The efficacy of threaded Kirschner wire fixation for midclavicular fracture: a single-center retrospective study.

What’s New in Orthopaedic Trauma

What's New in Orthopaedic Trauma.

What's New in Orthopaedic Trauma.

Objective To evaluate and compare the treatment outcomes of two minimally invasive internal fixation methods for midshaft clavicular fractures. Methods A retrospective study was conducted of 62 patients with midshaft clavicular fractures treated between January 2010 and August 2014. Among them 34 patients were treated with minimally invasive percutaneous locking reconstruction plate fixation (plate group), while 28 patients were treated with percutaneous elastic intramedullary nail fixation (nail group). Intraoperative parameters, pain score at postoperative day 3, bone union time, clinical outcomes and complications were compared between the two groups. Results There were no statistically significant differences in intraoperative fluoroscopy time, postoperative pain score and bone union time for type A fractures between the two groups. Surgery time was significantly shorter in the nail group. Bone union time for type B fractures was significantly shorter in the plate group. DASH score or Constant-Murley score for type A fractures were not different between the two groups at 6 months, but significantly higher in the plate group for type B fractures. At 12 months no significant differences in DASH or Constant-Murley scores were noted between the two groups for either type A or type B fractures. A higher rate of skin irritation was seen in the nail group. There were no significant differences between the two groups with regard to infection, loosening or migration of internal fixation and re-fracture. Conclusion Both percutaneous locking reconstruction plate fixation and percutaneous elastic intramedullary nail fixation are effective minimally invasive methods for treating midshaft clavicular fractures. For type B comminuted midshaft clavicular fractures, percutaneous locking reconstruction plate fixation is a better option due to its shorter bone union time, better function scores and lower complications. Key words: Clavicle; Fracture fixation, internal; Locking reconstruction plate; Elastic stable intramedullary nail

Background Humeral shaft fractures are commonly encountered in casualties. There are different methods of operative internal fixation with no consensus on the best technique. The objective of this study was to assess shoulder function and rate of complications among two different options of fixation, intramedullary nailing, and minimal invasive plate osteosynthesis (MIPO) in young adults. Methods Forty-two patients with humeral shaft fractures were included in the study and divided into two equal groups: group A treated with antegrade intramedullary locked nails (IMN) and group B with MIPO. Fracture union was evaluated with serial X-rays, and shoulder function was assessed in both groups using the scale of the American Shoulder and Elbow Surgeons (ASES), University of California at Los Angeles Shoulder Scale (UCLA), and visual analog score (VAS). The mean differences between groups were recorded and considered significant if the P value was ˂0.05. Results The results were reported prospectively with no significant differences in mean age, sex, side of injury, type of fracture, mechanism of injury, and the follow-up period between the groups studied. Group A had shorter operative time and minimal blood loss than group B. Regarding shoulder function scores (ASES, UCLA, and VAS), the results in the MIPO group were better than the IMN group with shorter time of union and fewer complications. Conclusion Despite a shorter operative time and lower blood loss during locked intramedullary nail fixation in the management of humeral shaft fractures, MIPO enables more superior shoulder function with better fracture healing and lower morbidities.

