Clavicle Shaft Fractures Research Articles

Effect of malunited midshaft clavicular fractures on shoulder function.

Background and Purpose. Displaced middle third clavicle fractures are traditionally treated non-operatively and heal with residual deformity. Few studies assessed treatment success by using patient-oriented outcome measures or objective muscle strength testing. The purpose of our study was to determine whether clavicle malunion affects functional results. Methods. Union was documented in 25 patients who were treated conservatively due to a displaced mid shaft clavicle fracture. Ten had significant malunion. Patients were examined at least 12 months following the fracture. Function was assessed by DASH and UCLA questionnaires. Clinical assessment included Range of Motion (ROM) measurement, manual and isokinetic muscle strength testing. Healthy shoulder served as a control. Results. Mean follow up time was 38 months. The mean DASH score was 9, mean UCLA score was 31.7. Range of motion was preserved—less than 6° side-to-side difference. Abduction strength reduction in the involved side amounted to 7%. No correlation was found between radiographic malunion and the functional results. Interpretation. Displaced healed middle clavicle fractures result in satisfactory functional results. The average deficits detected in strength and ROM were within the normal limits compared to the non-injured side. Radiographic healing position had no effect on functional outcome.

Fracture Clavicle with Acromioclavicular Dislocation: A Complex Injury

Isolated injuries of the acromioclavicular joint and clavicle shaft fracture are very common. However, the combination injury of mid-clavicular fracture with acromioclavicular dislocation is very rare. We present a case of fracture of midshaft clavicle with acromioclavicular dislocation treated with contoured clavicular locking plate and Tightrope (Arthrex Inc., Naples, FL, USA) stabilization of the acromioclavicular dislocation.

Does Interfragmentary Cerclage Wire Fixation in Clavicle Shaft Fracture Interfere the Fracture Healing?

138 통신저자:신 용 운 서울시 노원구 상계 7동 761-1 인제대학교 의과대학 상계백병원 정형외과학교실 Tel:02-950-1032ᆞFax:02-934-6342 E-mail:woonysos@hanmail.net 본 논문의 요지는 2009년도 대한정형외과학회 추계학술대회에서 발표되었음. 본 논문은 2009년도 인제대학교 학술연구조성비 보조에 의한 것임. 접수: 2010. 11. 22 심사(수정): 2011. 1. 6 게재확정: 2011. 3. 4 Address reprint requests to:Yong-Woon Shin, M.D. Department of Orthopedic surgery, Sanggye Paik Hospital, Inje University College of Medicine, 761-1, Sanggye 7-dong, Nowon-gu, Seoul 139-707, Korea Tel:82-2-950-1032ᆞFax:82-2-934-6342 E-mail:woonysos@hanmail.net 쇄골 간부 분쇄골절의 수술적 치료 시 환 강선 고정은 골절의 유합을 방해하는가?

Operative Treatment of Completely Displaced Clavicle Shaft Fractures in Children

Journal of Pediatric Orthopaedics: October/November 2010 - Volume 30 - Issue 7 - p 746 doi: 10.1097/BPO.0b013e3181f231fb

Biomechanical Comparison of Contemporary Clavicle Fixation Devices

Because recent studies have shown that malunited or nonunited clavicle fractures treated nonsurgically have poor outcomes, early fixation of certain clavicle shaft fractures using contemporary implants has become more common. Little is known about the physiologic loading of these implants. This study was designed to observe the biomechanical behavior and strength of implants used for fixation of the clavicle shaft. We used synthetic clavicle bones that were produced in 2 pieces to replicate the conditions of a transverse fracture. Ten specimens per group were tested using 3 clavicle fixation constructs: precontoured clavicle plates with unicortical locking, precontoured clavicle plates with bicortical nonlocking screws, and intramedullary Rockwood clavicle pins. Two loading conditions were used: cantilever bending and 3-point bending. For cantilever bending, both plate groups failed by fracture at the most medial screw hole. The pin group was unable to resist the small torque associated with off-axis loading. The pin group failed at a lower maximum load, which occurred with a greater maximum displacement. The pin group was also less stiff than the plate group. In the 3-point bending test, the pin group was significantly more flexible and achieved higher failure loads than the plate groups. There were no significant differences between the unicortical and bicortical screws for any of the measured variables with either loading condition. Both locking and nonlocking constructs appear to provide similar rigid fixation under the tested mechanical conditions. The intramedullary pin can provide high resistance to failure loads in situations when rigidity and rotational stiffness are not required. Intramedullary pin fixation appears to be inadequate where rotational stiffness is required.

