Clavicle Shaft Fractures Research Articles

Outcome of surgical management of clavicle shaft fracture in adult

Outcome of surgical management of clavicle shaft fracture in adult

Surgical access route and choice of implant in the region of the clavicle shaft

Clavicle fractures are among the most frequent injuries of the shoulder girdle. Nondisplaced fractures are generally treated conservatively, whereas dislocated fractures require surgical reduction and stabilization. A variety of implants and surgical techniques with reliable results are available. While all techniques provide similar healing rates, they share acommon disadvantage with the high incidence of implant irritation and correspondingly high rates of second interventions for material removal. The various surgical techniques for clavicle shaft fractures with their specific areas of application as well as advantages and disadvantages are presented. This review also provides an aid for deciding which surgical technique is most appropriate based on the fracture morphology. Furthermore, an overview of current research activities is presented, with aspecific focus on new implants which could help to reduce implant irritation. Open superior and anteroinferior plate osteosyntheses each show similar reliable results. The minimally invasive plate osteosynthesis (MIPO) technique offers an alternative for multifragmented fractures as it has alower complication rate compared to the open procedure. Double plate osteosynthesis using minifragment plates shows promising results with respect to the incidence of implant-related irritation. Larger prospective studies are still pending. Intramedullary nailing offers agood alternative, especially if material removal is planned anyway, e.g., in the pediatric setting.

New Generation Superior Single Plating versus Low-Profile Dual Mini-Fragment Plating of Diaphyseal Clavicle Fractures - A Biomechanical Study

Abstract Background Recently, a new generation of superior clavicle plates was developed featuring the variable-angle locking technology for enhanced screw positioning and optimized plate-to-bone fit design. On the other hand, mini-fragment plates used in dual plating mode have demonstrated promising clinical results. However, these two bone-implant constructs have not been investigated biomechanically in a human cadaveric model. Aims To compare the biomechanical competence of single superior plating using the new generation plate versus dual plating with low-profile mini-fragment plates. Methods Sixteen paired human cadaveric clavicles were assigned pairwise to two groups for instrumentation with either a 2.7 mm Variable Angle Locking Compression Plate placed superiorly (Group 1), or with one 2.5 mm anterior plate combined with one 2.0 mm superior matrix mandible plate (Group 2). An unstable clavicle shaft fracture AO/OTA15.2C was simulated by means of a 5 mm osteotomy gap. All specimens were cyclically tested to failure under craniocaudal cantilever bending, superimposed with bidirectional torsion around the shaft axis and monitored via motion tracking. Results Initial stiffness was significantly higher in Group 2 (9.28±4.40 N/mm) compared to Group 1 (3.68±1.08 N/mm), p=0.003. The amplitudes of interfragmentary motions in terms of craniocaudal and shear displacement, fracture gap opening, and torsion were significantly bigger over the course of 12500 cycles in Group 1 compared to Group 2; p≤0.038. Cycles to 2 mm shear displacement were significantly lower in Group 1 (22792±4346) compared to Group 2 (27437±1877), p=0.047. Conclusion From a biomechanical perspective, low-profile 2.5/2.0 dual plates demonstrated significantly higher initial stiffness, less interfragmentary movements, and higher resistance to failure compared to 2.7 single superior variable-angle locking plates and can therefore be considered as a useful alternative for diaphyseal clavicle fracture fixation especially in unstable fracture configurations.

Usefulness of double plate fixation after failed ORIF for clavicle shaft fracture

