plates and screws are the most commonly performed techniques, but they are associated with paraesthesia in the areas of incisions, extensive surgical exposure and high rates of implant removal. Minimally invasive techniques for treating these fractures have a lower rate of complications. The aim of this study is to evaluate which surgical treatment option (minimally invasive osteosynthesis or open reduction and internal fixation) has better prognosis in terms of complications and reoperations.Methods and analysisThe study proposed is a multicentric, pragmatic, randomised, open-label, superiority clinical trial between minimally invasive osteosynthesis and open reduction and internal fixation for surgical treatment of patients with displaced fractures of the clavicle shaft. In the proposed study, 190 individuals with displaced midshaft clavicle fractures, who require surgery as treatment, will be randomised. The assessment will occur at 2, 6, 12, 24 and 48 weeks, respectively. The primary outcome of the study will be the number of complications and reoperations. For sample size calculation, a moderate effective size between the techniques was considered in a two-tailed test, with 95% confidence and 90% power. Complications include cases of infection, hypertrophic scarring, non-union, refracture, implant failure, hypoesthesia, skin irritation and shoulder pain. Reoperations are defined as the number of surgeries for pseudoarthrosis, implant failure, infection and elective removal of the implant.Ethics and disseminationStudy approved by the institutional ethics committee (number 34249120.9.0000.5505—V.3). The results will be disseminated by publications in peer-reviewed journals and presentations in medical meetings.Trial registration numberRBR-3czz68)/UTN U1111-1257-8953.

scholarly journals Comparing functional outcome in lateral end clavicle fracture after conservative and plating

2017 ◽  
Vol 3 (4) ◽  
pp. 833
Author(s):  
Sachin Y. Kale ◽  
Prasad Chaudhari ◽  
Shikhar D. Singh ◽  
Sanjay B. Dhar ◽  
Prakash D. Samant ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Functional Outcomes ◽  
Standard Treatment ◽  
Clavicle Fracture ◽  
Operative Management ◽  
Skin Infections ◽  
Non Union ◽  
Medical College ◽  
Clavicle Fractures ◽  
Early Healing

<p class="abstract"><strong>Background:</strong> Fractures of the clavicle have been traditionally treated non- operatively but has been associated with various postoperative complications. In this study, we analyzed the outcomes of the operative management and compare its results with conservative treatment considering it as standard treatment option.</p><p class="abstract"><strong>Methods:</strong> The present study was carried out at the Department of Orthopedics, DY Patil Medical College and Hospital, Navi Mumbai. Open fractures, fractures associated with complication like head injury with associated other bone injuries were included in this study. We excluded patients less than 18 years of age, patients with middle third fracture of clavicle and patients with medial end clavicle fracture. The fractures were classified according to Robinson’s classification. Patients were followed up every week for 4 weeks then at 8 weeks, 12 weeks, 6 months and 1 year. The functional outcomes were assessed by Constant and Murley score.<strong></strong></p><p class="abstract"><strong>Results:</strong> We included 48 patients in the study, 34 of which were males, average age of the patients was 37.53±7.64 years. 23 injuries were on the left. There was statistically significant better union times with operative management (p=0.034). Various complications were observed like infection, implant failure, man union, non-union, deformity and skin infections, statistically seen more in patients who underwent conservative management. Overall, patients experienced excellent and good results with operative management in 6 and 12 patients respectively.</p><strong>Conclusions:</strong>Operative treatment gave statistically significant functional outcome and early healing compared to conservatively treated in displaced, communited lateral end clavicle fractures. <p> </p>

scholarly journals Functional and radiological assessment of displaced midshaft clavicle fractures treated through open reduction and internal fixation surgery using pre-contoured locking compression plates

2020 ◽  
Vol 7 (7) ◽  
pp. 2261
Author(s):  
Rohil Singh Kakkar ◽  
Deepak Mehta ◽  
Ankit Sisodia
Keyword(s):  
Internal Fixation ◽  
Functional Outcomes ◽  
Open Reduction ◽  
Radiological Assessment ◽  
Fracture Union ◽  
Contact Loading ◽  
Non Union ◽  
Locking Compression Plates ◽  
Clavicle Fractures

Background: Fractures of the clavicle constitute approximately 2.6% of all the fractures and nearly 44-66% of fractures around shoulder.Methods: This particular study is intended to assess the functional and radiological outcomes in a series of 32 patients with closed displaced midshaft clavicle fractures treated through open reduction and internal fixation surgery using pre-contoured clavicle locking compression plates.Results: All 32 patients achieved fracture union within 6 months follow up period. As per Constant-Murley scoring, 56.25% cases had excellent results, 34.37% cases had good, 6.25% cases had fair and 3.12% of the cases had poor results respectively.Conclusions: Open reduction and internal fixation surgery with pre-contoured locking compression plates in the displaced midshaft clavicle fractures restores the anatomy, biomechanics and contact loading characteristics of the clavicle and significantly reduces the incidence of non-union with improved functional outcomes resulting in better patient satisfaction.

scholarly journals Iatrogenic Supraclavicular Nerve Injuries in Surgical Treatment of Clavicle Fractures

2015 ◽  
Vol 22 (2) ◽  
pp. 50-54
Author(s):  
A. S Zolotov ◽  
M. S Feshchenko ◽  
O. I Pak
Keyword(s):  
Surgical Treatment ◽  
Postoperative Period ◽  
Surgical Intervention ◽  
Early Postoperative Period ◽  
Surgical Approaches ◽  
Nerve Injuries ◽  
Clavicle Fractures ◽  
Traumatic Damage

