Clavicle Shaft Fractures Research Articles

Comparison of post-operative numbness and patient satisfaction using minimally invasive plate osteosynthesis or open plating for acute displaced clavicular shaft fractures

BackgroundAnterior chest wall numbness after plate fixation of clavicular shaft fractures is a common complication. This is usually related to damage of the branches of the supraclavicular nerve in conventional open plating. We investigated whether the use of minimally invasive plate osteosynthesis could reduce the incidence of post-operative numbness and improve patients' satisfaction compared to open plating. MethodsBetween August 2012 and October 2015, 73 patients with acute clavicle shaft fracture (Robinson classification 2A2-2B2) were treated with plate fixation at our institution. Thirty-eight patients underwent minimally invasive plate osteosynthesis (MIPO), and the other 35 patients received conventional open reduction and internal fixation (ORIF). The incidence of anterior chest wall numbness, numbness area, and patient satisfaction were evaluated at 2 weeks, 3 months and 1 year after the operation by questionnaires. Shoulder joint function was evaluated using the Constant-Murley score and the Disability of the Arm, Shoulder and Hand (DASH) score, and pain was measured using a Visual Analogue Scale (VAS). ResultsThe patients in the MIPO group had a lower incidence and smaller area of anterior chest wall numbness than the ORIF group at each follow-up interval. The patients who underwent MIPO reported higher satisfaction with the operation. There was no significant difference in the Constant-Murley score, DASH score and VAS of the 2 groups at 1-year follow-up. ConclusionThe MIPO technique for clavicle shaft fractures is an effective way to reduce post-operative numbness and improve patients' satisfaction compare to conventional open plating. Surgeons could consider using this technique as an alternative procedure to prevent iatrogenic supraclavicular nerve damage and subsequent anterior chest wall numbness.

Management of Displaced Mid Shaft Clavicle Fractures by Flexible Intramedullary Nail

Management of Displaced Mid Shaft Clavicle Fractures by Flexible Intramedullary Nail

Complications after intramedullary stabilization of clavicle fractures

Operative treatment of clavicle fractures by intramedullary nailing with titanium elastic nailing (TEN) has been established as an alternative to plate osteosynthesis for many years. The main complication after TEN osteosynthesis is nail migration. The goal of this study was evaluation of predictors for medial nail migration and comparison with plate osteosynthesis. A retrospective analysis of electronic patient charts, surgical protocols and radiographs of all operatively treated clavicle shaft fractures between 2010-2014 (n= 141) was performed. When evaluating the patient charts and the surgical protocols special attention was paid to the fracture type, the duration of the operation, the need for an open reduction and the onset of complications as well as the duration until implant removal. Radiographs were analyzed concerning the implant location and an implant migration. Surgery time (39 vs. 83 min) as well as the time to implant removal (226 vs. 495 days) were significantly reduced (p= 0.00), while complication (39% vs. 21.4%) as well as reoperation rates (15% vs. 7.1%; p= 0.033) were increased in TEN compared to plate osteosynthesis. The main complication was medial nail migration. The following predictors regarding medial migration could be identified: open or closed reduction (p= 0.021), multifragmentary fractures (p= 0.049), oblique fractures (p= 0.08) and TEN thickness (33% at 2 mm, 0% at 3 mm). Advantages of TEN are ashorter surgery time as well as ashorter duration until implant removal. The TEN osteosynthesis led to asignificantly increased complication rate, with nail migration representing the major reason. When predictors for medial TEN migration are considered, typeB and Cfractures can also be sufficiently treated by alarge diameter TEN.

Title of the manuscript: study of complications associated with plate fixation of middle one third clavicle shaft fracture

1.1 Background: Both non-operative and surgical methods have been described for the management of this injury. Good outcome with high union rates and low complication rates has been reported with various surgical modalities. However, operative treatment has also got its own disadvantages. 1.2 Aim: To study the complications associated with plate fixation of middle one third clavicle shaft fracture. 1.3 Material and Methods: Thirty cases of mid-shaft clavicle fractures who underwent locking plate fixation were studied for complications and outcome. Those patients who attended regular follow-up and had recorded Constant-Murley Scores (CMS) were included. 1.4 Results: 28 fractures (93.3%) united at or before three months. 6 patients had hypertrophic skin scar and in 5 patients plate prominence occurred out of which one underwent implant removal, delayed union in 2 patients and plate breakage in 1 patient and restricted range of movements in 1 patient.23 (76.6%) had excellent functional outcome. 1.5 Conclusion: The low implant failure rate and complication rate in our study indicates that pre-contoured locking plate fixation is a safe procedure with excellent results in majority of patients.