PurposeWe aimed to evaluate the clinical and radiological outcomes of double plate fixation for failed clavicle shaft fracture surgery.Materials and methodsWe analyzed 14 patients who underwent double plate fixation due to plate failure after clavicle shaft fracture surgery from March 2016 to March 2021. The study used 3.5 mm locking compression plates for superior clavicle and anterior reconstruction in all patients. In addition, moldable allograft bone was used to fill the bone defect. Clinical and radiological evaluation was performed immediately, at 2 and 4 weeks, and 3, 6, 9, and 12 months postoperatively. The visual analog scale (VAS), University of California at Los Angeles (UCLA) shoulder scale, and American Shoulder and Elbow Surgeons (ASES) scores and range of motion of the shoulder were evaluated as clinical results. For radiological evaluation, anteroposterior, caudal, and cephalad views of both clavicles were used. Successful bone union was defined as complete adjoining of the fracture site through callus formation.ResultsSuccessful bone union was achieved in all patients, and the mean time to bone union was 16.7 ± 1.2 weeks (range, 12–24 weeks).Statistically significant improvement in forward flexion and external and internal rotation was observed from 135.5° ± 6.3, 45.2° ± 5.3, and 13° ± 2.3 preoperatively to 157.0° ± 9.3, 68.7° ± 6.3, and 9.8° ± 3.1 at the final follow-up, respectively.The VAS score improved from an average of 6.2 ± 2.8 preoperatively to 1.3 ± 0.7 at the final follow-up, which was statistically significant (P = 0.018). In addition, the ASES score significantly increased from a mean of 52.1 ± 6.3 points preoperatively to 83.6 ± 7.8 points at the final follow-up (P = 0.001).The average UCLA shoulder score was 16.7 ± 1.4 and 31.4 ± 2.2 points preoperatively and at the final follow-up, respectively, which was statistically significant (P = 0.001).ConclusionDouble plate fixation has shown good results after failed open reduction and internal fixation (ORIF) for clavicle shaft fractures. Therefore, in complicated situations after ORIF, double plate fixation is considered a surgical treatment option.

Reliability of preoperative conventional X-ray diagnostics for multifragmentary midclavicular fractures - a retrospective cohort study.

The aim of this study was to evaluate the reliability of assessing preoperative conventional X-ray diagnostics in determining whether a comminuted clavicle fracture is present. A total of 326 patients with complete clinical and radiological documentation treated for a central clavicle fracture at the author's department between January 1, 2012, and June 30, 2023, were included. Among these, 73 were female, and 253 were male in a mean age of 37.5 ± 17years. On preoperative X-ray images or operation reports, 109 (33%) or 78 (24%) simple and 217 (67%) or 248 (76%) comminuted fractures were identified. Thity-one out of 248 comminuted fractures were only discovered intraoperatively, accounting for 13%. According to the AO classification on preoperative X-ray or operation reports, 109 or 78 fractures were classified as type A (33% or 24%), 51 or 45 as type B (16% or 14%), and 166 or 203 as type C (51% or 62%). For 40 patients, the discrepancy between the preoperative X-ray and the intraoperative fracture type led to a change in the surgical procedure. This represents 12% of the total cohort or 91% of the fractures that were classified differently preoperatively compared to intraoperatively. In these cases, fractures were treated with open reduction and angular stable plate osteosynthesis instead of the preoperatively planned elastic stable intramedullary nailing (ESIN). The results of this study suggest that conventional X-ray diagnostics may not always detect comminuted clavicle shaft fractures. The treating physician should be aware of this issue.

NEW-GENERATION SUPERIOR SINGLE PLATING VERSUS LOW-PROFILE DUAL MINI-FRAGMENT PLATING OF DIAPHYSEAL CLAVICLE FRACTURES: A BIOMECHANICAL STUDY

Recently, a new generation of superior clavicle plates was developed featuring the variable-angle locking technology for enhanced screw positioning and optimized plate-to-bone fit design. On the other hand, mini-fragment plates used in dual plating mode have demonstrated promising clinical results. However, these two bone-implant constructs have not been investigated biomechanically in a human cadaveric model. Therefore, the aim of the current study was to compare the biomechanical competence of single superior plating using the new generation plate versus dual plating with low-profile mini-fragment plates.Sixteen paired human cadaveric clavicles were assigned pairwise to two groups for instrumentation with either a 2.7 mm Variable Angle Locking Compression Plate placed superiorly (Group 1), or with one 2.5 mm anterior plate combined with one 2.0 mm superior matrix mandible plate (Group 2). An unstable clavicle shaft fracture AO/OTA15.2C was simulated by means of a 5 mm osteotomy gap. All specimens were cyclically tested to failure under craniocaudal cantilever bending, superimposed with bidirectional torsion around the shaft axis and monitored via motion tracking.Initial stiffness was significantly higher in Group 2 (9.28±4.40 N/mm) compared to Group 1 (3.68±1.08 N/mm), p=0.003. The amplitudes of interfragmentary motions in terms of craniocaudal and shear displacement, fracture gap opening and torsion were significantly bigger over the course of 12500 cycles in Group 1 compared to Group 2; p≤0.038. Cycles to 2 mm shear displacement were significantly lower in Group 1 (22792±4346) compared to Group 2 (27437±1877), p=0.047.From a biomechanical perspective, low-profile 2.5/2.0 dual plates demonstrated significantly higher initial stiffness, less interfragmentary movements, and higher resistance to failure compared to 2.7 single superior variable-angle locking plates and can therefore be considered as a useful alternative for diaphyseal clavicle fracture fixation especially in unstable fracture configurations.

