Clavicle Fractures Research Articles

Osteosynthesis using Scorpion plate for neer type V distal clavicle fracture.

Neer type V distal clavicle fractures are considered the most unstable fracture type and are characterized by the disruption of continuity between the coracoclavicular (C-C) ligaments and proximal or distal bone fragments. However, owing to the rarity of such fractures, there is currently no universally accepted surgical procedure for their treatment. Recently, the scorpion plate, an anatomical, non-locking, pre-contoured plate with two grasping arms to fix the distal or inferior clavicular fragments, was introduced. This study aimed to investigate the postoperative functional and radiological outcomes of osteosynthesis using only scorpion plates in Neer type V fractures. We retrospectively identified 23 patients who underwent scorpion plate fixation for Neer type V fractures at two general hospitals. All patients underwent only plate fixation without C-C ligament augmentation. Subsequently, we investigated their postoperative functional outcomes, complication rates, and modified C-C distance ratio at 1 year. The mean postoperative Constant score was 96 ± 5, with all cases achieving bone union. Complications within 1 year postoperatively included plate loosening in one patient (4.3%) and plate irritation in two patients (8.7%). Additionally, the modified C-C distance ratio averaged 114 ± 15%. This study offers novel insights into the management of Neer type V distal clavicle fractures. Our findings indicate that osteosynthesis using only scorpion plates can lead to satisfactory functional outcomes with minimal complications.

Pediatric Orthopaedic Surgeons Manage Pediatric Diaphyseal Clavicle Fractures Differently Than Nonpediatric Orthopaedic Specialists.

Pediatric clavicle fractures are often managed by physicians with and without pediatric subspecialty training. The aim of this study is to identify if variability of practice exists between pediatric orthopaedic surgeons versus nonpediatric orthopaedic specialists during management of pediatric diaphyseal clavicle fractures. Patients ≤18 years of age with an acute, closed diaphyseal clavicle fracture treated between January 2018 and July 2023 by a large hospital-employed multispecialty orthopaedic practice (in a regional and academic health network) were retrospectively reviewed. The study involved 26 orthopaedic surgeons (including 3 pediatric, 8 sports medicine, and 6 general) and 11 nonoperative sports medicine physicians, all of which accept patients ranging 0 to 18 years of age. Exclusion criteria included open or impending open fractures and insufficient data. Demographic, radiographic, and outpatient treatment parameters were recorded. Age groups were separated into <10 and ≥10 years old to control for age-associated differences. Among 560 pediatric clavicle fractures, 385 met inclusion criteria (43.6% of which were treated by a pediatric orthopaedic surgeon), and 361 were treated nonoperatively. Follow-up averaged 48.8 days until orthopaedic discharge and 16.9 months until the most recent well-child visit (80% had a well-child visit after orthopaedic discharge). No patient <10 years of age had elective surgery, but pediatric orthopaedic surgeons demonstrated lower surgical rates in adolescent patients than nonpediatric specialties (4.3% vs. 14.4%, OR=3.8, P=0.027). Among the 169 nonoperative patients <10 years of age, pediatric orthopaedic surgeons completed fewer outpatient visits (2.1±0.8 vs. 2.4±0.8, P<0.037), shorter follow-up durations (28.5±18.9 vs. 41.8±22.6d, P<0.001), less radiographic series (2.1±0.8 vs. 2.4±1.0, P<0.047), and less total radiographs (4.3±1.8 vs. 5.0±2.3, P<0.013) than nonpediatric specialists. The surgical rate of acute, closed diaphyseal clavicle fractures is lower among pediatric versus nonpediatric orthopaedic surgeons in adolescents. During nonoperative management of pediatric clavicle fractures, pediatric orthopaedic surgeons treat young patients (but not adolescents) with less outpatient visits and radiographs than nonpediatric orthopaedic physicians. Level III.