Supplementary Technique for Unstable Clavicle Shaft Fractures: Interfragmentary Wiring and Temporary Axial K-Wire Pinning.

BackgroundTreatment of unstable clavicle fractures remains a challenge for orthopedic surgeons, but the evolution of treatment strategies has allowed for reliable results with minimal complications. Although several surgical options exist, open reduction with plating remains the treatment of choice for clavicle fractures. The purpose of this study is to determine an easy way to achieve successful preplating reduction while minimizing surrounding soft tissue damage during treatment of midshaft fractures of the clavicle.MethodsA retrospective study included all consecutive adult patients operated on by a single surgeon for acute displaced clavicular midshaft fracture between January 2010 and October 2014. Hybrid technique with interfragmentary cerclage wiring, temporary axial K-wire pinning, or their combination was used in all patients. The demographic data and clinical outcomes, including operation time, union time, restoration of anatomy, shoulder functional score, and complications were evaluated.ResultsThere were 54 male and 19 female patients, with an average age of 39.3 years (range, 18 to 77 years) for males and 58.3 years (range, 39 to 77 years) for females. They were followed up for 24 months (range, 12 to 44 months). All patients had reliable bone union after surgery using interfragmentary cerclage wiring and temporary axial K-wire fixation; fracture union was obtained at an average of 11.7 weeks (range, 8 to 21 weeks) postoperatively. Additionally, there was no postoperative loss of fracture reduction or plate loosening. At the final follow-up, all patients had regained excellent functional outcomes.ConclusionsThe cognizant effort to achieve anatomic reduction without surrounding soft tissue insult before definitive plating allows excellent radiologic and functional outcomes. Interfragmentary cerclage wiring and temporary axial K-wire pinning can overcome difficulties associated with unstable clavicle fractures to allow proper fracture reduction. In this article, we introduce a concise technique for achieving the desired outcomes reliably and efficiently when treating unstable clavicle midshaft fractures.

Usefulness of supraclavicular nerve preservation in surgery of clavicle shaft fractures

Usefulness of supraclavicular nerve preservation in surgery of clavicle shaft fractures

Study of operated fracture mid shaft clavicle

Introduction: It is the study of mid shaft clavicle fracture treated with anatomical locking plates. We wanted to study to study the surgical management and to assess its functional outcome in displaced mid-shaft clavicular fractures. To study the duration of union, complications and compare the results of operated cases with other operative study and conservative study. Materials and Method: The study consist of 100 patients with mid shaft clavicle fracture. We have treated patient with anatomical locking plates. Clinical outcome and function results were evaluated by Constant and Murley scoring system. Result: We have operated total 100 cases with anatomical plate in mid-shaft clavicle fractures. Average union time was 11.7 week. We have achieved 80% of excellent result. Conclusion: Anatomical plate for mid-shaft clavicle fracture are as per shape of the bone. Anatomical reduction is possible and axial alignment and rotational stability is provided. As plates have groove on inner surface so it preserves the periosteal blood supply which will help in faster healing of the bone. Rigid fixation with plate and screws for fresh displaced or comminuted middle third clavicle fracture gives immediate pain relief and prevents the development of shoulder stiffness and non union.