Which scapula fractures should we operate on and what are the functional outcomes?

Aim: In this study we reported the functional results and complications of patients with scapula fractures who underwent open reduction and internal fixation. Methods: The study included 16 patients with scapula fractures who were treated with open reduction and internal fixation(ORIF) between September 2015 and March 2022. Radiologic examination (AP in the scapular plane, lateral and axillary radiography) and computed tomography (CT) scans were performed in all patients. Fractures were classified according to the revised (AO/OTA) classification system. The patients underwent deltopectoral and posterior approaches described by Judet. Functional outcomes were measured using Constant-Murley scores. Results: Ten patients had a scapular neck fracture, or glenoid fossa fracture, five patients had a scapular trunk fracture affecting the glenohumeral joint, and one patient had a scapula process fracture. It was accompanied by clavicle shaft fracture in five patients. The mean follow-up period after injury was 42 months (6-92 months). The mean Constant-Murley score (CMS) for the shoulder with scapula fracture was 93.8 (±8.93). Conclusion: Open reduction and internal fixation of displaced scapular fractures is an effective treatment option in terms of union rate and functional outcome.

New generation of superior single plating vs. low-profile dual minifragment plating in diaphyseal clavicle fractures: a biomechanical comparative study

Recently, a new generation of superior clavicle plates was developed featuring the variable angle locking technology for enhanced screw positioning and a less prominent and optimized plate-to-bone fit design. On the other hand, mini-fragment plates in dual plating mode have demonstrated promising clinical results. The aim of the current study was to compare the biomechanical competence of single superior plating using the new generation plate versus dual plating using low-profile mini-fragment plates. Sixteen paired human cadaveric clavicles were pairwise assigned to two groups for instrumentation with either a superior 2.7 mm Variable Angle Locking Compression Plate (Group 1), or with one 2.5 mm anterior combined with one 2.0 mm superior matrix mandible plate (Group 2). An unstable clavicle shaft fracture (AO/OTA 15.2C) was simulated by means of a 5mm osteotomy gap. Specimens were cyclically tested to failure under craniocaudal cantilever bending, superimposed with bidirectional torsion around the shaft axis and monitored via motion tracking. Initial construct stiffness was significantly higher in Group 2 (9.28 ± 4.40 N/mm) compared to Group 1 (3.68 ± 1.08 N/mm), p=0.003. The amplitudes of interfragmentary motions in terms of axial and shear displacement, fracture gap opening and torsion, over the course of 12,500 cycles were significantly higher in Group 1 compared to Group 2, p≤0.038. Cycles to 2mm shear displacement were significantly lower in Group 1 (22792 ± 4346) compared to Group 2 (27437 ± 1877), p=0.047. From a biomechanical perspective, low-profile 2.5/2.0 dual plates can be considered as a useful alternative for diaphyseal clavicle fracture fixation especially in less common unstable fracture configurations. 2.7 single superior variable angle locking plates and can therefore be considered as a useful alternative for diaphyseal clavicle fracture fixation especially in less common unstable fracture configurations.

