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 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.

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.

scholarly journals Comparison of 2 plating techniques for lateral clavicle fractures, using a new standardized biomechanical testing setup

2017 ◽  
Vol 16 (2) ◽  
pp. 107-112
Author(s):  
Cyrill Suter ◽  
Martin Majewski ◽  
Andrej M. Nowakowski
Keyword(s):  
Standardized Testing ◽  
Computer Aided Design ◽  
Fatigue Testing ◽  
Clavicle Fracture ◽  
Biomechanical Testing ◽  
Bending Test ◽  
Plate Technique ◽  
Lateral Clavicle ◽  
Fixation Techniques ◽  
Clavicle Fractures

Background: Conservative treatment of lateral clavicle fractures (Neer type II) often ends with unsatisfactory results for patients. Operative treatment is thus gaining acceptance. A retrospective study found success using a double plate technique for these injuries. For the current study, a standardized testing setup was developed to compare the mechanical properties of single versus double plate technique for lateral clavicle fractures. Methods: Six synthetic bones were tested for each technique. Neer type IIB fractures were created using computer-aided design (CAD). Fatigue testing was carried out with a cantilever bending test. Parameters measured were cycles undergone, failure load and stiffness at the point of failure. Results: The standardized testing setup was able to provide reproducible failures. The double plate technique lasted about 16,000 more cycles and withstood an additional 22.4 N on average. Conclusions: The new modified standardized testing setup produced reproducible fixation failures for both clavicle fracture fixation techniques. The double plate technique seems to be mechanically superior to the single plate technique.

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 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 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.

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