Mid-shaft clavicular fractures are mainly treated conservatively with an average incidence of non-union in 4.5 %. Gender, age, grade of fragment dislocation and comminution are risk factors to develop a pseudarthrosis. In contrast to patients who where operated on, conservative treatment was also associated with a higher complication rate and pain level as well as a poor shoulder function and cosmetic result. Therefore more patients are treated operatively, especially modern minimally invasive techniques have been developed and remain as equals to the standard plate fixation. PATIENTS/MATERIAL: Within a period of 24 months patients with a mid-shaft clavicular fracture were included into a prospective, non-randomised multicentre study. A modified AO classification was used. Patients were treated either conservatively, by plating or intramedullary nailing. Pain level, cosmetic result, shoulder function and complication rate were documented as well as the influence of the profession on the therapeutic strategy and duration of unfitness for work. 120 patients (95 male, 25 female) were included in the study. Fractures were caused in 35 (29 %) by a direct, in 85 (71 %) by an indirect trauma mechanism. Because of their lower grade fractures with overlapping fragments 47 (39 %) patients were treated conservatively with a figure-of-eight-bandage. Patients with higher graded fractures and fragment displacement were stabilised either by intramedullary nailing (n = 20, 27 %) or plate fixation (n = 53, 73 %). 96 (80 %) patients were examined at a follow-up of eight weeks and eight months after injury. Early freedom from pain (p = 0.014), a better cosmetic result (p = 0.1) and an improved subjective (p = 0.004) and objective (p = 0.01) shoulder function were statistically significant in operated patients. Clavicle shortening was often found to be significant in conservatively treated patients (p = 0.006). Duration of unfitness for work depended on the physical activity in the job. The complication rate was 15 % for each therapy, non-union was detected in one (0.8 %) patient. Mid-shaft clavicular fractures have to be classified by the criteria contact and number of fragments. Advantages of operative procedures are early freedom from pain and shoulder function recovery. Non-displaced low grade shaft fractures without shortening should be treated conservatively, whereas displaced low-grade shaft fractures have a better result after intramedullary nailing. Plate fixation should be predominantly used in dislocated and comminuted fractures as well as in patients with a high level of physical activity in their jobs.