Operative Treatment of Clavicle Midshaft Fractures: Comparison between Reconstruction Plate and Reconstruction Locking Compression Plate

BackgroundTo compare the outcomes of reconstruction plate and reconstruction locking compression plate (LCP) for the treatment of clavicle midshaft fractures.MethodsForty one patients with a clavicle midshaft fracture were treated by internal fixation with a reconstruction plate (19 patients) or reconstruction LCP (22 patients). The clinical and radiological results were evaluated according to the Quick Disability of the Arm, Shoulder, and Hand (DASH) score and plain radiographs.ResultsThe mean time to union was 14.6 weeks in the reconstruction plate group compared to 13.2 weeks in the reconstruction LCP group (p > 0.05). The mean score to Quick DASH was 33.85 points in the reconstruction plate group compared to 34.81 points in the reconstruction LCP group (p > 0.05). The complications in the reconstruction plate were hypertrophic scarring in 2 cases, painful shoulder in 2 cases, limitation of shoulder motion in 2 cases, and screw loosening in 3 cases. In addition, the complications in the reconstruction LCP group was hypertrophic scarring in 4 cases, painful shoulder in 1 case and a limitation of shoulder motion in 1case (p > 0.05).ConclusionsThis study showed radiologically and clinically satisfactory results in both groups. Overall, operative treatment with a Reconstruction plate or reconstruction LCP for clavicle shaft fractures can be used to obtain stable fixation.

Operative Treatment of Completely Displaced Clavicle Shaft Fractures in Children

Fractures of the shaft of the clavicle are common in both adults and children. Recent adult studies have indicated that improved outcomes are achieved after open reduction and internal fixation. The purpose of this study was to analyze outcomes after open reduction and internal fixation of displaced clavicle shaft fractures in children. We analyzed a retrospective case series of 24 children whose displaced clavicle shaft fractures were treated through open reduction and internal fixation. Special attention was paid to the rate of healing, radiographic outcomes, functional outcomes, and complications. Twenty-four children with an average age of 12 years and 8 months (range 7 to 16 y) had their closed unilateral clavicle shaft fractures treated via open reduction and internal fixation. Patients were followed for an average of 2 years and 2 months. There were no deep or superficial infections and no nonunions. Eighty-seven percent (21 of 24) of children returned to unrestricted sports activities. Two patients suffered from scar sensitivity and 1 patient experienced a transient ulnar nerve neurapraxia secondary to their initial injury. All fractures healed and all orthopaedic implants were later electively removed. We conclude that open reduction and internal fixation of displaced clavicle shaft fractures in children can be performed safely. Level 4, therapeutic study (retrospective case series).

