Abstract
BackgroundTreatment of medial clavicle fractures is still controversially discussed in the community of upper extremity surgeons. An increasing number of symptomatic non-unions following conservative treatment of displaced fractures led to the development of various surgical approaches. Aim of this study was to evaluate the clinical and radiological outcome following operative treatment of displaced medial end clavicle fractures.MethodsPatients who presented with a displaced fracture of the medial clavicle between September 2012 and December 2019 were retrospectively enrolled in this study. All patients were operatively treated with open reduction and internal fixation (ORIF) using an anatomically precontoured locking compression plate (LCP) originally designed for the lateral clavicle (Synthes®, Umkirch, Germany). Functional outcome was recorded using the American Shoulder and Elbow Surgeons (ASES) Score, the Munich Shoulder Questionnaire (MSQ), Shoulder Pain and Disability Index (SPADI) and Constant Score.ResultsOverall 18 patients with a mean age of 54.5 ± 23.5 years suffering from a displaced fracture of the medial clavicle were identified. The mean follow-up was 40.9 ± 26.2 months. The mean ASES accounted for 88.3 ± 20.8 points, the mean MSQ was 83.1 ± 21.7 points, the mean SPADI was 85.6 ± 22.5 and a mean normative age- and sex-specific Constant Score of 77.5 ± 19.1 points resulted. No minor or major complications were observed. Radiologic fracture consolidation was achieved in all patients after a mean of 6.4 months.ConclusionSurgical treatment of displaced medial clavicle fractures using an anatomically precontoured locking plate originally designed for the lateral clavicle led to very good to excellent clinical and functional results.Trial registrationNo: DRKS00024813, retrospectively registered 19.03.2021 (www.drks.de).
Highlights
Treatment of medial clavicle fractures is still controversially discussed in the community of upper extremity surgeons
The common literature reveals a large number of publications regarding the treatment of midshaft as well as lateral clavicle fractures, little is known about optimal treatment of medial clavicle fractures [5, 9, 22, 23, 30]
Non-surgical treatment has been the treatment of choice even in displaced medial clavicle fractures due to good healing rates [23]
Summary
Treatment of medial clavicle fractures is still controversially discussed in the community of upper extremity surgeons. An increasing number of symptomatic non-unions following conservative treatment of displaced fractures led to the development of various surgical approaches. The majority of these patients are at high risk for concomitant injuries such as chest trauma or fractures of the shoulder girdle [3, 21, 23]. In this context, Throckmorton et al reported that 90% of the patients with medial clavicle fractures sustained multiple injuries and were considered as “multitrauma patients” [28]. Non-surgical treatment has been the treatment of choice even in displaced medial clavicle fractures due to good healing rates [23]. Various surgical approaches using different fixation techniques (i.e. intramedullary implants, cerclage techniques, locking plate fixation) were used resulting in good to excellent results [7, 10, 13, 23, 29, 37]
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