Clavicle Fractures In Adults Research Articles

Functional outcomes of tension band wiring versus hook plating in displaced, closed, and isolated distal clavicle fractures in adults: a comparative retrospective study.

Clavicle fractures are common among young people, generally as a consequence of car accidents, bike falls, and contact sports injuries. 15-20% of all clavicle fractures involve the lateral end of the bone. Thus, the distal clavicle fractures, in particular, have a high non-union rate ranging from 21 to 33% when treated non-operatively, underscoring the usual advice for operative treatment. While significant research has been conducted on clavicle fractures and their treatment options, no definitive guidelines or optimal approaches have been established. Hence, the aim of this study was to assess the clinical and radiological results of the two highly used surgical techniques, Tension Band Wiring (TBW) and Hook plate ones, in addition to investigating the associated functional recovery and outcomes. Between August 2019 and 2022, An analytical retrospective comparative study, was done on 38 patients (20 TBW and 18 Hook plate) diagnosed with unstable fracture of the lateral third of clavicle (Neer 2), aged between 18 and 65 years old, and followed up for more than 12 months. TBW technique was used in 20 patients (14 males and 6 females) with mean age 39.25 years and Hook plate was used in 18 patients (14 males,4 females) with mean age of 43.11 years. The union rate was 100% in Hook plate group and 95% in TBW group. The mean time of bony union to occur was (9.55) weeks in TBW group and (8.94) weeks in Hook plate group. The mean of constant-Murley score in the last follow-up was 85.32 in the TBW group and 87.38 in the Hook plate group. superficial infection occurred in 3 cases in TBW group (15%). Four patients complained of impingement, three patients complained of acromial erosion and one patient complained of acromial osteolysis in the Hook plate group. Both TBW and Hook plate are a good choice for the fixation of displaced distal clavicle fractures with good functional and radiological outcomes, where Hook plate have some advantages such as rigid fixation and early motion of the affected shoulder.

Do We Ever Need to Fix Clavicle Fractures in Adolescents?

Clavicle fractures in adults are increasingly being treated by surgical fixation following reports of symptomatic non-union, malunion and poor functional outcome with conservative treatment. This has led to a similar trend in the management of clavicle fractures in adolescents. This study aims to evaluate the outcome and complications of non-operatively treated clavicle fractures in adolescents. This is a retrospective, single institution study on adolescents aged 13-17 years who sustained a closed, isolated clavicle fracture, between 19972015. Clinical records were reviewed for demographic information, injury mode, time to radiographic fracture union, time to re-attainment of full shoulder range of motion (ROM), and time to return to full activities and sports. Complications and fracture-related issues were recorded. Radiographs were analysed for fracture location, displacement and shortening. A total of 115 patients (98 males, 17 females; mean age:13.9 ± 0.89 years) were included for study. 101 (88%) sustained a middle-third fracture while the remainder sustained a lateral-third fracture. A total of 96 (95%) of the middle-third fractures were displaced, and 12 (86%) of the lateral-third fractures were displaced. All displaced fractures in this study had shortening. Sports-related injuries and falls accounted for 68 (59%) and 34 (30%) of the cases respectively. Overall, the mean time to radiographic fracture union was 7.8 ± 4.35 weeks; there were no cases of non-union. Full shoulder ROM was re-attained in 6.6 ± 3.61 weeks, and full activities and sports was resumed in 11.4 ± 4.69 weeks. There were 5 cases of re-fracture and a single case of intermittent fracture site pain. Clavicle fractures in adolescents can and should be treated non-operatively in the first instance with the expectation of good outcomes in terms of time for fracture union, reattainment of shoulder full range of motion, and return to activities. Surgical stabilisation should be reserved for cases for which there is an absolute indication.

