Functional outcome of plating for displaced middle third clavicle fractures in adults

Introduction: Clavicle fractures are the common fractures around the shoulder. Conservative treatment is associated with higher incidence of nonunion. We conducted this study to assess the functional outcome of plating for displaced middle third clavicle fractures. Methods: This prospective study included 60 patients with displaced middle third clavicle fractures from April 2016 to March 2017. Fixation was done with a 3.5 mm reconstruction plate placed at the superior surface of the clavicle. Patients were followed-up for a minimum of one year. Functional outcome was assessed using Constant shoulder score. Results: There were 48 male and 12 female patients with a mean age of 33.17 years (range 18-74 years). The average follow-up period was 17.82 months. All fractures united at an average of 5.35 months. The mean Constant score at final follow-up was 89.12. There were two superficial infections and three implant failures. Conclusion: We conclude that treatment of displaced middle third clavicle fracture with plate gives good results.

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TREATMENT OF MIDSHAFT CLAVICLE FRACTURE WITH SUPERIOR PLATE PLACEMENT

Acta Ortopédica Brasileira ◽

10.1590/1413-785220202802226166 ◽

2020 ◽

Vol 28 (2) ◽

pp. 88-91

Author(s):

BEKIR ERAY KILINC ◽

YUNUS OC ◽

RAMAZAN ERDEN ERTURER

Keyword(s):

Constant Score ◽

Clavicle Fracture ◽

Controlled Study ◽

Retrospective Case ◽

Level Of Evidence ◽

Superior Surface ◽

The Mean ◽

Clinical And Radiological Results ◽

Anterior Posterior

ABSTRACT Objective: To evaluate the late clinical and radiological results of patients had locking plate anatomically compatible from superior surface and muscle cover on plate due to clavicle mid-region. Materials and Methods: Forty patients were included retrospectively. Patients had a routine right shoulder anterior posterior graph after examination. The results were assessed by returning to the patient's daily activities, Constant score, the Disability of the Arm, and Shoulder and Hand scoring, followed by radiological and clinical examination. Results: Fourteen (35%) patients were female and 26 (65%) were male. The mean age was 36.2 years. Twenty-six patients had right clavicle fracture and 14 patients had left. Twenty-three fractures were type 2B1 and 17 fractures were type 2B2. Mean follow-up time was 36.4 months. Radiologic union was at a mean of 9.1 ± 1.3 weeks. All patients had excellent results. The mean Constant score was 97.2 ± 1.8, the mean Disability of the Arm, and Shoulder and Hand score was 3.8 ± 2.4. Conclusion: It is possible to obtain complete union with high patient satisfaction by avoiding the complications and difficulties of the conservative treatment with the use of the anatomically compatible locking plates in superior fixation and our surgical dissection. Level of Evidence III, Retrospective Case controlled study.

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Early experience and patient-reported outcomes of 503 INFINITY total ankle arthroplasties

The Bone & Joint Journal ◽

10.1302/0301-620x.103b7.bjj-2020-2058.r2 ◽

2021 ◽

Vol 103-B (7) ◽

pp. 1270-1276

Author(s):

David N. Townshend ◽

Andrew J. F. Bing ◽

Timothy M. Clough ◽

Ian T. Sharpe ◽

Andy Goldberg ◽

...

Keyword(s):

Functional Outcome ◽

Early Experience ◽

Outcome Data ◽

Patient Specific ◽

Patient Specific Instrumentation ◽

Significant Difference ◽

Patient Reported ◽

The Mean ◽

One Year

Aims This is a multicentre, non-inventor, prospective observational study of 503 INFINITY fixed bearing total ankle arthroplasties (TAAs). We report our early experience, complications, and radiological and functional outcomes. Methods Patients were recruited from 11 specialist centres between June 2016 and November 2019. Demographic, radiological, and functional outcome data (Ankle Osteoarthritis Scale, Manchester Oxford Questionnaire, and EuroQol five-dimension five-level score) were collected preoperatively, at six months, one year, and two years. The Canadian Orthopaedic Foot and Ankle Society (COFAS) grading system was used to stratify deformity. Early and late complications and reoperations were recorded as adverse events. Radiographs were assessed for lucencies, cysts, and/or subsidence. Results In all, 500 patients reached six-month follow-up, 420 reached one-year follow-up, and 188 reached two-year follow-up. The mean age was 67.8 years (23.9 to 88.5). A total of 38 patients (7.5%) presented with inflammatory arthritis. A total of 101 (20.0%) of implantations used patient-specific instrumentation; 167 patients (33.1%) underwent an additional procedure at the time of surgery. A total of seven patients died of unrelated causes, two withdrew, and one was lost to follow-up. The mean follow-up was 16.2 months (6 to 36). There was a significant improvement from baseline across all functional outcome scores at six months, one, and two years. There was no significant difference in outcomes with the use of patient-specific instrumentation, type of arthritis, or COFAS type. Five (1.0%) implants were revised. The overall complication rate was 8.8%. The non-revision reoperation rate was 1.4%. The 30-day readmission rate was 1.2% and the one-year mortality 0.74%. Conclusion The early experience and complications reported in this study support the current use of the INFINITY TAA as a safe and effective implant in the treatment of end-stage ankle arthritis. Cite this article: Bone Joint J 2021;103-B(7):1270–1276.