Sectional measurements of shoulder muscle volume and computed tomography density in anterior shoulder instability

In patients with anterior shoulder instability (ASI), a chronic imbalance might exist between the anterior and posterior shoulder muscles (i.e., subscapular [Ssc] vs. infraspinatus and teres minor [Isp + TM]). The balance could be evaluated as the ratio of volume (VR Ssc/Isp+TM) and computed tomography density (CT-DR Ssc/Isp+TM) using a 3D sectional approach. A total of 28 CT images (19 patients) of non-pathological shoulders (clavicular fracture [CF]) and 17 CT images (17 patients) of ASI were used. Segmentation of Ssc and Isp + TM muscles was performed; the reconstructed models were separated by the Y-view plane and the planes situated 2.5 cm and 5 cm medial to the Y-view plane to generate muscle models. VR Ssc/Isp+TM and CT-DR Ssc/Isp+TM were measured in each section of both the groups, as well as in whole muscle measurements in the CF group. VR Ssc/Isp+TM and CT-DR Ssc/Isp+TM obtained through a 3D sectional approach in the CF group were comparable to the whole muscle measurements, with a value of 1.06 for both. In the ASI group, the VR Ssc/Isp+TM was higher, whereas the CT-DR Ssc/Isp+TM was lower than those in the CF group. The VR Ssc/Isp+TM and CT-DR Ssc/Isp+TM appeared to be balanced in the CF group. However an imbalance was observed in the ASI group. Our 3D sectional measurement approach has the potential to assess the balance between the anterior and posterior shoulder muscles in ASI.

Nice knots assistance in comminuted and displaced clavicle fractures reduce intraoperative blood and shorten operation time with a satisfactory postoperative clinical outcome

BackgroundThis study aims to evaluate the efficacy and clinical outcomes of Nice knot-assisted fixation in the management of comminuted and displaced clavicle fractures.MethodsA systematic search was conducted across multiple electronic databases, including PubMed, Embase, Cochrane Library, China Biology Medicine (CBM) database, CNKI, Wanfang, and VIP database, to identify studies comparing Nice knot-assisted fixation with traditional surgical treatment for displaced midshaft clavicle fractures. The primary outcomes assessed included fracture healing times, hospitalization days, complications, and functional outcomes. Secondary outcomes such as intraoperative blood loss, operative time, incision length, and fluoroscopy time were also evaluated. Data were analyzed using random-effects models, and summary statistics including Mean Difference (MD), risk ratios (RRs) and theirs’ 95% confidence intervals (CIs) were calculated.ResultsScreening of the literature yielded a total of 11 studies meeting the inclusion criteria, involving 754 patients. Meta-analysis of the pooled data demonstrated a significant advantage of Nice knot-assisted fixation over traditional surgical treatment in terms of operative time (MD = -11.53, 95% CI: -18.16 to -4.91, p = 0.0006) and blood loss (MD = -14.19, 95% CI: -20.93 to -7.45, p = 0.00001). Additionally, Nice knot-assisted fixation was associated with reduced fracture healing time (MD = -0.63, 95% CI: -1.12 to -0.14, p = 0.01) rather than hospitalization days (MD = -0.47, 95% CI: -1.14 to 0.21, p = 0.18) and complications (RR = 0.48, 95% CI: 0.23 to 1.01, p = 0.05) compared to traditional surgical treatment. Moreover, nice knot-assisted fixation was associated with increased constant-murley score and Neer score, and reduced visual analogue scale (VAS) score compared to traditional surgical treatment.ConclusionThis study highlights that Nice knot assistance offers advantages in reducing intraoperative blood loss, shortening operation time, and achieving favorable postoperative outcomes.

Surgical treatment options of displaced midshaft fractures of the clavicle in young adults: plate fixation versus intramedullary nailing.

This study aimed to compare the outcomes and complications of active young adults undergoing open reduction and plate fixation (ORPF) and intramedullary nailing (IMN) for displaced midshaft clavicle fractures (MCFs). A retrospective review was performed on all patients undergoing ORPF and IMN of complete MCFs at a single center between 2018 and 2022. Patients who were younger than 60 years with radiographic follow-up until union were included in the study. The mean age of the patients was 33.1 years. Outcome measures were achievement of union, time to healing, residual deformity, complications, and need for additional procedures. Of 39 patients, 29 underwent ORPF and 10 underwent IMN. Plate fixation provided faster functional recovery in the first 6 months, but no difference was observed after 1 year. All fractures in the IMN group healed (100%), compared to 90% in the ORPF group (P=0.08). Mean time to union was 21±8.9 weeks and was significantly different between the two groups (P<0.01), with the ORPF group averaging 23.1 weeks and the IMN group 20.8 weeks. Nonunion rates were higher in the ORPF group (10.3%) than in the IMN group (0.0%), but the difference was not significant (P=0.10). Both methods restored patients to their pre-injury functional levels. However, IMN, with its higher healing rate, fewer required revision surgeries, and lower incisional numbness, appears to be the preferred method for treating MSFs without comminution in young adults. Level of evidence: III.