Incidence and pattern of disturbed sensitivity in the zone of surgical intervention was studied in 24 patients with clavicle fractures. Traumatic damage of supraclavicular nerve (not related to surgery) was observed only in 1 case. Disturbance of sensitivity in the zone of surgical intervention was noted in 21 (87.5%) patients. Mean area of anesthesia made up 44.5±29.3 cm2 (from 8.0 to 125.5 cm2). That complication developed at both horizontal and vertical surgical approaches. Intraoperatively supraclavicular nerves were visualized and preserved in 6 patients however disturbed sensitivity in early postoperative period was observed in 4 cases. Preventive isolation of supraclavicular nerves does not always ensure the preservation of sensitivity in early postoperative period.

scholarly journals Two-year Functional Outcomes Of Operative Vs. Non-operative Treatment Of Completely Displaced Midshaft Clavicle Fractures In Adolescents: Results From A Prospective, Multicenter, Level 2 Study

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0042
Author(s):  
Benton E. Heyworth ◽  
Andrew T. Pennock ◽  
G. Ying Li ◽  
Leslie Kalish ◽  
Brittany Dragonetti ◽  
...  
Keyword(s):  
Operative Treatment ◽  
Functional Outcomes ◽  
Clavicle Fracture ◽  
Tertiary Care ◽  
High Volume ◽  
Treatment Decisions ◽  
Fracture Pattern ◽  
Complication Rates ◽  
Patient Reported ◽  
Clavicle Fractures

Objectives: To investigate the two-year functional outcomes and complications following operative versus non-operative treatment of completely displaced midshaft clavicle fractures in adolescents. Methods: All patients 10-18 years-old treated for a midshaft clavicle fracture between August, 2013 and August, 2018 at one of 8 geographically diverse, high-volume, tertiary-care pediatric centers were enrolled, with independent treatment decisions determined by individual providers. The sub-population of patients with completely displaced fractures was prospectively followed for over 2 years. Clinical course, complications, validated patient-reported outcome measures (PROs), quality of life metrics, and satisfaction scores were analyzed. To address the ceiling effect of the PRO/satisfaction data following clavicle injuries, a priori thresholds for ‘suboptimal’ scores were established (ASES scores <90, QuickDASH scores >10, EQ-5D <0.80). According to ‘intention to treat’ statistical principles, one post-operative complication (and a subsequent secondary operation) was analyzed within the non-operative cohort, given that the patient represented a ‘crossover’ from the non-operative to the operative treatment group. Results: Of the 909 patients enrolled in the prospective study, 417 patients (45.9%) demonstrated completely displaced fractures and maintained enrollment over the study period, 277 (66%) of whom had reached two year follow up, and 151 of whom provided adequate PRO data, representing a 55% response rate. Of these patients, 55 (36%) underwent operative treatment, while 96 (64%) were treated non-operatively. Those treated surgically showed no difference in gender distribution (76% males,p=0.43), athletic participation (p=0.76), or fracture pattern (p=0.18), but were older (mean age 15.3 vs. 13.5 years, p<0.001) and had greater shortening (p<0.001) than those treated non-operatively. Within the subset with adequate complication data, listed in Figure 1, complications were less common in non-surgical than surgical patients (p=0.0003), but this difference did not reach significance when sensory deficits were excluded (p=0.17). There was no difference in secondary surgeries (p=0.43). While greater percentages of operative than non-operative patients reported suboptimal PRO/satisfaction scores (ASES: 15% vs. 5%, QuickDASH 11% vs 5%, satisfaction 11% vs. 5%), these differences did not reach significance (p=0.07, 0.20, 0.06, respectively). Conclusion: At eight large pediatric centers with many surgeons making independent treatment decisions, non-operative treatment of adolescent clavicle fractures demonstrated lower complication rates and similar satisfaction and functional outcomes.These data establish a comprehensive functional assessment of adolescents treated for clavicle fractures, which represents the epidemiological sub-population most affected by this condition. Unlike several adult studies demonstrating superiority in operative treatment, this adolescent study demonstrates equivalent function and fewer complications associated with non-operative treatment. [Table: see text]

scholarly journals Mitral Regurgitation – A Multidisciplinary Challenge

2014 ◽  
Vol 9 (1) ◽  
pp. 49
Author(s):  
Eduardo Alegria-Barrero ◽  
Olaf W Franzen ◽  
◽  
Keyword(s):  
Surgical Treatment ◽  
High Risk ◽  
Mitral Regurgitation ◽  
Standard Of Care ◽  
Surgical Approaches ◽  
Repair Technique ◽  
The Past ◽  
Standard Of Care Treatment ◽  
Risk Patients ◽  
Management Challenge

Mitral regurgitation is an increasing valvular disease that represents a difficult management challenge. Surgical treatment for degenerative mitral regurgitation is the standard of care treatment. Percutaneous therapies have emerged rapidly over the past years as an option for treatment of mitral regurgitation for selected, predominantly high-risk patients. Catheter-based devices mimic these surgical approaches with less procedural risk. Mitraclip® implantation mimics the surgical edge-to-edge leaflet repair technique, reducing the regurgitant area. We review the increasing evidence with the Mitraclip device reported to date.

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