The sternoclavicular joint: a review of anatomy, injury and management

The sternoclavicular joint is the only true joint connecting the upper limb with the axial skeleton and is reliant on its capsular and ligamentous attachments for stability. Injuries to the sternoclavicular joint are uncommon and include sprains, dislocations, and fractures. Dislocations and medial clavicle fractures are often associated with high-energy trauma and can lead to life-threatening complications secondary to mediastinal injuries, particularly with posterior sternoclavicular joint dislocations. Given the rarity of these injuries, there are multiple case reports and retrospective studies detailing novel surgical techniques for managing injuries of the sternoclavicular joint and no single option has been implemented. We conducted a literature search on Medline, EMBASE and CINAHL to identify relevant articles focusing on sternoclavicular joint dislocation and subluxation, and medial clavicle fractures in adults. This review article aims to describe: the anatomy of the sternoclavicular joint; injuries including dislocation and medial clavicle fractures; and current investigation and management options including closed and open reduction techniques.

Comparative Study of Operative and Non-Operatively Treated Displaced Mid-Shaft Clavicle Fractures in Adults

Background: A displaced mid-shaft clavicle fracture in an adult is a break in the collarbone, which is the long bone that runs from the shoulder to the chest. Mid-shaft fractures occur in the middle portion of the collarbone and the displaced fracture means that the broken pieces have moved out of their normal alignment. Study design: It is a comparative study conducted at Orthopedics Department of Pakistan Railway General Hospital, Rawalpindi for the duration of six months from Jan 2022 to June 2022. Material and Methods: The patients who were treated without operation were compared with operative patients for better results. Both groups contained 60 patients. The average age of the patients was 29.9±7.8 in the control group and 32.1±8.1 in the non-operative group. There were 32 and 28 patients in control group that had right and left side of injury respectively. This study was approved by the ethical and the review board committee of the hospital. The data was collected and statistical analysis was performed. Results: The functional outcome of the patients is constant score fracture was calculated and clavicle shortening was carefully observed. The average shortening of clavicle was 0.71±8.1 cm. After a follow-up of 3 months’ clavicle shortening was calculated. The outcome was linked to amount of clavicle shortening among patients Conclusion: The study was done to find the functional outcome of non-operatively treated displaced mid-shaft clavicle fractures in the adult as compared with the operatively treated patients. The results showed that non-operative management of minimally displaced mid shaft clavicle fracture also had good functional outcome. Keywords: Clavicle fracture and the non-operative treatment.

Current concepts in the treatment of midshaft clavicle fractures in adults.

Midshaft clavicle fractures are the most common fracture of the clavicle accounting for 80% of all clavicle fractures. Traditionally, midshaft clavicle fractures are treated with conservative treatment even when prominent displacement is observed; however, recent studies revealed that nonunion or malunion rate may be higher with conservative treatment. Moreover, recent studies have shown better functional results and patient satisfaction with surgical treatment. This review article provides a review of clavicle anatomy, describes the current clavicle fracture classification system, and outlines various treatment options including current surgical options for clavicle fracture in adults.

Operative Versus Nonoperative Treatment of Z-Type Comminuted Clavicle Fractures in Adolescents: A Substratified Cohort Analysis