Background Domestic and foreign data have confirmed that clavicular fractures account for approximately 2%-3% of all adult fractures, and midshaft fractures are much more common with obvious displacement or comminution. The accompanied butterfly fragments increase the difficulty of maintaining the stability after fracture reduction. In recent years, literatures have reported that surgical treatment superior to conservative treatment. In 1997, foreign scholar Hill et al. reported that the nonunion rate of non-surgical treatment was as high as 15%. It was also reported that 30% of patients had poor shoulder joint function. For the clavicular fractures with obviously displaced or comminuted midshaft, surgical treatment has become the mainstream, which can significantly reduce the incidence of complications such as nonunion and malunion and has the merits of good and fast recovery of shoulder joint function. Methods 1．General information: From January 2014 to February 2017, 28 adult patients (19 males and 9 females) with comminuted midshaft clavicular fractures were treated with Nice knot combined with anatomic locking plate in our department. The age ranged from 22 to 73 years old with an average of (46.93±14.16) years old. Causes of injury: 8 cases of automobile accident, 10 cases of electric bicycle accident, 5 cases of bicycle fall and 5 cases of sports injury. According to Allman classification, all patients were type I fractures and were operated with open reduction and internal fixation within 3 to 5 days after injury. Inclusive criteria: (1) Patients over 18 years old with comminuted midshaft clavicular fractures of obvious displacement and shortening displacement of over 2 cm; (2) Fractures with obvious angular deformity and the risk of sink puncture; (3) Informed consent of the patient and family; (4) Patients without severe internal medicine disease and who can tolerate brachial plexus block or general anesthesia. Exclusive criteria: (1) Fractures with displacement of less than 2 cm; (2) Comminuted fractures without the risk of skin puncture; (3) Combination of multiple fractures; (4) Pathological clavicular fractures. 2. Surgical treatment: After brachial plexus block anesthesia, the patient was placed in beach chair position with conventional disinfection and draping. A straight or curved incision of approximately 6 to 10 cm with the fracture ends as center was made along clavicle. The tissue was cut open layer by layer, and the supraclavicular nerve was protected to the greatest extent. The fracture ends were stripped limitedly, and the blood clots were removed to secure fracture reduction. Attention should be paid to protect blood supply. During the operation, different reduction methods were adopted based on the size of butterfly fragment. For the fracture fragment of over 1 cm, cloth clamp was used for reduction. After anatomic reduction, No. 0 absorbable suture was used for fixation with 2 Nice knots. The reduction was beneficial for maintaining the stability of fracture and the length of clavicle. As the distal and proximal clavicular fractures were reduced, the anatomic plate of appropriate length was placed and fixed with drilling on both the distal and proximal ends. For the fracture fragment of 0.5 to 0.8 mm, the fracture was reduced at the distal and proximal sites, and an anatomic plate was placed to maintain the length of clavicle for bridge fixation. Then, the small butterfly fragment was reduced and fixed with 2 Nice knots of No. 0 suture. During the operation, attention should be paid to protect the blood supply of fracture end and butterfly fragment. At least 3 sextuple-layer cortex screws were used on each side of the plate for fixation. At least 2 Nice knots should be used for binding based on the size of butterfly fragment. The length of plate was selected in accordance with the comminution of fracture, and the plate with 8 to10 holes was most commonly used. The reduction, plate position and screw length were monitored under fluoroscopy with C-arm. After satisfactory reduction and fixation, the cavity was irrigated, and the wound was closed layer by layer.3.Postoeprative management: To prevent postoperative incision infection, 1.0 g of cefotiam dissolved in 100 ml of regular saline was conventionally used via intravenous infusion twice per day for 24 to 48 hours. For those who were allergic to cephalosporin and penicillin, 0.6 g of clindamycin dissolved in 100 ml of regular saline was used via intravenous infusion twice per day. The affected limb was immobilized with forearm sling for 4 to 6 weeks. The patients were instructed to conduct pendulum exercise 1 week after the operation. The active functional training of shoulder joint was started 3 weeks after the operation, and weight bearing should be avoided within 6 weeks. 4. Efficacy evaluation criteria: (1) Records of operation time and intraoperative blood loss for all patients; (2) Patients’ satisfaction with treatment; (3) Complications, including wound infection, neurovascular injury, internal fixation loosening, breaking, skin irritation, etc; (4) Shoulder function evaluated according to Constant-Murley score and therapeutic evaluation judged according to Lazzcano criteria. Patients' satisfaction, complication and shoulder function were evaluated at the last follow up. Results 28 patients were followed up for 6 to 16 months with an average of (10.27±3.22) months. The operation time was 55 to 90 minutes with an average of (63.33±21.27) minutes. The intraoperative blood loss was 40 to 100 ml with an average of (62.67±19.07) ml. All the surgical incisions were healed during the first stage without wound infection or neurovascular injury. Two slim patients were suffered from the skin irritation respectively caused by the cocked proximal and distal ends of plate. The symptom disappeared after the removal of internal fixator. During the last follow-up, the Constant-Murley score ranged from 80 to 100 points with an average of (90.00±5.98) points. The therapeutic evaluation was conducted based on Lazzcano criteria. Among the patients, there were 20 cases of excellence, 6 cases of good and 2 cases of moderate, and the good and excellent rate was 92.86%. Complications: 1 case of proximal skin irritation and 1 case of distal skin irritation. Conclusions As a new choice for the treatment of comminuted midshaft-clavicular fracture, Nice knot combined with anatomic locking plate can achieve good anatomic reduction, stable internal fixation, high healing rate and less complication. Since the binding of Nice knot plays an important role in maintaining the length of clavicle, satisfactory reduction can improve the trust of patient and family for doctor and reduce the contradiction between doctor and patient. Small suture knot can solve major clinical problem. With its good application value, Nice knot combined with anatomic locking plate is worth of applying clinically in the fixation of clavicle fracture with butterfly fragment. Key words: Nice knot; Anatomic plate; Clavicle; Fracture; Internal fixation