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Study of surgical outcome of mid third clavicle fractures surgically managed by locking compression plate

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20214965 ◽

2021 ◽

Vol 8 (1) ◽

pp. 72

Author(s):

Potharaju Swetha Rani ◽

M. Zeeshan Vasif

Keyword(s):

Functional Outcome ◽

Road Traffic ◽

Constant Score ◽

Clavicle Fracture ◽

High Energy ◽

Bony Union ◽

Non Union ◽

Fall From Height ◽

Clavicle Fractures ◽

A Prospective Study

<p class="abstract">Clavicle is one of the most frequently fractured bones in young and active individuals. They account for 2.6-12% of all fractures and for 44-66% of fractures around the shoulder. Majority of clavicle fractures are mid shaft (80-85%). Functional outcome of midshaft fracture not only depends on the union but also on its length which has to be maintained. Thus a displaced or comminuted fracture carries a risk of symptomatic malunion, non-union or poor functional outcome with cosmetic deformity. The recent trend is shifting to internal fixation of these displaced mid shaft clavicle fracture. This was a prospective study of 20 cases of fresh mid third clavicle fracture admitted to MNR medical college and hospital from August 2020 to September 2021. Cases were taken according to inclusion and exclusion criteria. Medically unsuitable and patients not willing for surgery were excluded from the study. There were 17 male patients and 3 female patients with mid 1/3 closed clavicle fracture. 12 patients had right sided clavicle fracture and 8 patients had fracture of the left clavicle. All 20 fractures were closed fractures. Majority of the patients sustained fracture due to road traffic accident (high energy trauma) in 16 cases, fall from height in 3 cases and assault in one case. The mean duration to surgery from the day of presentation and injury was 2.1 days for middle third clavicle fractures. Functional outcome as assessed by constant and Murley scoring was favourable with excellent to good result in 97% cases and fair in 3% cases. The average constant score was 93.35 in one year follow up in middle third group. This study has some limitations. The conclusions drawn from this analysis cannot be generalized because of the small number of cases. In conclusion, for middle third clavicle fractures bony union could be achieved with locking compression plates and the clinical outcomes were satisfactory. All the fractures united and there were no cases of nonunion.</p>

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Treatment of unstable distal clavicle fractures (Neer type IIb): a modified system using a miniature locking plate with a single button

Journal of International Medical Research ◽

10.1177/03000605211022505 ◽

2021 ◽

Vol 49 (6) ◽

pp. 030006052110225

Author(s):

Hua Ying ◽

Jihuan Wang ◽

Yuehua Sun ◽

Kerong Dai ◽

Chao Yu ◽

...

Keyword(s):

Los Angeles ◽

Locking Plate ◽

Constant Score ◽

Shoulder Injuries ◽

Distal Clavicle ◽

Clavicle Fractures ◽

The Mean ◽

Neer Type Iib ◽

Distal Clavicle Fractures

Distal clavicle fractures are common in patients with shoulder injuries. We retrospectively evaluated the clinical outcomes of a novel fixation technique using a miniature locking plate with a single button in patients with distal clavicle fractures associated with coracoclavicular ligament disruption. The study involved seven patients with distal clavicle fractures with a follow-up period of 12 months. All patients were diagnosed with type IIb fractures according to the Neer classification. The distal clavicle fracture was fixed with a miniature locking plate, and the coracoclavicular ligaments were reconstructed using a single button. Functional outcomes were assessed at the final follow-up visit. At the 1-year follow-up, all patients had achieved radiographic union. There were no cases of nonunion or osteolysis. The mean Constant score at the final follow-up was 88 ± 5.13 (range, 78–93); the mean Disabilities of the Arm, Shoulder and Hand score was 19.17 ± 7.70 (range, 11.67–25); and the mean University of California Los Angeles score was 30 ± 2.52 (range, 25–33). In summary, internal fixation using a miniature locking plate and coracoclavicular reconstruction with a single button is a reliable surgical technique for restoring stability in patients with Neer type IIb distal clavicle fractures.