Purpose: There has been a recent shift towards operative management of mid-shaft clavicle fractures in adults and adolescents. This has been largely based on studies in the adult population that showed reduced rates of nonunion, symptomatic malunion and better short-term functional outcomes. For injuries with a comminuted “Z-type” fracture pattern, characterized by vertical positioning of a segmental fragment, it is commonly accepted to treat surgically due to concerns about healing and bony prominence. The purpose of this study was to assess the clinical, radiographic, and patient-reported outcome measures (PROs) in adolescents with comminuted Z-type mid-shaft clavicle fractures by comparing an operative and nonoperative cohort.
 Methods: Patients aged 10 to 18 years treated for a diaphyseal clavicle fracture between August 2013 and February 2016 at one of eight geographically diverse pediatric centers were screened and enrolled at the time of injury. Inclusion criteria were a comminuted Z-type fragment ≥1cm in size, with >35 degrees of angulation relative to the long axis of the clavicle, and >100% fracture displacement at time of presentation. Clinical course, complications, validated PROs, quality of life metrics, and satisfaction scores were analyzed and compared between the operative (Op) and nonoperative (NonOp) cohorts.
 Results: Eighty-two patients (37 NonOp, 45 Op) were included, 60 (73%) of whom provided 2-year PROs with similar response rates between treatment cohorts. There were no significant differences in demographics or fracture characteristics in the two cohorts other than fracture shortening being greater in the operative cohort (mean 29mm) compared to the nonoperative cohort (mean 23mm, p=0.01). This confounder was controlled for in both regression analysis and propensity score matching. There was no statistically significant difference in the rates of nonunion (none), delayed union (Op 2%, NonOp 0%, p=1.0), symptomatic malunion (Op 0%, NonOp 3%, p=0.4), refracture (Op 4%, NonOp 3%, p=1.0), unexpected surgery (Op 11% vs. NonOp 5%, p=0.45), or clinically significant complications (Op 16%, NonOp 5%, p=0.17) between cohorts. There were no differences in PROs (Table 1), even when controlling for fracture shortening.
 Conclusions: Z-type mid-shaft clavicle fractures are one of the most severe fracture patterns seen in adolescent shoulders. Yet, in this comparative investigation of 2-year PROs and complications, surgery appears to offer no benefit over nonoperative management. 
 Significance: The comparable natural histories between this study’s operative and nonoperative cohorts are critical for surgeons and their adolescent patients to understand when deciding appropriate management, particularly when reviewing what are often very concerning appearing initial radiographs.

Comparison between conservative and surgical management of displaced mid-shaft clavicle fractures in adults

Clavicle fracture is a one of the most frequently fractured bones in the body with an incidence of 2.6-10% of all fractures due to its subcutaneous placement and relatively anterior position. Fractures affecting the middle third account for majority (approximately 80%) of all clavicular fractures and 50% of these are displaced. Both non-operative and surgical methods have been described for the management of clavicular fractures. However, it is not uniformly dictated on which treatment modality to opt for. Hence, this study was done in order to compare conservative approach with open reduction and internal fixation with plate in mid-shaft clavicular fractures in terms of subjective outcome, functional outcome, rates of non-union and mal-union and other local complications. Patients of age between 20-50yrs were allocated into two groups, each including 15 patients on alternate basis. Group 1 patients were managed conservatively, consisting of a figure-of-eight bandage and a sling, whereas patients of group 2 were treated surgically by open reduction & internal fixation with plate & screws. Follow-up examination was done at every 2 weeks for 6 weeks and then 3, 6 and 9 months using patient’s subjective evaluation, functional outcome, radiographic assessment and other complications. The study showed that time to union was significantly shorter in patients treated surgically and this group also showed a favourable Constant shoulder score at all follow-ups. Though there was no statistically significant difference between the groups with regard to complication rate, subjective outcome or functional outcome, the surgical intervention group fared better especially when considering overall outcome results. The present study showed that the time to union was lesser, rate of mal-union and non-union was lower, and Constant shoulder scores were higher in the surgical group. This affirms that while conservative treatment remains the treatment of choice for simple un-displaced mid-shaft clavicle fractures, for displaced and comminuted fractures the surgical intervention gives better outcomes and early functional recovery in young active adults.

Arm Sling Versus Figure of Eight for Treating Midshaft Clavicle Fracture in Adults – A Systematic Review