IntroductionMinimally invasive plate osteosynthesis (MIPO) has been reported to be superior to open reduction and internal fixation (ORIF) for the treatment of different long bone fractures. This retrospective study aimed to compare MIPO with the mini-open technique versus conventional ORIF for the treatment of displaced midshaft clavicular fractures. We hypothesized that this technique would improve supraclavicular nerve (SCN) injury-related numbness, decrease surgical incision, blood loss, thick scar, and overall patient satisfaction.MethodsWe retrospectively reviewed 45 cases of displaced midclavicular fractures that were treated surgically at our hospital between December 2020 and June 2022. There were 20 (44.4%) patients using mini-open with MIPO and 25 (55.6%) patients using conventional ORIF treated with anatomical locking plate guided by C-arm X-ray machine. Comparison of surgical indices (operative time, blood loss, incision length, and fluoroscopy exposure times) and postoperative complications (anterior chest wall numbness, area of numbness, superficial infection, hardware irritation, and scar satisfaction) were compared between the two groups. In addition, Disabilities of the Arm, Shoulder and Hand (DASH), Constant–Murley Score (CMS), and overall surgical satisfaction were compared between the two groups.ResultsThe mini-open MIPO group had statistically significant benefits on the basis of surgical length, blood loss, visual analog scale (VAS) score on the first and third postoperative days, and length of hospital stay. Major complications, such as SCN-related numbness, area of numbness, and thick scarring, were greatly reduced. The cosmetic and overall surgical satisfaction was greater in MIPO. Conversely, hardware irritation, surgical infection, and numbness were more frequent in the ORIF group. There were no significant differences in DASH and CMS scores between the groups at the 12-month follow-up.ConclusionsMIPO is a more effective and safer modern surgical method than ORIF for displaced midclavicle fractures. Improvements in operative indices, postoperative numbness owing to SCN injury, surgical incision, and cosmesis satisfaction were achieved.Level of evidenceLevel III, retrospective case–control study.Supplementary informationThe online version contains supplementary material available at 10.1186/s10195-025-00865-8.

Objective To explore the clinical advantages of minimally invasive percutaneous plate osteosynthesis (MIPPO) in the treatment of proximal humerus fractures of Neer typeⅢ andⅣ. Methods From May 2015 to May 2018, 78 cases of proximal humerus fractures of Neer type Ⅲ and Ⅳ were treated with MIPPO and open reduction and internal fixation (ORIF). There were 36 cases in MIPPO group, 20 males and 16 females, including 21 cases of Part Ⅲ fractures and 15 cases of Part Ⅳ fractures; and 42 cases in ORIF group, 24 males and 18 females, including 26 cases of Part Ⅲ fractures and 16 cases of Part Ⅳ fractures. The length of incision, the amount of bleeding, the time of operation, the time of fracture healing, the UCLA score of shoulder joint before and 3, 6 months after operation, the Constant-Murley score of shoulder joint function at 3, 6, 12 months after operation, the classification of joint function at the last follow-up, the axillary nerve injury and other complications were compared. The shoulder joint function of MIPPO group was evaluated after fracture healing. Results All the 78 patients were follow-up for (17.3±2.8) months. The incision length, fracture healing time and intraoperative bleeding in MIPPO group were significantly shorter than those in ORIF group. The UCLA scores of shoulder joint in MIPPO group were 29.04±1.63 and 30.95±1.69 at 3 and 6 months after operation, which were higher than those in ORIF group 22.11±2.33 and 25.96±2.01. The shoulder function Constant-Murley scores of MIPPO group were 55.64±2.83 and 75.01±5.71 at 3 and 6 months after operation, which were higher than those of ORIF group 45.03±6.32 and 64.61±6.77. However, there was no significant difference between the two groups in the shoulder function Constant-Murley score and the last shoulder function grade at 12 months after operation. After fracture healing, the shoulder function of MIPPO group was further evaluated: the average flexion angle was 170.5 ° (ranged, 161° to 180°), the average external rotation angle was 71° (ranged, 63.5° to 83.5°), the average internal rotation angle was 73.6 ° (ranged, 68° to 79°) and the recovery of mobility was good. The complication rate of MIPPO group was 5.56%, which was better than that of ORIF group 11.90% (P<0.05). Conclusion Both MIPPO and ORIF can treat proximal humerus fractures of Neer type Ⅲ and Ⅳ. The former is superior to the latter in incision length, bleeding volume, fracture healing time, shoulder joint function recovery at 3 and 6 months after operation, complications and other aspects, which is worth clinical promotion. Key words: Humeral fractures; Fracture fixation,internal; Axillary nerve injury; Minimal invasive