Biomechanical and clinical evaluation of minimal invasive plate osteosynthesis for two-part clavicle shaft fractures

BackgroundMany surgical treatment methods exist for clavicle shaft fractures. A locking compression plate (LCP) fixation with three screws per fracture side is commonly used. For certain fractures a stabilization with 2 screws per side is potentially suitable, offering the advantage of reduced soft tissue approach, while avoiding the disadvantages of minimally-invasive nailing at the same time. This hypothesis was evaluated biomechanically and clinically.MethodsFour treatment procedures were investigated biomechanically using composite human clavicle specimens. A load-to-failure test was performed using a three-point cantilever test. In group 1, a simple shaft fracture was simulated and stabilized with 2 screws per fracture side (5-hole LCP). In the second group 3 screws per side (7-hole LCP) were used. In group 3, a non-reduced fracture zone was simulated and treated with 3 screws per side (7-hole LCP). In group 4, an anatomically reduced fracture zone was simulated and treated with 3 screws per side (7-hole LCP). Furthermore 27 patients treated with a short plate and 2 screws per side (similar to group 1) were assessed after a minimum follow-up of 12 months (Constant and DASH Score).ResultsThe maximum load-to-failure of group 1 was 367N. We observed the highest load-to-failure in group 2 with 497N and the lowest in group 3 with 90N. In group 4 a maximum load-to-failure of 298N could be evaluated. There was no significant difference in load-to-failure between the treatment of a simple clavicle fracture using 5- or 7-hole LCP (p = 0.121). However, we found a significant difference of load-to-failure between the simple and anatomically reduced fracture using a 7-hole plate (p = 0.014). The mean constant score of the surgically treated patients was 95 and the DASH score 3.0. Fracture consolidation was observed in 96.3%.ConclusionsFor certain non-fragmented and well interlocking 2-part fractures, a plate osteosynthesis fixed with only 2 screws per fracture side might offer sufficient biomechanical stability, better soft tissue preservation and comparable fusion rates compared to the operative treatment with 3 screws per side. However, the maximum load-to-failure of the 7-hole LCP was higher than of the 5-hole LCP, but this difference was not statistically significant.Trial registrationApproval from the ethics committee of the Technical University of Dresden was retrospectively obtained (EK 588122019).

LOW-PROFILE DUAL MINI-FRAGMENT PLATING OF DIAPHYSEAL CLAVICLE FRACTURES: A BIOMECHANICAL STUDY

Implant removal after clavicle plating is common. Low-profile dual mini-fragment plate constructs are considered safe for fixation of diaphyseal clavicle fractures. The aim of this study was to investigate: (1) the biomechanical competence of different dual plate designs from stiffness and cycles to failure, and (2) to compare them against 3.5mm single superoanterior plating.Twelve artificial clavicles were assigned to 2 groups and instrumented with titanium matrix mandible plates as follows: group 1 (G1) (2.5mm anterior+2.0mm superior) and group 2 (G2) (2.0mm anterior+2.0mm superior). An unstable clavicle shaft fracture (AO/OTA15.2C) was simulated. Specimens were cyclically tested to failure under craniocaudal cantilever bending, superimposed with torsion around the shaft axis and compared to previous published data of 6 locked superoanterior plates tested under the same conditions (G3).Displacement (mm) after 5000 cycles was highest in G3 (10.7±0.8) followed by G2 (8.5±1.0) and G1 (7.5±1.0), respectively. Both outcomes were significantly higher in G3 as compared to both G1 and G2 (p≤0.027). Cycles to failure were highest in G3 (19536±3586) followed by G1 (15834±3492) and G2 (11104±3177), being significantly higher in G3 compared to G2 (p=0.004). Failure was breakage of one or two plates at the level of the osteotomy in all specimens. One G1 specimen demonstrated failure of the anterior plate. Both plates in other G1 specimens. Majority of G2 had fractures in both plates. No screw pullout or additional clavicle fractures were observed among specimens.Low-profile 2.0/2.0 dual plates demonstrated similar initial stiffness compared to 3.5mm single plates, however, had significantly lower failure endurance. Low-profile 2.5/2.0 dual plates showed significant higher initial stiffness and similar resistance to failure compared to 3.5mm single locked plates and can be considered as a useful alternative for diaphyseal clavicle fracture fixation. These results complement the promising results of several clinical studies.

