Distal Clavicle
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2021 ◽  
Vol 22 (1) ◽  
Shingo Abe ◽  
Kota Koizumi ◽  
Tsuyoshi Murase ◽  
Kohji Kuriyama

Abstract Background The locking plate is a useful treatment for lateral clavicle fractures, however, there are limits to the fragment size that can be fixed. The current study aimed to measure the screw angles of three locking plates for lateral clavicle fractures. In addition, to assess the number of screws that can be inserted in different fragment sizes, to elucidate the size limits for locking plate fixation. Methods The following three locking plates were analyzed: the distal clavicle plate [Acumed, LLC, Oregon, the USA], the LCP clavicle plate lateral extension [Depuy Synthes, LLC, PA, the USA], and the HAI clavicle plate [HOMS Engineering, Inc., Nagano, Japan]. We measured the angles between the most medial and lateral locking screws in the coronal plane and between the most anterior and posterior locking screws in the sagittal plane. A computer simulation was used to position the plates as laterally as possible in ten normal three-dimensional clavicle models. Lateral fragment sizes of 10, 15, 20, 25, and 30 mm were simulated in the acromioclavicular joint, and the number of screws that could be inserted in the lateral fragment was assessed. Subsequently, the area covered by the locking screws on the inferior surface of the clavicle was measured. Results The distal clavicle plate had relatively large screw angles (20° in the coronal plane and 32° in the sagittal plane). The LCP clavicle lateral extension had a large angle (38°) in the sagittal plane. However, the maximum angle of the HAI clavicle plate was 13° in either plane. The distal clavicle plate allowed most screws to be inserted in each size of bone fragment. For all locking plates, all screws could be inserted in 25 mm fragments. The screws of distal clavicle plate covered the largest area on the inferior surface of the clavicle. Conclusions Screw angles and the numbers of screws that could be inserted in the lateral fragment differed among products. Other augmented fixation procedures should be considered for fractures with fragment sizes < 25 mm that cannot be fixed with a sufficient number of screws.

2021 ◽  
Vol 10 (4) ◽  
pp. 3175-3178
Om C Wadhokar

The collarbone, or wishbone, is a thin, S-shaped bone about 6 inches (15 cm) long and serves as a support between the shoulder blade and the sternum (sternum). Clavicle fracture so occur as a result of injury or trauma. The most common site of fracture is the junction between the two curvatures of the bone, which is the weakest point. The displacement post fracture is most common in clavicular fracture because the attachment of the muscle sternocleidomastoid pulls the Sternal head upwards and the pectoral muscle pulls the distal clavicle downwards. After a distal clavicle fracture, radiographic nonunion has been identified in 10% to 44% of patients. Most of clavicular fractures are managed non-surgically by physical therapy which consists of a rehabilitation program without hampering the fracture healing, the rehabilitation consists of pain reduction, improving strength and range of motion of the shoulder, Scapular and neck muscles and postural correction exercises in addition to a brace to support the upper limb as the clavicle is the bone connecting the Axilla to the shoulder girdle. And the patient is started with medical management which usually consist of analgesics. 62 year old male patient with left clavicle fracture was diagnosed on x-ray after a hit from a bullock cart. Following this incident the patient underwent a prompt series of physical rehabilitation which included strengthening exercises, thoracic expansion exercises, breathing exercises. The case report suggests that a physiotherapy treatment procedure led to the improvement of functional goals progressively and significantly.

2021 ◽  
pp. 036354652110367
Nicholas M. Panarello ◽  
Donald F. Colantonio ◽  
Colin J. Harrington ◽  
Scott M. Feeley ◽  
Tahler D. Bandarra ◽  

Background: Coracoclavicular (CC) ligament reconstruction is a commonly performed procedure for high-grade acromioclavicular (AC) joint separations. Although distal clavicle and coracoid process fractures represent potential complications, they have been described in only case reports and small case series. Purpose: To identify the incidence and characteristics of clavicle and coracoid fractures after CC ligament reconstruction. Study Design: Case series; Level of evidence, 4. Methods: The US Military Health System Data Repository was queried for patients with a Current Procedural Terminology code for CC ligament repair or reconstruction between October 2013 and March 2020. The electronic health records, including patient characteristics, radiographs, operative reports, and clinical notes, were evaluated for intraoperative or postoperative clavicle or coracoid fractures. Initial operative technique, fracture management, and subsequent clinical outcomes were reviewed for these patients. Results: A total of 896 primary CC ligament repairs or reconstructions were performed during the study period. There were 21 postoperative fractures and 1 intraoperative fracture in 20 patients. Of these fractures, 12 involved the coracoid and 10 involved the clavicle. The overall incidence of fracture was 3.81 fractures per 1000 person-years. In 5 patients who sustained a fracture, bone tunnels were not drilled in the fractured bone during the index procedure. A total of 17 fractures were ultimately treated operatively, whereas 5 fractures had nonoperative management. Of the 16 active-duty servicemembers who sustained intraoperative or postoperative fractures, 11 were unable to return to full military duty after their fracture care. Conclusion: Fracture of the distal clavicle or coracoid process after CC ligament repair or reconstruction is a rare but serious complication that can occur independent of bone tunnels created during the index procedure. Fractures associated with CC ligament procedures occurred at a rate of 2.46 per 100 cases. Most patients were ultimately treated surgically with open reduction and internal fixation or revision CC ligament reconstruction. Although the majority of patients with intraoperative or postoperative fractures regained full range of motion, complications such as anterior shoulder pain, AC joint asymmetry, and activity-related weakness were common sequelae resulting in physical limitations and separation from military service.

Guilherme Vieira Lima ◽  
Natanael Sousa Santos Filho ◽  
Cézar Augusto Pimentel Furlan ◽  
Joel Murachovsky ◽  
Vitor LaBanca ◽  

Christoph J. Laux ◽  
Paul Borbas ◽  
Christina Villefort ◽  
Simon Hofstede ◽  
Lukas Ernstbrunner ◽  

Cureus ◽  
2021 ◽  
Vivek Sharma ◽  
Amit Modi ◽  
Alison Armstrong ◽  
Radhakant Pandey ◽  
Dhiraj Sharma ◽  

Andreas Panagopoulos ◽  
Konstantina Solou ◽  
Marios Nicolaides ◽  
Ioannis K. Triantafyllopoulos ◽  
Antonis Kouzelis ◽  

Enrico M. Forlenza ◽  
Joshua Wright-Chisem ◽  
Matthew R. Cohn ◽  
John M. Apostolakos ◽  
Avinesh Agarwalla ◽  

2021 ◽  
pp. 152-156
Mouad Guenbdar ◽  
Mourad Bennani ◽  
Taoufik Cherrad ◽  
Hassan Zejjari ◽  
Jamal Louaste ◽  

Bilateral clavicle nonunion is extremely rare (4 published cases), and no case of bilateral distal clavicle nonunion has been reported in the literature. We present the case of a 75-year-old patient followed up for chronic obstructive pulmonary disease, presenting a bilateral fracture of the distal clavicle type “Neer 1” following a road traffic accident and orthopedically treated. After 1 year, the patient complained of mild pain at both shoulders occasionally in cold weather and during an unusual effort without neurovascular symptom associated. The shoulder radiographs showed bilateral distal clavicle nonunion. We chose a conservative treatment because of the mild symptomatology, advanced age, and limited functional demands. The functional outcome was satisfactory. The therapeutic decision in the treatment of the bilateral distal clavicle nonunion is difficult, whereas the therapeutic indications are based on symptomatology, functional impairment, age, comorbidities, and functional demands.

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