Treatment Trends in Older Adults With Midshaft Clavicle Fractures

We present a retrospective administrative claims database review examining the effect of recent literature supporting surgical clavicle fixation in a primarily young male population, on the treatment of midshaft clavicle fractures in patients older than 65 years. We tested the null hypothesis that there is no change in trends in surgical fixation of midshaft clavicle fractures in patients older than 65 years. Secondary analysis examined overall trends and trends based on sex. Data from 2007 to 2012 were extracted using the Medicare Standard Analytic File and Humana administrative claim databases contained within the PearlDiver Patient Records Database. Patients with clavicle shaft fractures and their treatments were identified by International Classification of Disease, Ninth Revision, and Current Procedural Terminology codes. The primary response variable was the proportion of surgical to nonsurgical cases per year, and explanatory variables included age and sex. Data were analyzed using a trend in proportions test with significance set at P less than .05. A total of 32,929 patients with clavicle shaft fractures were identified. During the study period, the proportion of clavicle shaft fractures treated surgically in patients older than 65 years (2.4%-4.6%) and younger than 65 years (11.2%-16.4%) showed a significant increasing trend. When analyzed by both sex and age, there was also an increasing trend in the proportion of surgically treated males in the older than 65 years (3.3%-6.2%) and the younger than 65 years groups (10.9%-19.5%). Lastly, there was an increase in the proportion of surgically treated females older than 65 years (1.7%-3.4%) and younger than 65 years (12.1%-14.3%). Our analysis demonstrates an overall increase in the proportion of surgically treated clavicle shaft fractures, including in the male and female population older than 65 years. In the setting of an aging population, future research evaluating possible benefits ofsurgical intervention in this population is needed prior to adopting this practice pattern. II.

Functional outcomes following non-operative versus operative treatment of clavicle fractures in adolescents.

PurposeSuperiority of non-operative versus operative treatment of clavicle shaft fractures remains unclear. We aimed to assess shoulder function in adolescents following shortened clavicle fracture and compare operative versus non-operative treatment.MethodsPatients aged 12 to 18 years at the time of fracture and minimum 1.5 years post injury were identified for this institutional review board (IRB)-approved study. For this retrospective cohort study, patients were frequency-matched for age, gender, shortening of the clavicle fracture and activity level. The dominant arm was controlled in the statistical model. Initial radiographs were used to measure clavicle shortening. At follow-up, isokinetic testing of both shoulders was performed in flexion, external rotation and the plane of scapular motion. Maximum number of isotonic repetitions and average isometric torque were recorded, as were ASES and DASH scores. Data were analysed comparing non-operative and operative groups and involved and uninvolved shoulders.ResultsTwenty patients were recruited (18 male, 2 female), with ten in each group. Median clavicle shortening was 17.5 mm (11.4 to 23.6). There was no statistical difference in average ASES (100 vs 99; p = 0.84) or DASH (0.0 vs 1.7; p = 0.08) between non-operative and operative groups, respectively. Results of isokinetic testing comparison between non-operative and operative groups showed no statistical difference for any individual association, controlling for the dominant arm. Among the non-operative group, the involved arm had decreased functional measures compared with the uninvolved arm on all measures, when controlling for dominant arm, and there was increased variability of the functional estimate.ConclusionsThe increased variability in functional measures for the non-operative group suggests some patients may have dysfunction.

Operative versus conservative treatment in displaced mid shaft fractures of clavicle: A retrospective comparative study

Background: Clavicle fractures are common, with an overall incidence of 36.5 – 64 per 100,000 people every year. Traditionally, midshaft clavicle fractures have been treated nonoperatively. Recently, there has been increasing interest in the operative treatment and plate fixation or intramedullary nailing is often the treatment modality of choice. Numerous clinical studies have been published to compare surgical and conservative treatments. The best treatment for displaced midshaft clavicle fractures remains a topic of debate. So We sought to compare patient-oriented outcome and complication rates following nonoperative treatment and those after operative treatment of displaced midshaft clavicular fractures. Objectives: To compare functional outcome and complication rates following nonoperative treatment and those after operative treatment of displaced midshaft clavicular fractures. Materials and Methods: 60 patients with a displaced midshaft fracture of the clavicle who were presented to RL Jalappa Hospital from June 2015 to October 2016 and either treated by conservative or operative methods of treatment and who were in regular follow up are selected. Functional assessment was done at 6 weeks, 3 months and 6 months with use of the Disabilities of the Arm, Shoulder and Hand (DASH) and Constant scores Complications, if any will be recorded. Results: DASH Scores and Constant scores were significantly better in the operative group compared to the conservative group at all time points. Conclusion: Operative treatment resulted in early return to function compared to conservative treatment but at the cost if complications like infection and other hardware related problems.

