Acute Midshaft Clavicular Fractures Research Articles

New interlocking intramedullary nail for treating acute midshaft clavicular fractures in adults: A retrospective study.

The aim of this study was to retrospectively examine the radiological and functional results of midshaft clavicle fractures that were treated with a new, interlocking intramedullary nail, and employing a different locking option. Between January 2018 and January 2020, 24 displaced midshaft clavicle fractures were operated with new, interlocking intramedullary nail. Fractures were classified according to the AO/orthopedic trauma association classification, according to which there were 22 15.2.B (wedge) and 2 15.2.C (comminuted) fractures. The mean patient age was 35.5±14.2 (range: 18-63) years. Eighteen (75%) of the patients were male and six (25%) were female. Follow-up data were recorded at a minimum of 1 year (range 12-36 months), with an average of 21.5 months (SD±8). The mean interval between the injury and surgery was 4.1 (SD±2.3; range: 1-9) days. Full shoulder movements had been achieved by all patients, relative to the contralateral side. The mean constant score was 95.6 (SD±4.2; range 90-100), and the mean visual analog scale score was 0.8 (SD±0.8; range: 0-3). Union was achieved in all patients. The mean union time was 9.5 (SD±1.8; range 6-12) weeks as assessed by radiograph. Average shortening of the clavicle relative to the contralateral side was 3.4% (SD±1.1; range 1.1-6.3). One patient experienced implant irritation, implant removal was performed after 14 months. No implant migration, hardware loosening, implant breakage, or neurovascular damage occurred. One hypertrophic scarring developed. One wound detachment developed at the 3rd post-operative week. We think that this new intramedullary nail is a good alternative for wedge type fractures in adult, acute, displaced, and midshaft clavicle fractures.

Minimally invasive plate osteosynthesis in midshaft clavicular fracture in adults

Background Clavicle fractures are common injuries in adults, accounting for 5–12% of all fractures and 44% of all shoulder fractures. Fracture of the middle third is the most common fracture in both children and adults. It is ∼80% of clavicle fractures; proximal and distal segments are secured by ligamentous and muscular attachments. Poor outcomes from conservative treatment, including nonunion, malunion, or shortening of the clavicle in displaced or comminuted fractures, have prompted a shift in treatment to surgery. There has been a trend toward operative treatment of clavicle midshaft fractures. There are various methods for treating clavicle midshaft fractures, such as intramedullary K-wires or elastic stable intramedullary nailing and plate fixation. Minimally invasive percutaneous plate osteosynthesis technique may be a good alternative as it has been proven in other long bones. Objective This study is performed to address the technique of percutaneous plating and to evaluate the radiographic and clinical outcomes in midshaft fractures of the clavicle in adults treated with minimally invasive plate osteosynthesis (MIPO). Patients and methods From December 2015 to November 2017, this prospective case series study was done at Al Azhar University Hospitals. In our study, we present the outcomes of 17 patients (12 men and five women) with acute midshaft clavicular fractures who were treated with the MIPO technique with 3.5-mm superior reconstruction plates. The patients had a mean age of 27.76 years (range, 16–45 years). The left arm was affected in nine patients the right arm in eight patients. The fractures were classified using the Robinson classification system: 10 were type 2B1 and seven were type 2B2. Results Fracture union was obtained in all patients at a mean of 11.35±1.90 weeks (range, 8–15 weeks). No delayed unions or nonunions were observed. There were no major complications such as infections, plate breakages, or neurovascular injuries. All of the patients obtained satisfactory shoulder functions. The mean Constant score was 97.47±2.45 (range, 93–100), and the mean Disability of the Arm, Shoulder, and Hand score was 1.29±1.93 (range, 0–5) at the last control visit. Conclusion This study demonstrated that the MIPO procedure that uses superior 3.5-mm reconstruction plates for midshaft clavicular fractures can be a reproducible procedure and an alternative to conventional operative methods. In addition, satisfactory clinical and radiologic outcomes were obtained without serious complications. This technique can provide excellent biological healing and optimal stabilization strength. Level of evidence Level IV, case series, treatment study.

Minimally invasive plate osteosynthesis for midshaft clavicular fractures using superior anatomic plating

The minimally invasive plate osteosynthesis procedure has been widely applied for long-bone fixations; however, this technique is not commonly used for clavicular midshaft fractures. In this study, we introduced this technique for midshaft clavicular fractures using superior anatomic locking plates and evaluated its clinical and radiographic outcomes. From June 2013 to July 2014, 15 patients with acute midshaft clavicular fractures were treated with the minimally invasive plate osteosynthesis technique using a 3.5-mm clavicular superior anatomic locking plate. Anteroposterior plain X-ray images of the clavicle were taken at 4-week intervals until union was observed. The last clinical follow-up assessments were performed postoperatively at a mean of 16.54 months (range, 10-23 months). In addition, for clinical evaluations, the Constant score and the Disability of the Arm, Shoulder and Hand score were assessed. The average operative time was 60.2 ± 20.1 minutes (range, 40-80 minutes), with blood loss of 25 ± 5 mL (range, 20-30 mL) during the operation. The mean union time for the patients was 10.1 ± 1.4 weeks (range, 8-12 weeks), and no delayed union or nonunion was observed. There were no major complications, including infections, plate breakages, or neurovascular injuries. No skin irritation was observed, and only 2 patients felt local incision numbness. All patients obtained satisfactory shoulder functions. The mean Constant score was 99 ± 1.8 (range, 95-100), and the mean Disability of the Arm, Shoulder and Hand score was 3.8 ± 2.9 (range, 0-10) at the last control visit. The minimally invasive plate osteosynthesis procedure that was introduced in this study for midshaft clavicular fractures with superior anatomic locking plate is a reproducible procedure and an alternative to conventional operative methods.