Factors influencing clavicular tunnel widening after single bundle coracoclavicular ligament reconstruction.

The coracoclavicular ligament reconstruction (CLR) technique for the treatment of acromioclavicular joint (ACJ) dislocation has gained immense clinical popularity. However, this technique also has some limitations including complications such as distal clavicle fractures, coracoid fractures, bone tunnel widening, implant failure, and loss of reduction. A study was conducted to analyse the extent of CTW after single-bundle CLR by measuring radiographic parameters to determine its relationship with clinical variables to reduce the risk of clavicular tunnel widening (CTW), thereby providing important insights for clinical practice. This retrospective analysis was conducted at Affiliated Fuyang People's Hospital of Bengbu Medical University, and data from 96 patients who underwent single-bundle CLR for type III-VI ACJ dislocation between January 2018 and December 2023 were initially collected. Finally, 84 patients met the inclusion criteria (63 male and 21 female, mean age: 49.5 ± 12.36 years). The clavicle tunnel (CT) width and coracoclavicular distance (CCD) was measured immediately postoperatively and at 6 months follow up using radiographic imaging, and the degree of expansion at 6 months was recorded. Preoperative variables including patient sex, age, injury cause, injury side, body mass index (BMI), Rockwood classification, extent of the CCD after surgery, and the CT location were recorded to analyze their correlation with the extent of CTW at 6 months follow up. With an average follow-up duration of 10 months (range: 6-18 months). Both the extent of the CCD and CTW measured at 6 months postoperatively were differently enlarged, compared to early postoperative period (EPO) (P < 0.05). The results showed that there were no statistically significant differences in the CTW at 6 months postoperatively with respect to patients' sex, causes of injury, sides of injury, and Rockwood classification types(P > 0.05). However, the location of CT was significantly associated with the extent of CTW at 6 months postoperatively (P < 0.05). The location of CT drilling is a significant factor that affects tunnel widening. When the drilling site is situated closer to the conoid tubercle, the extent of CTW is greater than when the tunnel is located farther from the conoid tubercle.

Kirschner wire intramedullary fixation combined with improved nice knot-end cerclage temporarily fixation-assisted reduction before plate osteosynthesis in treating displaced and comminuted clavicle fractures

Background and objectiveNice knots have been used as an assisted reduction technique in surgery for displaced and comminuted fractures. This study aims to investigate the clinical efficacy of Kirschner wire intramedullary fixation combined with improved Nice knot-end cerclage temporarily fixation-assisted reduction before plate osteosynthesis in treating displaced and comminuted clavicle fractures.MethodsA retrospective study selected 210 patients with comminuted displaced clavicle fractures (January 2017–December 2020) in our hospital. The patients were divided into two groups via the fracture reduction method: the observation group (intramedullary Kirschner’s wire fixation combined with modified Nice node-to-end cerclage temporarily fixation-assisted reduction; n = 42) and the control group (including four subgroups with 42 cases in each subgroup, with assisted reduction methods of clamp fixation, screw fixation, square knot fixation and Kirschner wire fixation; each subgroup n = 42). The operation time, intraoperative bleeding, visual analogue scale (VAS) score at 24 h after the operation, healing time, postoperative limb functional activities, patients’ self-perception, subjective satisfaction and shoulder joint function were compared.ResultsThe operation time and the intraoperative blood loss of the observation group was significantly lower than that of each subgroup in the control group (p < 0.05). The VAS score of the observation group 24 h after the operation was significantly lower than that of each subgroup in the control group apart from the screw fixation group (p < 0.05). The Neer score of the observation group was significantly higher than that of each subgroup in the control group apart from the square knot fixation group (p < 0.05). The square knot is relatively better than the other four methods. Patients were generally satisfied with the modified Nice treatment.ConclusionThe use of a Kirschner wire intramedullary fixation combined with improved Nice knot-end cerclage temporarily fixation-assisted reduction before plate osteosynthesis in treating displaced and comminuted clavicle fractures can achieve satisfactory postoperative clinical results.