Postnatal Growth of the Clavicle: Birth to 18 Years of Age

The purpose of our study was to perform a large cross-sectional study aimed at determining the postnatal growth pattern of the clavicle from birth to 18 years of age. We analyzed the digital chest radiographs of a convenience sample of 961 individuals between birth and 18 years of age. Malrotated radiographs were excluded. Right and left clavicle lengths were measured in millimeters from the most lateral ossified border to the most medial ossified border of each clavicle. Study patients were divided into 19 subgroups with the first group being labeled as "birth to 11 months of age" followed by 1-year-olds, 2-year olds, etc. Patients were also grouped by sex. There was a minimum of 25 patients in each group. At 18 years of age the mean+/-SD clavicle length for females was 149+/-12 mm and for males it was 161+/-11 mm. Although a statistically significant difference (P=0.049) was noted between the length of right and left clavicles it was not clinically significant (0.036 mm). A steady growth rate was noted for both genders from birth to the age of 12 years (8.4 mm/y). Above the age of 12 years there were significant differences in the growth of the clavicles of girls (2.6 mm/y) versus boys (5.4 mm/y) (P<0.001). Our data suggest that females achieve 80% of their clavicle length by 9 years of age and boys by 12 years of age. This cross-sectional study establishes that relatively little clavicle growth (20%) remains for girls beyond age 9 years and for boys beyond 12 years. The length of one clavicle may be properly judged by comparing it with the contralateral clavicle. Remodeling of the clavicle shaft fractures is currently believed to be proportional to remaining growth. Our study questions the capacity of the clavicle to re-establish normal length beyond the age thresholds we have identified.

Treatment of mid-shaft clavicle fractures: A comparative study

We retrospectively evaluated 51 patients (17 in each of three groups) with mid shaft clavicle fractures. Group 1 underwent intramedullary stabilization using clavicle pins. Group 2 underwent open reduction and internal fixation using plates and group 3 underwent non operative treatment with a sling. Group1 patients progressed to union within 8 to 12 weeks. In Group 2, six patients had scar related pain and two had prominent metal work and discomfort and in group 3, three patients developed non union and one had symptomatic malunion. Our results suggest that the displaced and shortened midshaft clavicle fractures require operative fixation and the techniques of clavicle pinning resulted in less complications, short hospital stay and good functional outcome.

Low-intensity pulsed ultrasound (LIPUS) in fresh clavicle fractures: A multi-centre double blind randomised controlled trial

Several randomised trials have been published on the effect of low-intensity pulsed ultrasound (LIPUS) on fracture healing in both distal radius and tibia fractures. Most studies showed a positive effect on time to clinical and radiological healing. We hypothesised that LIPUS has a beneficial effect on the healing of fresh clavicle fractures as well and studied its effect in non-operatively treated shaft fractures. We conducted a randomised double blind, placebo-controlled multi-centre trial in 101 adult patients with a non-operatively treated fresh clavicle shaft fracture. Of these patients, 49 used a placebo transducer and 52 patients had an active transducer with ultrasound stimulation (Exogen 2000). Data were analysed on intention to treat basis. Baseline parameters of both groups were not significantly different. There were no differences in time to subjective clinical fracture healing, resumption of daily activities, sports or professional work, Visual Analogue pain Scores (VAS) and use of pain medication. Our findings did not confirm that LIPUS accelerates clinical healing time of fresh clavicle shaft fractures. Level 1 evidence that low-intensity pulsed ultrasound does not accelerate clinical fracture healing in non-operatively treated fresh midshaft clavicle fractures.

Comparison of Results in Two Operative Treatments for Clavicle Shaft Fractures in Adult: Comparison of Results between Open Reduction and Internal Fixation with the Plate and Percutaneous Reduction by Towel Clip and Intramedullary Fixation with Steinmann Pin

Comparison of Results in Two Operative Treatments for Clavicle Shaft Fractures in Adult: Comparison of Results between Open Reduction and Internal Fixation with the Plate and Percutaneous Reduction by Towel Clip and Intramedullary Fixation with Steinmann Pin

A Multicenter Randomized Controlled Trial of Nonoperative and Operative Treatment of Displaced Clavicle Shaft Fractures

Canadian Orthopedic Trauma Society, Royal Columbian Hospital, New Westminster, BC, Canada Canadian Academy of Sport Medicine Annual Scientific Symposium May 10–13, 2006, Edmonton, Alberta, Canada

Operative Treatment with the Reconstruction Plate for the Displaced Clavicle Shaft Fracture of Adults

Operative Treatment with the Reconstruction Plate for the Displaced Clavicle Shaft Fracture of Adults

Operative Treatment of the Displaced Clavicle Shaft Fracture in Adult

Operative Treatment of the Displaced Clavicle Shaft Fracture in Adult