Additional x-ray views increase decision to treat clavicular fractures surgically

The trauma series for clavicular fractures includes anterior-posterior and 20° cephalic tilt radiographs. Management of clavicular fractures either nonoperatively or operatively is dependent on radiographs. We hypothesized that the interobserver and intraobserver reliability of the treatment decision would be improved with a novel 4-view radiographic series over the standard 2-view radiographic trauma series. Four-view radiographic analysis was performed and consisted of anterior-posterior, 20° cephalic tilt, 45° cephalic tilt, and 45° caudal tilt. Radiographs were collected for 50 consecutive patients presenting with acute midshaft clavicular fractures. Four blinded orthopedists were asked to judge whether each case should be treated either operatively or nonoperatively based on the standard 2-view series and then the 4-view series a minimum of 1 week later. This procedure was repeated a minimum of 2 months later. The incidence of surgeon treatment modification was analyzed along with interobserver and intraobserver reliability of both series. In 17 cases, at least 1 surgeon changed the treatment decision between 2- and 4-view review. In 13 cases (26%), the treatment was changed from nonoperative to operative. Significantly greater intraobserver reliability was observed for the 4- versus 2-view series (R = 0.76 and R = 0.64, respectively), with no difference in interobserver reliability (intraclass correlation coefficient of 0.88 and 0.87, respectively). With the use of a novel 4-view radiographic series that includes orthogonal viewing angles, surgeons are more likely to treat clavicular fractures operatively and their intraobserver reliability is improved, suggesting improved visualization of anterior-posterior displacement.

Acute midshaft clavicular fractures——Intramedullary fixation versus nonoperative treatment

Limited evidence from one small retrospective cohort study and 13 case series suggest little difference in union rates and healing time between treatment with intramedullary (IM) fixation and nonoperative treatment.Pooled estimates combining all studies may suggest improved shoulder function with IM fixation. Methodologically rigorous comparative studies with adequate power are needed to effectively compare IM fixation and nonoperative treatment. 从一项小规模的回顾性队列研究和13项病例分析中得到有限证据认为,急性锁骨中段骨折不论是采用髓内固定还是非手术治疗,骨折的愈合率和恢复时间在两种治疗方法间无差别.结合上述所有研究计算合并后发现采用髓内固定治疗可有效提高肩关节的功能恢复.要更好的比较两种治疗方法间的差异则需要采用方法严格的大样本对照试验来验证.……

Acute Midshaft Clavicular Fracture

Clavicular fractures represent 2.6% to 5% of all fractures, and middle third fractures account for 69% to 82% of fractures of the clavicle. The junction of the outer and middle third is the thinnest part of the bone and is the only area not protected by or reinforced with muscle and ligamentous attachments. These anatomic features make it prone to fracture, particularly with a fall on the point of the shoulder, which results in an axial load to the clavicle. Optimal treatment of nondisplaced or minimally displaced midshaft fracture is with a sling or figure-of-8 dressing; the nonunion rate is very low. However, when midshaft clavicular fractures are completely displaced or comminuted, and when they occur in elderly patients or females, the risk of nonunion, cosmetic deformity, and poor outcome may be markedly higher. Thus, some surgeons propose surgical stabilization of a complex midshaft clavicular fracture with either plate-and-screw fixation or intramedullary devices. Further randomized, prospective trials are needed to provide better data on which to base treatment decisions.

Closed Reduction and Internal Fixation for Acute Midshaft Clavicular Fractures Using Cannulated Screws

Although most acute midshaft clavicular fractures can be successfully treated nonsurgically, surgery is more appropriate for cases with severe displaced fractures, skin tenting, initial shortening of fracture ends, and associated with multiple injuries. However, methods of surgical treatment for such fractures remain controversial. This study discusses a closed reduction and internal fixation technique for midshaft clavicular fracture. Between 2000 through 2003, 34 acute midshaft clavicular fractures were operatively treated with cannulated screws using closed reduction technique by one surgeon. The follow-up and clinical evaluation was performed by another surgeon. Thirty-one patients were followed for an average of 27.4 months (range, 24-37 months). Thirty (96.8%) fractures healed within 12 weeks, and one fracture healed at 18 weeks. No major surgical complications occurred, although superficial wound infection occurred in one patient. No implants needed to be removed. The final union rate was 100%. Closed reduction and internal fixation with cannulated screw is an alternative choice for treating acute midshaft clavicular fracture in selected cases where surgery is indicated and should be done cautiously.