We consider dual-plate fixation to improve construct rigidity in cases with fracture complexity. The purpose of this study is to compare the rate of nonunion, prognosis, and complications at 6-12 months for surgically treated acute mid-shaft clavicle fractures when extra-periosteal dual-plate fixation is used in place of the conventional single-plate fixation. The comparative study was conducted on 47 patients who received acute mid-shaft clavicular fracture treatment in our hospital from March 2015 to July 2018. All patients were divided into dual-plate fixation treatment (group A) and single-plate fixation (group B). Patients undergoing single-plate fixation were compared to dual-plate fixation. Patients were followed up for 6-12 months. Charts were reviewed to assess union rates, prognosis, and complications. Forty-seven clavicles (30 single plates and 17 dual plates) were evaluated. All patients (100%) in dual plating group and 128 (93.3%) in single plating group obtained bony union by 1 year. When comparing groups at 3 months, radiographic union was present in 50.0% of single plates and 64.7% in the dual plating group (p = 0.032). However, at 6 months, no significant difference existed (90.0% vs. 94.1%, p = 0.297). Comparing groups at 1.5 and 6 months, Constant-Murley outcome scores were present with no significant difference (p = 0.129, p = 0.054) between single plates and dual plating group. However, at 3 months, significance difference existed. Three months after the operation, patients with dual-plate fixation showed good functional recovery. Extra-periosteal dual plating for acute mid-shaft clavicle fractures can be safely considered for the treatment of complex acute mid-shaft clavicle fractures without increasing the risk of nonunion or revision. Open reduction and internal fixation with an extra-periosteal dual plating technique is a reliable option for treatment of acute mid-shaft clavicle fractures, especially in the setting of severely comminuted fractures and in situations where bone quality is questionable and additional fixation is desired.

Objective To compare the clinical effects of closed reduction and intramedullary nailing versus open reduction and plate fixation in the treatment of displaced midshaft clavicular fractures. Methods A prospective, randomized, controlled trial was performed between July 2012 and May 2014 in 194 patients with acute displaced midshaft clavicular fracture. They were 136 males and 58 females, from 16 to 65 years of age. They were randomly divided into 2 groups to received either closed reduction and intramedullary nailing(n= 98)or open reduction and plate fixation(n= 96). We recorded operation time, intraoperative blood loss, hospitalization expenses, fracture healing time and complication rate. Functional assessments were conducted at 3, 6 and 12 months using the Disabilities of the Arm, Shoulder and Hand(DASH)and Constant-Murley scores. The preoperative general data showed no statistical significance between the 2 groups(P> 0. 05). Results All the 194 patients were followed up for 12 to 27 months(average, 15. 6 ±3. 1 months). The operation time(27. 7 ±16. 3 min), intraoperative blood loss(18. 6 ±14. 4 mL), hospitalization expenses(12, 462. 0 ±3, 263. 4 yuan), and fracture healing time(12. 1 ±3. 0 weeks)in the intramedullary nailing group were significantly better than those(62. 3 ±19. 4 min, 40. 3 ±17. 4 mL, 24, 760. 0 ±3, 320. 4 yuan, and 16. 9 ±2. 8 weeks)in the plate fixation group(P 0. 05). The complication rate in the intramedullary nailing group(25.5%, 25/98)was significantly higher than in the plate fixation group(9.4%, 9/96)(P<0. 05). Conclusions In the treatment of displaced midshaft clavicular fractures, compared with open reduction and plate fixation, closed reduction and intramedullary nailing has advantages of less invasion, lower cost and faster fracture healing, but a disadvantage of higher complication rate. The 2 treatments may lead to similar functional recovery of the shoulder. Key words: Clavicle; Fracture fixation, internal; Bone plates; Bone nails