Introduction: The clavicle is a long, dual-curved bone that forms the only direct link between the axial and appendicular skeletons. Clavicle fracture is the most frequent trauma of the scapular girdle, and involves the midshaft. Although the proportion managed operatively has increased in recent years, the majority (80%) occur at the midshaft are treated non-operatively. Conservative treatments (including figure of eight and arm sling) has a high union rate and good clinical outcome in majority of cases, but very few randomized studies have compared the two. Therefore, a systematic review is needed to compare between arm sling and figure of eight bandage for treat the midshaft clavicle fracture in adults. The author hopes that this systematic review can be the consideration for the better treatment in closed clavicle fracture in adults. Method: The following strategy was used terms on several journals of comparison between arm sling with figure of eight bandage for threatening midshaft clavicle fracture in adults. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to perform the comprehensive data collection. The authors used 5 years publication date and English language to select an appropriate journal. Result: The result is presented by comparison between arm sling and figure of egiht for the treatment outcomes. The author identified 11 relevant articles about comparison between arm sling and figure of eight to treat midshaft clavicle fracture in adults. The total number of patients was 3064 samples. The articles compare about the level of pain by VAS score, level of shortening and mean time of union. Conclusion: The arm sling has better advantages for non-operative treatment to midshaft clavicle fracture in adults than figure of eight bandage. It shows from the level of pain, level of shortening and mean time of union. The arm sling treatment has less level of pain, less level of shortening and less mean time of union than figure of eight bandage.

Arm Sling Versus Figure of Eight for Treating Midshaft Clavicle Fracture in Adults – A Systematic Review

Introduction: The clavicle is a long, dual-curved bone that forms the only direct link between the axial and appendicular skeletons. Clavicle fracture is the most frequent trauma of the scapular girdle, and involves the midshaft. Although the proportion managed operatively has increased in recent years, the majority (80%) occur at the midshaft are treated non-operatively. Conservative treatments (including figure of eight and arm sling) has a high union rate and good clinical outcome in majority of cases, but very few randomized studies have compared the two. Therefore, a systematic review is needed to compare between arm sling and figure of eight bandage for treat the midshaft clavicle fracture in adults. The author hopes that this systematic review can be the consideration for the better treatment in closed clavicle fracture in adults. Method: The following strategy was used terms on several journals of comparison between arm sling with figure of eight bandage for threatening midshaft clavicle fracture in adults. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to perform the comprehensive data collection. The authors used 5 years publication date and English language to select an appropriate journal. Result: The result is presented by comparison between arm sling and figure of egiht for the treatment outcomes. The author identified 11 relevant articles about comparison between arm sling and figure of eight to treat midshaft clavicle fracture in adults. The total number of patients was 3064 samples. The articles compare about the level of pain by VAS score, level of shortening and mean time of union. Conclusion: The arm sling has better advantages for non-operative treatment to midshaft clavicle fracture in adults than figure of eight bandage. It shows from the level of pain, level of shortening and mean time of union. The arm sling treatment has less level of pain, less level of shortening and less mean time of union than figure of eight bandage.

A prospective comparative study of functional outcome in patients treated non-operatively and surgically (by plate osteosynthesis) for mid-shaft clavicle fractures in adults

Clavicle fracture is a common traumatic injury around shoulder girdle due to their subcutaneous position. It is caused by either low-energy or high-energy impact. Fractures of the clavicle have been traditionally treated non-operatively. Although many methods of closed reduction have been described, it is recognized that reduction is practically impossible to maintain and a certain amount of deformity and disability is expected in adults. 30 patients with mid-shaft clavicle fracture were systematically randomized (alternate patient) into either operative treatment with plate fixation or non-operative treatment with clavicle brace and sling. All fractures were classified using Robinson’s classification for clavicle fractures and only Type 2A2 and 2B1 were considered for the study. Patients were followed up at 3wks, 6wks, 3rd month & 6th month. Functional outcomes were assessed according to the Constant and Murley Scoring and radiologically. Maximum number (90%) of patients had Robinson’s Type 2B1 fracture. The mean duration of hospital stay for patients in Group A(operative) and Group B(non operative) was 3.67 ± 0.90 days and 1.73 ± 0.46 days respectively. In Group A, the mean duration of trauma to surgery was 3.13 ± 2.64 days. While the mean operative time was 104.87 ± 13.52 minutes. The duration of union was significantly lesser in Group A as compared to Group B according to Chi-Square test (p0.05). Primary open reduction and internal fixation with pre-contoured clavicle plate for displaced, middle third clavicle fractures provide a more rigid fixation and allows early mobilization whereas conservative treatment require longer periods of immobilization till fracture union. Functional outcomes are better with surgical management of middle third clavicle fractures with pre-contoured locking compression plate. The successful use of locking compression plate for middle third fractures of clavicle requires careful assessment of fracture pattern, patient selection, meticulous operative technique, appropriate choice of fixation, judicious internal fixation, careful post-operative monitoring and aggressive early institution rehabilitation. So, there is need to individualize the treatment as per the need and functional demand of the patient to give the optimum outcome.