Less than 1.5 cm shortening in clavicle midshaft fracture has long-term functional impact

IntroductionMediolateral shortening is a risk in treatment of clavicle shaft fracture, and can lead to scapular dyskinesis and shoulder dysfunction. Many studies advocated surgical treatment if shortening exceeds 15mm. HypothesisClavicle shaft shortening of less than 15mm has negative impact on shoulder function at more than 1 year's follow-up. Materials and methodsA retrospective case-control comparative study was performed, with assessment by an independent observer. Clavicle length was measured on frontal radiographs showing both clavicles, and the ratio between the healthy and affected sides was calculated. Functional impact was assessed on Quick-DASH. Scapular dyskinesis was analyzed by global antepulsion on Kibler's classification. In total, 217 files were retrieved for a 6-year period. Clinical assessment was performed for 20 patients managed non-operatively and 20 patients managed by locking plate fixation, at a mean 37.5months’ follow-up (range: 12–69months). ResultsMean Quick-DASH score was significantly higher in the non-operated group: 11.363 [0–50] versus 2.045 [0–11.36] (p=0.0092). Pearson ρ correlation between percentage shortening and Quick-DASH score was −0.3956 [95% CI: −0.6295; −0.0959] (p=0.012). Clavicle length ratio differed significantly between groups: operated group, +2.2% [−5.1%; +17%] for 0.34cm; non-operated group, −8.28% [−17.3%; −0.7%] for 1.38cm (p<0.0001). Shoulder dyskinesis was significantly more frequent non-operated patients: 10 versus 3 (p=0.018). A threshold of 1.3cm shortening was found for functional impact. ConclusionRestoring scapuloclavicular triangle length is an important aim in management of clavicular fracture. Surgery by locking plate fixation is therefore to be recommended in case of>8% radiological shortening (1.3cm) to avoid medium- and long-term complications in shoulder function. Level of evidenceIII; case-control study.

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.

Insertion sites of the muscles attached to the clavicle: a cadaveric study of the clavicle

BackgroundClavicle fractures are common injuries, especially in young, active individuals. Operative treatment is recommended for completely displaced clavicle shaft fractures, and plate fixation is stronger than the use of intramedullary nails. Few studies have reported on iatrogenic injuries to the muscle attached to the clavicle during fracture surgery. The aim of this study was to clarify the area of the insertion sites of muscles attached to the clavicle in Japanese cadavers using gross anatomy and three-dimensional (3D) analysis. We also aimed to compare the effects of anterior plate templating and superior plate templating on clavicle shaft fractures using 3D images.MethodsThirty-eight clavicles from Japanese cadavers were analyzed. We removed all clavicles to identify the insertion sites and measured the size of the insertion area of each muscle. Three-dimensional templating was performed on both the superior and anterior plates of the clavicle using data obtained from computed tomography. The areas covered by these plates on the muscles attached to the clavicle were compared. Histological examination was performed on four randomly selected specimens.ResultsThe sternocleidomastoid muscle was attached proximally and superiorly; the trapezius muscle was attached posteriorly and partly superiorly; and the pectoralis major muscle and deltoid muscles were attached anteriorly and partially superiorly. The non-attachment area was located mainly in the posterosuperior part of the clavicle. It was difficult to distinguish the borders of the periosteum and pectoralis major muscles. The anterior plate covered a significantly broader area (mean 6.94 ± 1.36 cm2) of the muscles attached to the clavicle than did the superior plate (mean 4.11 ± 1.52 cm2) (p < 0.0001). On microscopy, these muscles were inserted directly into the periosteum.ConclusionMost of the pectoralis major and deltoid muscles were attached anteriorly. The non-attachment area was located mainly from the superior to posterior part of the clavicle midshaft. Both macroscopically and microscopically, the boundaries between the periosteum and these muscles were difficult to demarcate. The anterior plate covered a significantly broader area of the muscles attached to the clavicle than that by the superior plate.

Minimally invasive plate osteosynthesis for clavicle fractures.