Management of displaced midshaft clavicle fractures in adolescent patients using intramedullary flexible nails: A case series

IntroductionClavicle fractures are common injuries in adolescent patients. In this study we present our technique and results for treating non-comminuted displaced midshaft clavicle fractures using flexible intra medullary nails. MethodsA retrospective review of prospectively collected data using the electronic medical record was performed. Adolescent patients presenting to a level one pediatric trauma center with acute displaced non comminuted clavicular shaft fractures who were treated with intra medullary flexible nails were included in this study. ResultsSeven adolescent patients with non-comminuted displaced mid shaft clavicle fractures were treated with flexible nails over a period of five and half years with an average follow up time of 10 months. The average age was 14.6 years (range 14–16), and a 2mm nail was used in all cases. Closed reduction was obtained in five cases with only two cases needing open reduction to pass the nail. One patient had skin breakdown over the nail entry and had the nail removed in clinic two months after surgery, all other patients healed with no complication. Sports and full shoulder activity were allowed when radiographic healing was seen at an average 8 weeks. Implant removal was performed four of the seven patients. ConclusionFlexible intramedullary nailing is an effective minimally invasive method for the treatment of displaced midshaft clavicle fractures in the adolescent population. The surgeon should be aware that a 2mm nail is likely the optimal diameter, and the nail is difficult to pass beyond the lateral 2–3cm of the distal segment due to canal narrowing, but passage further than this is not necessary to achieve stability and union. Following these pearls will allow the surgeon to successfully perform the procedure.

Arthroscopic fixation of the clavicle shaft fracture.

This article describes an arthroscopic technique for the fixation of clavicle shaft fractures. A viewing portal is made 2 cm anterior to the fracture site, and a working portal is made 2 cm lateral to the fracture site. The guide wire for a 4.0-mm cannulated screw is inserted through the fracture site to the medial fracture fragment under arthroscopic guidance. Through the medial fragment, the guide wire is delivered through the skin anteriorly. The fracture is reduced, and then, the guide wire is drilled back across the fracture site to the lateral fracture fragment. After confirming the reduction under arthroscopy, the appropriately sized cannulated screw is inserted after reaming. This arthroscopic technique would be useful for the precise reduction and minimal invasive fixation of clavicle shaft fractures. Preliminary results are encouraging, and further studies with long-term follow-up are needed to determine the precise indications and limitations of the procedure.

A Comparison between Minimally Invasive Percutaneous Plate Osteosynthesis and Plate Fixation in the Treatment of Clavicle Midshaft Fracture

Purpose: To retrospectively compare minimally invasive percutaneous plate osteosynthesis (MIPPO) with open plate fixation for the treatment of clavicle midshaft fracture. Materials and Methods: Between November 2011 to May 2014, 40 cases that were followed for more than 1 year–among all cases of MIPPO and open plate fixation–were analyzed. The study population was divided into two groups: group A included 20 cases of MIPPO and group B included 20 open plate fixation cases. The comparative analysis between the two groups was based on the operative time, bone union, functional evaluation (American Shoulder and Elbow Society score), incision length, pain relief (visual analogue scale, VAS), and complication. Results: The bone union was successful for all the cases, and the functional evaluation scores of the shoulder joint were satisfactory for both groups (p＞0.05). The operative time was 47.5 minutes and 58.7 minutes for group A and B, respectively (p＜0.05). The incision length for group A was 6.2 cm and that for group B was 10.7 cm with statistical significance (p＜0.05). Pain relief (VAS) after surgery for group A showed a quick recuperation in the early stages. For complications, there were 2 cases of dysesthesia and 1 case of malunion due to metal fixation failure in group A. There were 6 cases of dysesthesia and 2 cases of cosmetic problem due to hypertrophic scar in group B. Conclusion: Surgical results of clavicle shaft fracture were satisfactory for both groups, but group A had advantages of shorter operative time, minimal incision length, and better pain relief in the early stages compared with group B. However, we need further evaluations with long-term follow-up results and complications, such as malunion and exposure on radiation.