Is a figure of eight bandage better than a simple sling for midshaft clavicle fractures in adults?

Is a figure of eight bandage better than a simple sling for midshaft clavicle fractures in adults?

Displaced midshaft clavicle fractures in adults – is non-operative management enough?

IntroductionDisplaced fractures of middle third of clavicle are traditionally managed non-operatively. Recently, the trend is towards surgical management considering functional deficits in some of the non-operatively managed patients. The purpose of the study was to examine the functional outcome of non-operative treatment in these injuries, while identifying the factors responsible for less than ideal outcome and determine the guidelines for patient counselling. Patients and MethodsOne hundred patients with displaced fractures of middle third of clavicle were prospectively evaluated clinico-radiologically for one year from injury. Risk factors for non-union were determined using Fisher's exact test. Logistic regression was used to identify factors contributing to functional outcome. Threshold values for the radiological displacements were estimated with the smooth threshold regression using the logistic transition function. ResultsNinety-four out of 100 fractures united. The factors associated with non-union were: smoking, diabetes and poor soft tissue condition over the fracture. Ninety-two out of 94 patients who had their fractures united achieved “good” (Constant Score above 70) or “very good” (Constant Score above 85) functional outcome at one year, out of which only 49 belonged to “very good” category. The most important factors influencing functional outcome were fracture angulation and clavicular shortening. From the model, it was estimated that with one unit increase in degree of angulation or 1 mm increase in shortening, the odds of scoring above 85 reduces by around 14%. Based on this, an equation and a probability calculator were developed from which the probability of achieving a Constant Score above 85 can be calculated. Threshold analysis yielded 22.8° for angulation and 16.8 mm for shortening at which the probability of achieving “very good” function is only 0.23. ConclusionDisplaced midshaft clavicular fractures with the intent of achieving “good” outcome must be managed non-operatively. If the patient expectation is not to accept even minor functional deficits, the treatment objective must be raised to achieve a minimum Constant score of 86. Substituting the radiological displacements in the equation, the probability of the patient achieving this objective can be calculated. Non-operative management is offered if this probability figure is acceptable to the patient, otherwise counselled for surgery. Non-operatively managed patients with coexisting diabetes, smoking or poor soft tissue condition must be watched for the possibility of going for non-union.

A clinical study on role of surgical management of clavicle fractures in adults

Introduction: Current literature has clearly shown that the indications for surgical treatment of clavicle fractures in adults are expanding. Although clavicle fractures in children and adolescents have traditionally been treated non-operatively, surgical treatment of displaced clavicle fractures may be indicated in adults.Results: Excellent outcomes and rapid return to work can be achieved with surgical management of displaced clavicle fractures in the adults with high functional demands, similar to those of their adult counterparts. Complications include hardware irritation, screw loosening, pin migration, peri-incisional numbness, and refracture. Athletes and families must be counseled regarding complications and potential need for secondary surgery to remove hardware.Conclusion: The patients with a displaced, shortened, or comminuted clavicle fracture presents a unique, controversial dilemma for the surgeon. Earlier return to work, can be achieved with surgical management to restore length and alignment and may prevent malunion, nonunion, and poor outcomes.