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.

Measurement of Clavicular Symmetry: A Hint for Midshaft Clavicular Fracture Management

Measurement of Clavicular Symmetry: A Hint for Midshaft Clavicular Fracture Management

Diagnostic accuracy of point-of-care ultrasound in detecting clavicle fractures

Diagnostic accuracy of point-of-care ultrasound in detecting clavicle fractures

Simultaneous clavicular hook plate fixation in bilateral distal clavicle fractures (Neer type II): A case report.

Bilateral distal clavicle fractures (BDCF) are exceedingly rare types of fractures. This study aimed to evaluate the surgical treatment under a single anesthesia for trauma-induced BDCF (Neer type II) through a case report. The patient brought to the emergency department due to a motor vehicle accident exhibited severe pain, tenderness, swelling, and deformity in both shoulder regions upon physical examination. No significant pain or tenderness was detected in other areas of the body. There were also no signs of additional neurological deficits or vascular pathology in the extremities. Radiographic examinations led to a diagnosis of BDCF (Neer type II). Surgical intervention involved the simultaneous application of a neutral-angled hook plate to both clavicles via open reduction. Postoperative radiographs taken at the 12th week demonstrated complete healing in both fractures and no functional limitations in shoulder movements. BDCF can compromise the stability of the shoulder girdle, necessitating surgical intervention with anatomical reduction and rigid fixation.

Detection of clavicle fracture after martial arts training based on 3D segmentation and multi-perspective fusion

To improve the diagnosis efficiency of clavicle fractures, a Diagnosis Model of Clavicle Fracture Based on 3D Segmentation and Multi Perspective Fusion (3Ds MPF) is proposed in the experiment. By performing 3D segmentation on clavicle images, key layer images are extracted, and multi-perspective image data are fused and output to achieve accurate classification and diagnosis results. The results show that on the relevant dataset, the loss function value of the constructed model is less than 0.01, and the calculation accuracy is as high as 0.999. The average classification accuracy in actual use exceeds 90%, and it can capture the majority of fracture features in clavicle computed tomography images. The above results indicate that the model constructed by the research institute can significantly improve the judgment efficiency of computed tomography images, which helps to enhance the detection and diagnosis of clinical fracture conditions. The experimental results have helped improve the clinical diagnostic efficiency of fracture detection work.

Return to Sport After Conservative Management of Midshaft Clavicle Fractures in Professional Jockeys.

This study explores the functional recovery and rates return to play (RTP) of professional jockeys following midshaft clavicle fractures, which have been managed conservatively. The high incidence of these fractures in horse racing underscores the importance of evaluating nonsurgical recovery paths for effective RTP. We used a retrospective cohort study to assess treatment outcomes. The research is set in the professional horse racing scene of Ireland. Sixteen professional Irish jockeys with conservatively managed midshaft clavicular fractures were examined. Jockeys who underwent surgery or were inactive at injury time were excluded. The study involved no direct interventions. Recovery was assessed using the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score and Patient-Reported Outcome Measures, alongside racing records to track RTP. The all-male cohort had an average age of 27 years. Results showed an average 67.1-day absence from racing, with 94% returning to preinjury competition levels. Complications were minimal, and patient outcomes were positive, as indicated by a mean QuickDASH score of 2.58, suggesting minimal residual disability. Findings highlight the success of conservative management for midshaft clavicle fractures in professional jockeys, enabling them to return to prior competitive levels with few complications and excellent functional recovery.