Treatment of comminuted clavicle shaft fractures with minimally invasive plate osteosynthesis (MIPO). Multifragmentary (≥ 2 intermediate fragments) clavicle shaft fractures with no need for anatomical reduction (AO15.2B and15.2C). Even simple fractures (AO15.2A) with significant soft tissue injuries Tscherne gradeI-III are suitable. Medial or lateral clavicle fractures as well as simple fracture pattern where anatomical reduction is indispensable. Short incision over the medial and lateral end of the main fracture fragments. Either medial or lateral epiperosteal plate insertion. Under image intensifier guidance, the plate is centered either superior or anteroinferior on the clavicle and fixed with acompression wire temporarily (alternatively by acortical screw) in one of the most lateral holes. Fracture reduction (axis, length, and rotation) over the plate and preliminary fixation medially. After correct reduction has been achieved, further cortical screws and/or locking head screws can be inserted (lag before locking screws). Relative stability is achieved by applying abridging technique. No immobilization is needed. Patients are encouraged to perform functional rehabilitation with active and passive physical therapy. Loading is increased according to radiological signs of bony consolidation. In aretrospective evaluation from 2001-2021, 1128 clavicle osteosyntheses were performed, of which 908 (80.5%) were treated with plate osteosynthesis and 220 (19.5%) with titanium elastic nail (TEN). Of the 908 plate osteosyntheses, 43 (4.7%) were performed with the MIPO approach. Finally, 42patients (35men and 7women; mean age of 44 ± 15years) with 43clavicle shaft fractures were analyzed. The operation was accomplished in 63 ± 28 min, and average fluoroscopy time was 45 ± 42 s. Acollective of 27patients could be evaluated after amedian follow-up of 14months (range 1-51months). In all, 26fractures healed in atimely manner. In1patient apseudarthrosis occurred which was treated with re-osteosynthesis and cancellous bone grafting in an open technique. Another patient revealed awound complication with need of operative wound revision 6weeks after the index surgery. Further postoperative course was uneventful in both patients. All were pain-free and able to return to work. After an average of 17 ± 8months, 18hardware removals (66.7%) were performed.

Utility of tens nail and planting for fracture of mid shaft clavicle fracture: A narrative review

Aim: To treat midshaft clavicle fractures using open reduction with internal fixation and titanium elastic nailing system. The purpose of this review article is to narrate various difficulty encountered in patients with midshaft clavicle fracture. Method: An extensive search of all materials related to the topic was done for 25 years in Google Scholar and many more search engines. Overall, 20 articles focusing on the different aspects of mid shaft clavicle were identified and analyzed. Conclusion: As majority of article shows that, treatment of patients with midshaft clavicle fractures with TENS patients had an excellent success, compared with plating. Thus, we concluded that TENS is therefore superior to plating for the treatment of clavicular fractures.

Outcome analysis of plate versus intramedullary devices for mid shaft clavicle fractures

Outcome analysis of plate versus intramedullary devices for mid shaft clavicle fractures

FUNCTIONAL OUTCOME AFTER PLATE FIXATION OF DISPLACED MID SHAFT CLAVICLE FRACTURES

Background: Clavicle fracture is a common injury due to its subcutaneous and relatively anterior position comprising of 2.6% of all fractures. Both non-operative and surgical methods have been described for the management of this injury .However, there is no uniform consensus on the denite choice of treatment. Hence, this prospective study was undertaken to know the functional outcome of displaced mid shaft clavicle after plate xation including rate of union and complications observed. Method: In this study we analysed 24 patients for mid shaft clavicle fracture for a period of 24 months between February 2018 and January 2020 and studied union rate, complications with serial x rays and clinical examination. Result:All patients underwent full history taking, Clinical examination and Radiographic views were taken.The youngest patient was 18 years of age and the oldest patient was 60 years. The average patient age was 30.57 years. 17 patients (73.91%) were males while 6 patients (26.09%) were females. In this study, 16 patients (69.56%) were operated within 2 weeks and 7 patients [30.43 %] were operated between 2 to 4 weeks... Road trafc accident was seen in 16 patients [69.56%], fall on outstretched hand 6 patients [26.08%] had fracture of clavicle due to fall on shoulder from two wheeler and 1 patient (4.35%) had a fall of heavy object on the affected clavicle. The functional outcome is assessed by modied Constant and Murley score. The mean modied Constant Shoulder Score was 65.39 with range 48-72. 17 patients (73.91 %) had very good functional outcome, good functional outcome in 5 patients (21.74 %) and mean in 1 patient (4.35 %) all patients had their fractures united by 12 weeks. Average time to union was 8.68 weeks. In this study 1 patient (4.35%) had plate loosening which required implant removal after union and in 1 patient (4.35%) had plate prominence and in another 1 patient (4.35%) supercial surgical site infection. Conclusion: anatomic reduction with plate xation and early mobilization of displaced clavicle fractures is a viable treatment option, especially in young active adults with good outcomes and no major complications.