Exploring patient satisfaction after operative and nonoperative treatment for midshaft clavicle fractures: a focus group analysis

BackgroundThere is no consensus on the optimal treatment for displaced midshaft clavicle fractures. Several studies indicate superior patient satisfaction in favour of operative reconstruction. It is unknown what drives superior satisfaction in this treatment group. The aim of this study was to explore patient satisfaction and identify contributors to patient satisfaction after operative and nonoperative treatment for displaced midshaft clavicle fractures in adults using a focus group approach.MethodsFour face-to-face and two web-based focus groups were hosted. A total of 24 participants who were treated nonoperatively (n = 14) or operatively (n = 10) agreed to participate. Participants were selected using purposive sampling, ensuring variation in gender, age, treatment complications and outcomes. A question script was developed to systematically explore patient expectations, attitudes and satisfaction with different dimensions of care. All focus groups were voice-recorded and transcribed at verbatim. Thematic analysis was conducted on all face-to-face and web-based transcripts.ResultsThe main emerging themes across treatment groups were; need for more information, functional recovery, speed of recovery and patient-doctor interaction. There was no difference in themes observed between operative and nonoperative focus groups. The lack of information was the most important complaint in dissatisfied patients.ConclusionOur study shows that informing patients about their injury, treatment options and expectations for recovery is paramount for overall patient satisfaction after treatment for a displaced midshaft clavicle fracture.Level of evidenceLevel III, focus group study.

The Clavicle Continues to Grow During Adolescence and Early Adulthood.

As more adults undergo surgical fixation of clavicle fractures with improved outcomes, interest is renewed in managing clavicle fractures in adolescents. The medial clavicular physis does not fuse until 23 to 25years of age, but studies report minimal clavicular growth during adolescence-studies that employed cross-sectional methodologies, which cannot not capture growth in patients over time. The assumption that clavicle length at each stage is uniform, as is the final overall length, may not be accurate if the age groups studied comprise various ethnicities, socioeconomic status, or height. We sought to quantify longitudinal clavicular growth on serial radiographs in adolescents and young adults. Our hypothesis was that substantial clavicular growth would be seen beyond the age of 12 years. We conducted a longitudinal case series of non-syndromic patients in a single orthopedic clinic and analyzed serial radiographic images of the clavicles. For ethical reasons, only patients with non-neuromuscular scoliosis and kyphosis (in whom the existing standard of care includes serial thoracic radiographs) were considered for inclusion. Patients ages 10 to 25years old were included in the study if three or more serial thoracic radiographs over a minimum 5years were available that captured the entire length of at least one non-rotated clavicle. Three types of radiographs were included for analysis: digital low-dose-radiation stereoradiographic (EOS Imaging, Paris, France), non-EOS digital, and non-EOS printed. The overall longitudinal growth, yearly growth, and the yearly growth percentage were calculated for each clavicle. Fifty-seven patients (22 male and 35 female) met the inclusion criteria. In male patients, at ages 12 to 15years, the clavicular growth was 4.9mm/year, or 4%/year; at ages 16 to 19years, growth was 3.2mm/year, or 2.4%/year; and at ages 20 to 25years, growth was 1.7mm/year, or 1.1%/year. In female patients, at ages 12 to 15years, growth was 4.7mm/year, or 4%/year; at 16 to 19years, growth was 2.2mm/year, or 1.7%/year; and at ages 20 to 25years, growth was 0.2mm/year or 0.1%/year. We could not detect the age of terminal growth in either sex because growth was ongoing in most patients in the oldest group. We found substantial clavicular growth potential after age 18years, when growth is thought to be nearly finished, as well as remodeling potential even up to age 25years. Further research is needed, but our findings suggest that strategies for managing clavicle fracture in adults may not be applied universally to adolescents and young adults.