Purpose: The surgical management of periprosthetic femoral fractures is particularly challenging in geriatric patients due to physiological limitations. The choice between open reduction and internal fixation (ORIF) and hip revision arthroplasty for treating Vancouver B2 and B3 fractures remains controversial. This study aims to contribute further evidence by analyzing the in-hospital outcomes in geriatric patients with Vancouver B2/3 fractures. Methods: This retrospective study analyzed 133 patients treated for Vancouver B2/3 fractures at a level I trauma center from 2017 to 2023. Data were collected on preclinical characteristics, comorbidities, Vancouver classification, surgery-related parameters, and postoperative outcomes for an age- and gender-matched analysis. A subgroup analysis was also conducted on patients classified as American Society of Anesthesiologists (ASA) class 3 and 4. Results: Among the 133 patients, 85 suffered Vancouver B2 fractures and 48 Vancouver B3 fractures. Age-and-gender-matched analysis revealed that ORIF was more commonly performed in patients with higher ASA grades. A subgroup analysis of ASA 3 and 4 patients and an age-and-gender-matched analysis showed that ORIF resulted in shorter operation times and less blood loss. No significant differences were found in mortality or complication rates. Conclusions: ORIF is associated with shorter operation times, less bleeding, and comparable in-hospital outcomes in treating Vancouver B2/3 fractures in higher-risk geriatric patients compared to revision arthroplasty. The retrospective design and small sample size in the ORIF group are limitations of the study. Further studies with functional evaluation are still required.

This study compared the clinical effectiveness and wound complications of a three-dimensional model-assisted spatial weaving screw fixation (3D-SWSF) versus open reduction and internal fixation (ORIF) via an L-shaped extensile lateral approach for calcaneal fractures. This single-centre retrospective cohort study was conducted with two cohort groups in which patients with Sanders II and III calcaneal fractures underwent 3D-SWSF or conventional ORIF. The clinical outcome measures included operation duration, time to operation, wound complications, blood loss volume, hospital stays, American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score, and visual analog scale (VAS) score. The pre-operative, post-operative, and one-yearfollow-up Gissane's angle (GA), Böhler's angle (BA), height, and width and length of the calcaneal fractures were also compared between the two groups. From Oct 2015 to Oct 2019, 31 patients received 3D-SWSF and 41 received conventional ORIF. A total of 11 (26.8%) patients in ORIF group had wound complications, compared with only two (6.5%) in 3D-SWSF group (p = 0.032). Operative time, blood loss, and hospital stay in 3D-SWSF group were lesser than those in ORIF group. The patients treated with 3D-SWSF had better AOFAS and VAS scores than those treated with ORIF at the last follow-up. The post-operative and one-year follow-up radiographic indexes as well as the GA, BA, length, width, and height of the calcaneal fractures were relatively comparable between the two groups. Our study revealed that 3D-SWSF could effectively decrease the risk of wound complications, shorten operation time, reduce length of hospitalization, and improve post-operative rehabilitation.

IntroductionProximal humeral fractures are common in elderly patients with osteoporosis. Complex three- or four-part fractures often require surgical intervention. Philos locking plates and Multiloc intramedullary nails are widely used, but their comparative effectiveness in osteoporotic elderly patients remains uncertain.MethodsA retrospective study was performed on 90 elderly patients (aged 70–95 years) with Neer three- or four-part proximal humeral fractures treated between January 2021 and December 2023. Patients received either Philos plate fixation (n = 50) or Multiloc intramedullary nail fixation (n = 40). Clinical data included incision length, operative time, blood loss, complications, and functional outcomes. Pain was assessed via VAS, and shoulder function via Constant-Murley scores at 1 week, 1 month, and 12 months postoperatively.ResultsBoth groups achieved fracture healing and functional improvement. Compared to the Philos group, the Multiloc group had shorter incisions, less blood loss, and shorter operative time (all P < 0.05). VAS scores were lower and Constant-Murley scores higher in the Multiloc group at all time points (P < 0.05). Complication rates were lower in the Multiloc group (10% vs. 20%).DiscussionBoth techniques are effective, but Multiloc intramedullary nail fixation offers superior early outcomes and fewer complications. It may be preferable for elderly patients with osteoporotic proximal humeral fractures when proper surgical technique is ensured.

Level II, therapeutic study.