Operative versus conservative management in mid shaft clavicle fracture: A 2 year randomized controlled study

Background: Clavicle fractures are common injuries in active individuals, and it is becoming increasingly apparent that clavicular malunion is a distinct clinical entity with radiographic, orthopedic, neurologic, and cosmetic features. Aims: To analyze the outcome of managements of nonoperative and operative procedures in fracture clavicle. Materials and Methods: This two year randomized controlled trial was conducted in the Department of Orthopaedics of Shri B M Patil medical college from January 2014 to December 2015. After taking institutional ethical clearance and informed consent of the patients. Injuries were classified according to the robinson classification scheme. Patients were treated either conservatively or operatively and followed up at 6 weeks and 3, 6, and 12 months. Results: The mean time for fracture healing was significantly shorter in the operative group (14.6 ± 0.70 weeks) than nonoperative group (22.47 ± 0.74 weeks). The difference is statistically highly significant (P < 0.000). DASH score and Constant Moore Score were significantly better in the operative group. Constant Moore Score was 94.21 in O (OP & ON) and NO was 78.6 and CM SCORE in OP was 96.8 and ON was 91.62Conclusion: Operative fixation of the clavicle fracture results in improved functional outcome, shorter time for union compared with nonoperative treatment at 2 year of follow up and primary operative intervention in clavicle fracture in active adults may be of immense importance.

Plating versus conservative treatment in mid shaft fractures of clavicle: A comparative study.

Mid shaft clavicle fractures have traditionally been treated by conservative means with good outcome. ORIF with plating is an upcoming option to improve outcome further. Aim of this study is to compare the outcome of anterosuperior plating with conservative treatment. The study was conducted over a period of one year, with 50 skeletally mature closed mid shaft fractures included. Alternate patients were operated using a 3.5mm anterosuperior LCP. The functional outcome was evaluated by the Constant and Murley score at the end of 3 months from injury. The fracture union time and associated problems were also compared. In the operative group, 19 patients (76%) had excellent functional outcome, 4 patients (16%) had good functional outcome and 2 patients (8%) had fair functional outcome. In the operated group, 2 patients (8%) had hypertrophic skin scar and in 2 patients (8%) plate prominence occurred. In 1 patient (4%), infection (superficial) occurred. In 1 patient (4%), plate loosening occurred. In 2 patients (8%), delayed union occurred which went for malunion and in 1 patient (4%), plate breakage occurred. In the non-operative group, 7 patients (28%) had good functional outcome, 8 patients (32%) had fair functional outcome and 10 patients (40%) had poor functional outcome. In this study, early primary plate fixation of comminuted mid shaft clavicular fractures results in improved patient-oriented outcomes, improved surgeon-oriented outcomes, earlier return to function and decreased rates of non-union and malunion.

Plating: A Rational Option for Mid Shaft Clavicle Fractures

Fractures of clavicle is one of the most common injuries of human skeleton. It has been traditionally treated non-operatively but the recent trend is shifting towards internal fixation because of the high complication rates and poor functional outcome with cosmetic deformity. The present study is undertaken to study the role of surgical management and assess its functional outcome in fresh displaced mid shaft clavicle fractures from August 2013 to July 2015. A total of 40 patients with displaced mid shaft clavicle fractures were included in the study. Patients were between the age group of 19 to 55 years with 30 male and 10 females. Fractures were classified according to Robinson's classification. Functional Outcome was evaluated according to the 100-point scoring system of CONSTANT AND MURLEY. Excellent results were noted in 75%, good for 20%, fair for 5%. We encourage plating as a one of the method of fixation of clavicle fractures, because stable fixation in middle third clavicle fractures performed carefully is safe and effective treatment method to gives immediate pain relief and restore normal shoulder function with minimal complication.

