Abstract
BackgroundPlate fixation is an established method for treating unstable distal clavicle fractures. However, the appropriate timing of surgery for acute distal clavicle fractures remains unclear. The present study aimed to evaluate the clinical outcomes of osteosynthesis using a Scorpion plate and to assess the influence of surgery timing on the surgical outcomes for acute unstable distal clavicle fractures.MethodsWe retrospectively reviewed 105 patients who underwent fixation for acute unstable distal clavicle fractures (Neer type II and V) using the Scorpion plate between 2008 and 2018. Patients were divided into early (45 patients) and delayed (60 patients) treatment groups based on the timing of the surgical intervention (within or after 7 days). The outcomes were postoperative complications (nonunion, peri-implant fracture, plate loosening, plate-related pain, and stiffness). We evaluated the outcomes from X-ray radiographs and clinical notes.ResultsAmong the 105 patients, nonunion, plate loosening, plate-related pain, and stiffness were observed in six patients (5.7%), four patients (3.8%), seven patients (6.7%), and one patient (1.0%), respectively. The nonunion rate was significantly higher in the delayed treatment group than that in the early treatment group (P = 0.036). Although the difference was not significant, plate loosening and stiffness were only observed in the delayed treatment group.ConclusionOur results demonstrated that osteosynthesis using Scorpion plates achieved satisfactory surgical outcomes for unstable distal clavicle fractures. In addition, this study suggested that performing surgery within 6 days after injury is recommended to reduce postoperative complications.
Highlights
Distal clavicle fractures have a high nonunion risk (22– 50%) in patients treated non-surgically due to the instability caused by the two opposing forces of trapezius traction and the weight of the upper extremity [1,2,3].for unstable distal clavicle fractures classified as Neer type II or V [4, 5], surgical treatment is usually indicated [6]
The proportion of males and additional fixation with Kirschner wire or suture anchor in the Results In this study, there was a significant difference in the time from injury to surgery between the early and delayed groups (P < 0.001), there were no significant differences in age, sex, affected side, smoking rate, type of clavicle fracture, type of plates and additional fixation with a Kirschner Wire or a suture-anchor (Table 1)
Nonunion was only observed in the delayed group, and the frequency of nonunion was significantly higher in the delayed group than that in the early group (P = 0.036)
Summary
Distal clavicle fractures have a high nonunion risk (22– 50%) in patients treated non-surgically due to the instability caused by the two opposing forces of trapezius traction and the weight of the upper extremity [1,2,3].for unstable distal clavicle fractures classified as Neer type II or V [4, 5], surgical treatment is usually indicated [6]. We have used the anatomical nonlocking plates, “SCORPION®” (Fig. 1a and b) and “SCORPION® NEO” (Fig. 2a and b) (Aimedic MMT, Tokyo, Japan), to treat unstable distal clavicle fractures. In fixation with Scorpion plate, the distal bone fragment is grasped by the plate arm and fixed with one or two screws, while the proximal bone fragment is fixed with. Plate fixation is an established method for treating unstable distal clavicle fractures. The appropriate timing of surgery for acute distal clavicle fractures remains unclear. The present study aimed to evaluate the clinical outcomes of osteosynthesis using a Scorpion plate and to assess the influence of surgery timing on the surgical outcomes for acute unstable distal clavicle fractures
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