Functional outcomes, union rate, and complications of the Anser Clavicle Pin at 1 year: a novel intramedullary device in managing midshaft clavicle fractures

BackgroundSurgical management of displaced midshaft clavicle fractures in adults leads to better union rates, improved early functional outcomes, and increased patient satisfaction compared with nonoperative treatment. However, both intramedullary fixation and plate osteosynthesis are subject to a specific array of disadvantages and complications. The Anser Clavicle Pin is a novel intramedullary device designed to address these disadvantages and complications. The aim of this study was to evaluate the union rate, functional outcomes, and complications of the Anser Clavicle Pin at 1-year follow-up.MethodsA prospective explorative case series including 20 patients with displaced midshaft clavicle fractures was performed in 2 hospitals. The primary outcomes were union rate, functional outcomes (Constant-Murley score and Disabilities of the Arm, Shoulder and Hand score), and complications. The secondary outcomes were closed reduction rate, operative time, image-intensifier time, hospital stay, incision length, time to radiologic union, postoperative pain reduction, reoperation rate, health-related quality-of-life score, and patient satisfaction.ResultsThere was a 100% union rate. The Constant-Murley score at 1 year was 96.7 (standard deviation [SD], 5). The Disabilities of the Arm, Shoulder and Hand score was 5.1 (SD, 10). There were no infections, neuropathy of the supraclavicular nerve, or hardware irritation requiring removal of hardware. Three device-related complications (15%) occurred, including plastic deformation, protrusion, and hardware failure. The satisfaction score was 8.9 (SD, 1) on the visual analog scale at the 1-year follow-up.ConclusionManaging displaced midshaft clavicle fractures with the Anser Clavicle Pin results in a 100% union rate and excellent functional outcomes and patient satisfaction. It has a low non–device-related complication rate, and the device-related complications that occurred in this series may be prevented in the future.

External Fixation in the Treatment of Displaced Midshaft Clavicle Fractures in Adults: A Retrospective Study

The study aims to compare the clinical outcome of external fixation (EF) and plating fixation (PF) in the treatment of displaced midshaft clavicle fractures in adults. Fifty-nine patients meeting the inclusion criteria were selected; 29 cases of external fixation and 30 cases of open-reduction plate fixation. The average follow-up period was 32 months. Outcomes analysis included: satisfaction with the received treatment, local appearance and shoulder function; residual symptoms; constant shoulder score (CSS); disability of the arm, shoulder and hand score (DASH). 25 cases of EF and all patients in PF group were successfully followed up. No statistically significant differences were observed between two groups in overall satisfaction (P = 0.12), CSS (P = 0.132), DASH (P = 0.113), or healing time (P = 0.086). In the EF group, there was one case of non-union (4%) and three cases of angular deformity. PF group had one case of non-union (3%) and no malunion; hardware irritation and the need for a second surgery were the biggest complications. Compared with PF, EF provided a better treatment overall, with the advantages of simple procedure, no damage to the soft tissue and blood supply, a short healing time, and no second operation.

External Fixation in the Treatment of Displaced Midshaft Clavicle Fractures in Adults: A Retrospective Study

The study aims to compare the clinical outcome of External Fixation (EF) and Plating Fixation (PF) in the treatment of displaced midshaft clavicle fractures in adults. Fifty-nine patients meeting the inclusion criteria were selected; 29 cases of external fixation and 30 cases of open-reduction plate fixation. The average follow-up period was 32 months. Outcomes analysis included: satisfaction with the received treatment, local appearance and shoulder function; residual symptoms; Constant Shoulder Score (CSS); Disability of the Arm, Shoulder and Hand Score (DASH). 25 cases of EF and all patients in PF group were successfully followed up. No statistically significant differences were observed between two groups in overall satisfaction (P=0.12), CSS (P=0.132), DASH (P=0.113), or healing time (P=0.086). In the EF group, there was one case of nonunion (4%) and three cases of angular deformity. PF group had one case of nonunion (3%) and no malunion; hardware irritation and the need for a second surgery were the biggest complications. Compared with PF, EF provided a better treatment overall, with the advantages of simple procedure, no damage to the soft tissue and blood supply, a short healing time, and no second operation.