Finite element analysis of locking plate and two types of intramedullary nails for treating mid-shaft clavicle fractures

BackgroundBoth plate and intramedullary nail fixations, including straight and anatomic nails, have been clinically adopted for the treatment of displaced mid-shaft clavicle fractures. However, the biomechanical performances of these fixations and implants have not been well evaluated. This study aims to compare the construct stability, stress distribution and fracture micro-motion of three fixations based on finite element (FE) method. MethodsThe FE model of clavicle was reconstructed from CT images of a male volunteer. A mid-shaft fracture gap was created in the intact clavicle. Three fixation styles were simulated including locking plate (LP), anatomic intramedullary nail (CRx), and straight intramedullary nail (RCP). Two loading scenarios (axial compression and inferior bending) were applied at the distal end of the clavicle to simulate arm abduction, while the sternal end was fixed. ResultsUnder both conditions, the LP was the stiffest, followed by the CRx, and the RCP was the weakest. LP also displayed a more evenly stress distribution for both implant and bone. RCP had a higher stress compared with CRx in both conditions. Moreover, all implants sustained higher stress level under the loading condition of bending than compression. ConclusionsThe plate fixation significantly stabilizes the fracture gap, reduces the implant stress, and serves as the recommended fixation for the mid-shaft clavicle fracture. The CRx is an alternative device to treat clavicle shaft fracture, but the shoulder excessive activities should be avoided after operation.

Intramedullary Screw Fixation for Clavicle Shaft Fractures: Comparison of the Anterograde versus the Retrograde Technique

Background: The purpose of this study was to investigate the difference between two nailing approaches of intramedullary screw fixa-tion, the retrograde nailing versus the anterograde nailing, on the radiological and clinical outcomes in patients with clavicle shaft fractures.Methods: From April 2002 to August 2014, we enrolled a total of 22 patients with clavicle shaft fractures to participate in this study. Twelve patients received retrograde intramedullary nailing and 10 received anterograde nailing. The average duration of follow-up was 12 months. In all the patients, we took follow-up radiographs of the anteroposterior and the axial views to assess the postoperative ra-diological outcomes. We measured the visual analogue scale (VAS) score, American Shoulder and Elbow Surgeons (ASES) score, and the range of motion (ROM). Results: Clinically, we did not find a statistically significant difference in the retrograde group and the anterograde group in terms of the duration to bone union, the VAS score the ASES score and the ROMs. Radiologically, we found that the difference in the clavicle short-ening of the affected arm and the unaffected arm did not show a statistically significant difference at the immediate postopera- tive assessment. we found that the difference in the clavicle shortening of the affected arm between the immediate postoperative and the final follow-up value did not show a statistically significant difference. Conclusions: We found that both the retrograde nailing and the anterograde nailing gave a favorable outcome for clavicle shaft frac-tures. Although we saw evidence of clavicle shortening after intramedullary screw fixation, this was not a factor that influenced clinical outcome.(Clin Shoulder Elbow 2016;19(1):8-14)Key Words: Fracture; Clavicle; Anterograde; Retrograde

A Novel Intramedullary Locked Fixation Device for Treatment of Clavicle Shaft Fractures.

An intramedullary nail (the Sonoma CRx) with a unique flexible anatomical design and locking system is a viable alternative for treatment of displaced and shortened clavicle shaft fractures. Place the patient in the beach-chair position and drape the arm free so that you can obtain an exaggerated anteroposterior and an axial fluoroscopic view of the clavicle by manipulating the position of the arm. The surgical technique necessitates opening the fracture site in order to implant the device. The preparation of the medial fragment is of utmost importance as the intramedullary Sonoma CRx nail should be placed as far as possible into the medial fragment of the clavicle, to provide the highest level of stability and the lowest risk of device failure. Preparation of the lateral fragment is more challenging than preparation of the medial fragment because of its relative immobility and shorter medullary canal. Use the longest possible intramedullary nail that the clavicle can accommodate and insert the nail as far medially as possible into the medullary canal of the clavicle bone. Lock the device at its medial end with distally deployed grippers and laterally with a locking screw placed through a jig. Comminuted fractures are not a contraindication to the use of the intramedullary device as they can be reduced by the nail and secured by using cerclage sutures. Protect the affected shoulder in a shoulder immobilizer for six weeks. In our original study, forty-seven consecutive patients with a displaced and shortened clavicle shaft fracture were treated with open reduction and internal fixation using the Sonoma CRx device.

Use of Composite Wiring on Surgical Treatments of Clavicle Shaft Fractures

Use of Composite Wiring on Surgical Treatments of Clavicle Shaft Fractures