Surgical Fixation of Clavicle Shaft Fractures Using Superior Locking Plates With Lateral End Extension: A Retrospective Study.

Background Reports of high rates of non-union with poor functional outcomes following non-operative management of clavicle fractures have resulted in a shift of opinion towards the promising outcomes of surgical fixation. Varied implant choices with varying reports of successand associated complications have resulted in no definitive consensus on the choice of the ideal implant. Materials and Methods This is a retrospective study of clavicle shaft fractures stabilized using a Superior Clavicle Locking plate with lateral extensionin 40 active adult patients, predominantly male, with an average age of 36.7 years. Results Post-operatively, early mobilization was initiatedand on final discharge, there were no complaints of pain. All patients returned to their pre-injury levels of activity by four months, with all having achieved, essentially, a full range of movement by eight weeks post-operatively. Radiological union was observed in all patients by 5 months, except one. The QuickDASH scores of all the patients were less than 25 on discharge. Conclusion When surgical stabilization is considered in the management of active adults with clavicle shaft fractures, the superior clavicle locking plate with lateral extension appears to be a suitable implant by providing stable fixation lateral to the fracture, which is difficult with a regular locking plate.

Two-Year Functional Outcomes of Operative vs Nonoperative Treatment of Completely Displaced Midshaft Clavicle Fractures in Adolescents: Results From the Prospective Multicenter FACTS Study Group

Background: The optimal treatment of midshaft clavicle fractures is controversial. Few previous comparative functional outcome studies have investigated these fractures in adolescents, the most commonly affected epidemiologic subpopulation. Purpose/Hypothesis: The purpose was to prospectively compare the outcomes of operative versus nonoperative treatment in adolescents with completely displaced midshaft clavicle fractures. The study hypothesis was that surgery would yield superior outcomes. Study Design: Cohort study; Level of evidence, 2. Methods: Patients aged 10 to 18 years treated for a midshaft clavicle fracture over a 5-year period at 1 of 8 pediatric centers were prospectively screened, with independent treatment decisions determined by individual musculoskeletal professionals. Demographics, radiographic clinical features, complications, and patient-reported outcomes (PROs) were prospectively recorded for 2 years. Regression and matching techniques were utilized to adjust for potential age- and fracture severity–based confounders for creation of comparable subgroups for analysis. Results: Of 416 adolescents with completely displaced midshaft clavicle fractures, 282 (68) provided 2-year PRO data. Operative patients (n = 88; 31%) demonstrated no difference in sex (78% male) or athletic participation but were older (mean age, 15.2 vs 13.5 years; P < .001), had more comminuted fractures (49.4% vs 26.3%; P < .001), and had greater fracture shortening (25.5 vs 20.7 mm; P < .001) than nonoperative patients (n = 194; 69%). There was no difference in mean PRO scores or rates of “suboptimal” scores (based on threshold values established a priori) between the operative and nonoperative treatment groups (American Shoulder and Elbow Surgeons, 96.8 vs 98.4; shortened version of the Disabilities of the Arm, Shoulder and Hand, 3.0 vs 1.6; EuroQol [EQ] visual analog scale, 93.0 vs 93.9; EQ–5 Dimensions index, 0.96 vs 0.98), even after regression and matching techniques adjusted for confounders. Operative patients had more unexpected subsequent surgery (10.4% vs 1.4%; P = .004) and clinically significant complications (20.8% vs 5.2%; P = .001). Overall, nonunion (0.4%), delayed union (1.9%), symptomatic malunion (0.4%), and refracture (2.6%) were exceedingly rare, with no difference between treatment groups. Conclusion: Surgery demonstrated no benefit in patient-reported quality of life, satisfaction, shoulder-specific function, or prevention of complications after completely displaced clavicle shaft fractures in adolescents at 2 years after injury. Registration: NCT04250415 (ClinicalTrials.gov identifier).

Rates of readmission and reoperation after operative management of midshaft clavicle fractures in adolescents.

The present letter to the editor is a commentary on the study titled “Rates of readmission and reoperation after operative management of midshaft clavicle fractures in adolescents”. There is a debate over whether surgical treatment of clavicle shaft fractures improves clinical outcomes in adolescents. The readmission and reoperation rates following surgery should be identified.