Complications du traitement chirurgical des fractures distales de la clavicule

IntroductionDistal clavicle fractures have low rates of union when treated with conservative measures. Operative treatment is generally recommended for Neer type II and V. Multiple fixation methods exist with no clear gold standard. The goal of the current study is to assess the outcomes and complications of distal clavicle fractures treated with one of three fixation methods: standard clavicular plate, hook plate, or suture fixation about the coracoid. MethodsThis is a retrospective cohort study of surgically treated unstable Neer type II and V distal clavicle fractures in adults. These operations were performed by multiple surgeons within a single healthcare system between January 2010 and September 2012. Patients were divided into three cohorts: pre-contoured clavicular locking plates, hook plates, and suture-only fixation methods. Univariate and mulivariate modeling analyses were performed. ResultsIn total, 74 distal clavicle fractures comprised the final cohort. Fifty-eight (77%) of these fractures were Neer type II; the remaining 16 (21.6%) were Neer type V. Median follow-up time was 12 months (range 10–28). BMI, smoking status, diabetes, and ASA class were similar among all cohorts. Twenty-one patients were treated with suture fixation alone (28.3%), 37 with a contoured clavicular plate (50%) and 16 with hook-plate fixation (21.6%). Twenty-one patients (28.4%) experienced complications, including two hardware failures requiring revision surgery. In total, 10/16 (62.5%) of patients with hook-plates required hardware removal for irritation, compared to 6/37 (16.2%) with a contoured clavicular plate (OR=8.61, p-value=0.001), and none with sutures alone. In total, 3/21 patients (14.2%) treated with suture fixation methods were diagnosed with adhesive capsulitis post-operatively; no patients in the plate fixation groups received this diagnosis. The Neer V group had a higher proportion of any complications (37.5%) compared to Neer II (25.9%), and a higher rate of stiffness (12.5% v. 1.7% in Neer II). ConclusionThis study compared the outcomes of three different fixation methods for unstable distal clavicle fractures. The overall union rate with any method of operative intervention was very high (98.6%), consistent with previous studies. Hook plates had a much higher re-operation rate, mostly owing to a higher incidence of hardware removal, an expected outcome owing to the prominence of these plates in the subacromial space. Contoured clavicular plates were associated with a lower incidence of irritation and hardware removal than hook plates, although one patient in this group experienced loss of fracture fixation and went on to asymptomatic radiographic nonunion. Suture-only fixation methods had the lowest rate of re-operation, with only one of 21 procedures resulting in failure and requiring revision. However, there was a significantly higher rate of adhesive capsulitis in the suture fixation cohort, perhaps due to the tethering effect of the clavicle to the coracoid or violation of the rotator interval. While this study supports that most distal clavicle fracture fixation methods can achieve stable union, there is a highly variable complication profile associated with each fixation method. The routine use of hook plate fixation cannot be recommended.

Bipolar clavicular fractures and treatment options

IntroductionFractures of the clavicle are common injuries, accounting 2.6–4% of all fractures in adults. Of these fractures, 21–28% are lateral clavicle fractures and 2–3% are medial clavicle fractures. Bipolar clavicle fractures are defined as a lateral and medial fracture and are uncommon. There is no consensus on the treatment of these fractures. The aim of this study is to provide a treatment on bipolar clavicle fractures based on the current literature.MethodsThe electronic databases PubMed, the Cochrane library and EMBASE were searched up on September 25th, 2017. Two reviewers (KR and TG) independently screened titles and abstracts for their relevance. Studies designed to evaluate the outcomes of conservative and/or operative treatment of segmental bipolar clavicle fractures in adults (> 16 years) were included. Editorials and commentaries were excluded, as well as synthetic, cadaveric and animal studies. Primary outcomes considered were pain reduction and shoulder function. Secondary outcomes considered are complications.ResultsTen studies reporting results from ten patients were included for the review. In most patients, if treated operatively, surgical treatment with the use of double plating was performed. Only in elderly patients conservative treatment was adopted. All included patients were pain free and had a full range of motion after 3–6 months. Only two case reports provided a DASH score, while in eight studies no functional outcome score was measured.ConclusionA missed bipolar fracture can complicate the clinical progress. Surgical management of these fractures may be necessary; however, the treatment of choice depends on the age of the patient, daily activities and comorbidity.