Treatment of Neer IIb distal clavicular fracture with locking plate under arthroscope

To investigate the feasibility and clinical effect of the treatment of NeerⅡb distal clavicular fracture with locking plate under arthroscopy. Between June 2018 and September 2022, the medical records of 15 patients with NeerⅡb distal clavicular fracture treated with locking plate under arthroscope were retrospectively analyzed, including 9 males and 6 females, aged from 25 to 57 years old with an average of (42.50±7.75) years old, 5 left shoulder, 10 right shoulder, and duration of the disease ranged from 4 to 7 days with an average of (5.16±0.98) d. Visual analog score (VAS), Constant-Murley shoulder joint score scale and Neer standard score were used before operation, 1 month after operation and the last follow-up. All patients successfully completed the treatment of NeerⅡb distal clavicular fracture with locking plate under arthroscopy, with the operation time ranging from 0.3 to1.0 h with an average of (0.55±0.24) h. All patients were healed at stageⅠ. The follow-up time ranged from 6 to 15 months with an average of (9.2±2.8) months. The preoperative VAS score was 7.23±0.67, the Constant-Murley shoulder joint score was (19.57±0.91), and the Neer standard score was (11.27±1.12);The VAS score was (1.56±0.81), the Constant-Murley shoulder joint score was (52.62±1.54), and the Neer standard score was (61.98±2.99) in the first month after operation;At the last follow-up, the VAS was (0.42±0.54), the Constant-Murley shoulder joint score was (91.24±1.97), and the Neer standard score was (93.24±3.38). The difference between VAS, Constant-Murley shoulder joint score and Neer standard score was statistically significant at one month postoperative and preoperative (P<0.05), and the difference between the last follow-up visit and one month postoperative was statistically significant (P<0.05). The treatment of NeerⅡb distal clavicular fracture with locking plate under arthroscope can restore the function of shoulder joint, with definite curative effect and feasibility.

Association of elevated exosomal miR-21 levels with nonunion in clavicular fractures post-ORIF: A prospective analysis

BackgroundThis study investigates the relationship between plasma exosomal miRNAs and nonunion risk following open reduction and internal fixation (ORIF) of clavicle fractures, aiming to identify predictive molecule to enhance patient management and personalized orthopedic care. MethodsConducted as a prospective cohort study at Taian City Central Hospital, participants included individuals with unilateral, closed clavicle fractures who underwent ORIF (n = 763, 546 males and 217 females). Plasma samples were collected preoperatively for exosome isolation and miRNA extraction, specifically analyzing miR-100, miR-124, miR-125b, and miR-21 using quantitative polymerase chain reaction (qPCR). Patients were classified into union and nonunion groups based on follow-up outcomes at a minimum of three months post-surgery. ResultsOut of 763 patients, 720 achieved union while 43 developed nonunion. Notably, the nonunion group exhibited significantly elevated exosomal miR-21 expression levels. Univariate analysis demonstrated a significant association between high miR-21 expression and nonunion occurrence (Relative Risk [RR] = 1.82, P = 0.0004). Multivariate logistic regression analysis corroborated this association (RR > 1.8, P < 0.05), adjusting for covariates. High miR-21 levels (3.12 to 7.89) were robustly associated with nonunion outcomes (RR > 4), independent of other factors. Receiver operating characteristic (ROC) curve analysis indicated certain clinical diagnostic value of miR-21 for predicting nonunion (Area Under the Curve [AUC] = 0.7885). ConclusionsThe elevated preoperative levels of exosomal miR-21 were significantly associated with an increased risk of bone nonunion at three months ORIF in patients with clavicle fractures, indicating that miR-21 holds potential as a non-specific predictive molecule.

Fracture Mapping in High-Energy Chest Trauma

Background: High-energy chest trauma often results in rib fractures and associated chest injuries. This study explored fracture distribution patterns in high-energy chest trauma, using three-dimensional (3D) fracture mapping technology. Methods: This retrospective study analyzed cases of high-energy chest trauma with rib fractures treated at a Level 1 Trauma Center, from February 2012 to January 2023. Specifically, 3D computed tomography (CT) was used to reconstruct rib fractures and create fracture-frequency heat maps, analyzing the influence of other thoracic fractures on rib fracture distribution. Results: Rib fractures were frequently found in the anterior and posterior thoracic areas. On average, patients sustained 7 ± 3.87 rib fractures, with clavicle fractures in 25.5% and scapular fractures in 19.6% of cases. Scapular fractures led to more posterior rib fractures, while sternal fractures were associated with more anterior rib fractures. Clavicle fractures were linked to fractures of the first to third ribs. Conclusions: Rib fractures in high-energy chest trauma occurred most often in the anterior and posterior regions. Fractures of the scapula and sternum influence the positioning of the fracture lines. Clavicular fractures are associated with a higher incidence of upper rib fractures. These findings can help inform surgical decisions and complication management.