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Locking plate combined with titanium cable for Neer type II distal clavicle fractures

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04137-4 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Fan Zhang ◽

Qiang Fu ◽

Yongchuan Li ◽

Nan Lu ◽

Aimin Chen ◽

...

Keyword(s):

Complication Rate ◽

Locking Plate ◽

Type Ii ◽

Distal Clavicle ◽

Union Rate ◽

Clavicle Fractures ◽

The Mean ◽

One Year ◽

Distal Clavicle Fractures

Abstract Background There is controversy about the optimal strategy treatment of unstable distal clavicle fractures. We explored use of a surgical strategy: combination of a distal clavicle locking plate and a titanium cable. The purpose of this retrospective case series study was to evaluate the clinical outcomes of this new strategy in treating Neer type II distal clavicle fractures. Methods Twenty-one patients with Neer type II distal clavicle fracture were treated with a distal clavicle locking plate and a titanium cable. All patients were followed for at least one year. We retrospectively collected and reviewed follow-up data. The clinical outcomes were assessed for union rate, functional score, and complication rate. Results All patients achieved bony union within 6 months. The average follow-up period was 20.6 months (range12–48 months). The mean Constant score at one-year follow-up was 94.6 ± 3.3 (range 84–98), and the mean UCLA (University of California, Los Angeles) score was 33.3 ± 2.6 (range 27–35). Only one complication (wound infection) was observed during follow-up. Two patients received another operation for implant removal due to local irritation. Conclusions Use of a distal clavicle locking plate in combination with a titanium cable for treatment of Neer type II fractures results in high union rate, a low complication rate, and good shoulder function. This combined surgical strategy can be considered an effective method for treating unstable distal clavicle fractures.

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A PROSPECTIVE STUDY OF FUNCTIONAL OUTCOME OF CLOSED DISPLACED MID- SHAFT CLAVICLE FRACTURES TREATED WITH INTRAMEDULLARY TITANIUM ELASTIC NAIL SYSTEM

10.36106/ijar/9002786 ◽

2021 ◽

pp. 81-83

Author(s):

S. Kishore Babu ◽

Pamu Bala Avinash ◽

S. Rajeswara Rao

Keyword(s):

Minimally Invasive ◽

Clavicle Fracture ◽

Invasive Procedure ◽

Routine Work ◽

Elastic Nail ◽

Clavicle Fractures ◽

The Mean ◽

Average Size ◽

A Prospective Study

Background: Clavicle fracturesare common injuries in young individuals, mostly related to sports and road trafc accidents. In contrast, in children and elderly, they are related to falls, and account for approximately 2.6% of all fractures. A middle-third shaft clavicle fracture is the most common site( 80% of all clavicle fractures). Methodology: A study was carried out in 30 patients with simple middle third clavicular fractures who weretreated with closed intra-medullary xation with TENS nailing. Postoperatively range ofmovements,ability to get back to routine work were assessed and noted. Results :At the end of the study, 30 patients in the follow-up group with 21 male and 9 femalepatients taken. The mean age was 34.9 years noted. The mean time intervalbetween injury and surgery was 3.55 days (range 1–6 days). For all the patients the clinical andradiological union achieved at a mean of 8.6 weeks (Range, 6-12 weeks). seventeen out of the 30 patients had closednailing while thirteen patients (43%) required open reduction of their fracture. The average size of theexible titanium nail used was 2.5 mm (range, 2 - 3mm). Conclusion :The present study advise the use of minimally invasive antegradetitanium elastic nail for xation of displaced midshaft clavicle fractures as a safe minimally invasive procedure.

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

BMC Surgery ◽

10.1186/s12893-021-01274-4 ◽

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.

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Coracoclavicular ligament augmentation at clavicle distal-third fracture treatment

ScienceRise Medical Science ◽

10.15587/2519-4798.2021.229927 ◽

2021 ◽

pp. 27-31

Author(s):

Bulent Karslioglu ◽

Metin Uzun ◽

Suleyman Semih Dedeoglu ◽

Yunus Imren ◽

Ahmet Keskin

Keyword(s):