Factors associated with neonatal brachial palsy in shoulder dystocia: a longitudinal study.

The main goal is to analyze factors related to brachial plexus injury (BPI) after Shoulder Dystocia (SD). Longitudinal prospective analysis of SD arose in a tertiary hospital from 1/1st/ 2019 to 12/31st/ 2020. A multivariable logistic regression for BPI after SD and a survival analysis for BPI recovery after SD were performed. In this period 13,414 deliveries were attended, 10,676 of those were vaginal deliveries (79.6%) reporting 69 cases of SD, with an incidence of 0.65%. SD required 102.1 seconds (SD) 10.8) as an average for solving it. Internal maneuvers were needed in 42.0% of SD reported. Neonatal BPI was suspected in 23 newborns (33.3%) at birth. Neonatal BPI at 48 hours of life was statistically associated with maternal BMI above 30 kg/m² (OR = 7.91; CI95% 1.3-47.7; p = 0.024), > 120 seconds for solving SD (OR = 14.4; CI95% 1.7-121.82; p = 0.014) and operative delivery (OR = 6.8; CI 95% 1.2-37.6; p = 0.028). The BPI recovery was statistically associated with clavicle fracture (HR = 0.31 CI95% 0.10-0.96 p = 0.042) and specific rehabilitation treatment (HR = 9.2 CI 95% 1.87-45.23 p = 0.006). The following factors were associated with neonatal BPI at 48 hours of life: Maternal BMI above 30 kg/m², operative delivery, or shoulder dystocia that requires more than 120 seconds for solving it. The BPI recovery was associated with clavicle fracture and specific rehabilitation treatment.

Is the clavicla pro humero a reliable reconstruction for paediatric proximal humerus sarcomas?

The proximal humeral reconstruction is challenging. This study aims to investigate the survival, function and complications of clavicla pro humero (CPH) for pediatric proximal humeral reconstruction. A retrospective cohort study was conducted on eight patients (4 males, and 4 females) who underwent clavicla pro humero reconstruction between January 2009 and December 2020 in our institution. The average age was 10.4 ± 2.7 years (range, 6 to 14 years). The functional outcomes were assessed by the Musculoskeletal Tumor Society Score (MSTS-93), the Toronto Extremity Salvage Score (TESS), the American Shoulder and Elbow Surgeons (ASES) score and the range of motion (ROM) of the shoulder. The complications and overall survivorship of clavicla pro humero were recorded in the follow-up. The mean follow-up of all patients was 54.6 ± 23.9 months (range, 24 to 84 months) and 73.3 ± 8.5 months (range, 72 to 84 months) in all survivors. All patients had a bone union at an average of 3.8 months after the initial procedure. Only one patient had no complications in the follow-up. The most common complications were clavicle fracture (87.5%, 7/8), followed by pseudarthrosis (62.5%, 5/8), proximal clavicle osteolysis (37.5%, 3/8) and skin flap necrosis (12.5%, 1/8). The average MSTS-93 score was 79% (range, 73-86%), the average TESS was 82% (range, 76-86%) and the average ASES was 70% (68-73%), respectively. The clavicla pro humero procedure provides rapid bone union but has a high complication rate. Therefore, we do not recommend this technique as a routine surgical procedure for paediatric proximal humeral reconstruction when other methods are available. level IV therapeutic study.

Minimally Invasive Plate Osteosynthesis with Mini-Open Technique and Supraclavicular Nerve Preservation Reduces Postoperative Numbness in Acute Displaced Midshaft Clavicle Fracture

Background: Minimally invasive plate osteosynthesis (MIPO) for clavicular shaft fracture yields favorable functional outcomes and results in less surgery-related soft tissue injury than other techniques. Anterior chest and shoulder skin numbness, a common complication after open reduction and plate fixation, is related to injury to the supraclavicular nerves. We propose MIPO combined with a mini-open approach without fluoroscopy for nerve preservation to minimize the risk of postoperative numbness compared with traditional open plating without nerve preservation. Methods: A total of 59 patients were retrospectively identified, with a follow-up period of 6 months. Thirty-two patients underwent MIPO with mini-open and nerve preservation technique (MIPO group), and 27 patients underwent traditional open plating without nerve preservation (open group). Constant–Murley shoulder outcome score, operation time, wound length, skin numbness, and number of implant removals were compared between the groups. Results: The MIPO group had significantly lower rates of anterior chest and shoulder skin numbness than the open group (MIPO: 12.5% vs. open: 55.6%; p &lt; 0.001). Operation time was significantly longer in the MIPO group than in the open group (MIPO: 109.38 ± 18.83 vs. open: 81.48 ± 18.85; p &lt; 0.001). Wound length was significantly shorter in the MIPO group than in the open group (MIPO: 4.73 ± 0.79 vs. open: 9.76 ± 1.64; p &lt; 0.001). Both groups had similarly excellent Constant–Murley shoulder scores. There were significantly fewer implant removals in the MIPO group than in the open group (MIPO: 6.3% vs. open: 25.9%; p = 0.036). Neither group experienced any infection, implant failure, or nonunion. Conclusions: Our technique combining MIPO with the mini-open approach and supraclavicular nerve preservation yields a lower incidence of skin numbness than traditional open plating without nerve preservation.

Clavipectoral fascial plane block versus superficial cervical plexus block for fracture clavicle surgery: a randomized clinical trial

Background &amp; objective: Both, the clavipectoral fascial plane block as well as superficial cervical plane block have been utilized as a regional anesthesia technique for clavicular fracture surgery. We compared the efficacy and safety of clavipectoral plane block with superficial cervical plexus block for intraoperative and postoperative pain relief in clavicular fracture surgery under general anesthesia (GA). Methodology: This double-blinded randomized controlled trial included 84 patients, aged between 21 and 60 y, ASA classification I and II, with fracture clavicle, either isolated or part of other trauma, undergoing fracture clavicle fixation. The patients were divided into two groups. The first group received a clavipectoral fascial plane block and the other received a superficial cervical plane block. The visual analogue scale (VAS) scores were recorded as primary outcome, while the patients’ hemodynamics, time to first rescue analgesic, and total morphine consumption were the secondary outcomes at post-anesthesia care unit (PACU) then every 2 h in the ward till 8 h. Results: Compared to the superficial cervical plexus block the clavipectoral plane block was superior in analgesia and more effective during surgical dissection and intraoperative manipulations with a clinically and statistically significant difference all the time from PACU to 8 h postoperatively. The heart rate and arterial blood pressure were much more stable in the clavipectoral group. Also, time to first rescue analgesic was more in the clavipectoral group than in the superficial cervical block. Total morphine consumption was significantly less in the clavipectoral group than in the superficial cervical group. Conclusion: Clavipectoral plane bock is superior to superficial cervical block in fracture clavicle surgeries regarding efficacy and safety. Postoperative pain, measured by VAS, was less with clavipectoral plane block, with more hemodynamic stability and less opioid consumption postoperatively. Abbreviations: PACU - post-anesthesia care unit; CFP - Clavipectoral fascial plane; SCP - Superficial cervical plexus Keywords: Clavipectoral Plane Bock; Fracture Clavicle; Pain, Postoperative; Superficial Cervical Plexus Block Citation: Sayed AG, Abdelmoez WA, Ali OM, Elshafeey AE. Clavipectoral fascial plane block versus superficial cervical plexus block for fracture clavicle surgery: a randomized clinical trial. Anaesth. pain intensive care 2024;28(5):945−950; DOI: 10.35975/apic.v28i5.2573 Received: April 03, 2024; Reviewed: May 13, 2024; Accepted: July 02, 2024