Surgical Treatment ◽

Constant Score ◽

Full Range ◽

Bony Union ◽

Distal Clavicle ◽

Ligament Augmentation ◽

Clavicle Fractures ◽

The Mean

The aim: type 2B clavicle fractures with conoid ligament rupture are considered unstable. Although surgical treatment is recommended as the standard treatment modality for type 2B fractures, there is no consensus about the type of operative treatment. We aimed to evaluate results of surgical treatment with an anatomical distal clavicle plate using CC ligament augmentation. Materials and methods: 15 patients that diagnosed with distal clavicle fractures, who underwent surgery for unstable type 2 fractures. The average patient age was 38 years (range 24–52 years). All patients were male; the right clavicle was injured in 10 patients whereas the left clavicle was injured in 5 cases. Surgical treatment was done with a distal clavicle anatomic locked plate augmentation (ZipTight™) at all cases. The mean follow-up period was 24 months (range, 12–40 months). Results: bony union was achieved at a mean follow-up of 8 weeks (range 6-10 weeks). The mean Constant score was 97 (range, 92–100). There were no complications or no need to second operation. All patients achieved satisfactory full range of shoulder motion. Hardware removal was performed for prominence in one case after the union was completed. Conclusion: the augmented technique reported here, provides early motion, increased stability and anatomic healing compared to other conventional options. We recommend augmentative CC ligament repair techniques over the distal locking anatomic plate for type 2 fractures

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Coracoclavicular Ligament Augmentation at Clavicle Distal-Third Fracture Treatment

TRAUMA ◽

10.22141/1608-1706.2.22.2021.231953 ◽

2021 ◽

Vol 22 (2) ◽

pp. 17-20

Author(s):

Bulent Karslioglu

Keyword(s):

Surgical Treatment ◽

Constant Score ◽

Bony Union ◽

Distal Clavicle ◽

Early Motion ◽

Ligament Augmentation ◽

Clavicle Fractures ◽

The Mean

Background. Type 2B clavicle fractures with conoid ligament rupture are considered unstable. Although surgical treatment is recommended as the standard treatment modality for type 2B fractures, there is no consensus about the type of operative treatment. Material and methods. 15 patients that diagnosed with distal clavicle fractures, who underwent surgery for unstable type 2 fractures. Surgical treatment was done with a distal clavicle anatomic locked plate augmentation (ZipTight™) at all cases. The mean follow-up period was 24 months (range 12–40 months). Results. Bony union was achieved at a mean follow-up of 8 weeks (range 6–10 weeks). The mean Constant score was 97 (range 92–100). There were no complications or no need to second operation. Conclusions. The augmented technique reported here, provides early motion, increased stability and anatomic healing compared to other conventional options.

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Biomechanical Aspects of Locking Reconstruction Plate Positioning in Osteosynthesis of Transverse Clavicle Fracture

Medicina ◽

10.3390/medicina48020012 ◽

2012 ◽

Vol 48 (2) ◽

pp. 12 ◽

Cited By ~ 1

Author(s):

Egidijus Kontautas ◽

Andrej Pijadin ◽

Andrius Vilkauskas ◽

Aurelijus Domeika

Keyword(s):

Clavicle Fracture ◽

Testing Machine ◽

Biomechanical Stability ◽

Reconstruction Plate ◽

Maximal Load ◽

Load To Failure ◽

Clavicle Fractures ◽

The Mean ◽

Cantilever Bending ◽

Transverse Fractures

The aim of this study was to evaluate and compare the biomechanical effects of locking reconstruction plate positioning on the osteosynthesis of clavicle midshaft simulated transverse fractures. Material and Methods. Twelve synthetic clavicles with simulated midshaft transverse fractures were repaired with a 3.5-mm locking reconstruction plate in the anteroinferior or the superior position. The clavicles were randomly assigned to 2 groups (6 per group). Each repaired clavicle was tested in cantilever bending by using the universal testing machine. The maximal load and the displacement of the specimens at a load of 40 N were recorded for each group. Results. The anteroinferior plating osteosynthesis with a 3.5-mm locking reconstruction plate could bear an average maximal load of 183.3 N (SD, 11.3); the corresponding load for the superior plating osteosynthesis with the identical implants was 444.8 N (SD, 102.3), and the mean displacement was 1.5 mm (SD, 0.5) and 0.7 mm (SD, 0.2), respectively. Conclusions. The superior plating osteosynthesis of simulated midshaft transverse clavicle fractures with the 7-hole 3.5-mm locking reconstruction plate had a significantly higher bending (from top to bottom) load to failure in comparison with the anteroinferior plating osteosynthesis of the clavicle with the identical implants. Clavicles plated with the 7-hole 3.5-mm locking reconstruction plate at the superior aspect exhibited a significantly greater biomechanical stability at a load of 40 N than those plated at the anteroinferior aspect.

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