Clavicular Plate Research Articles

Ancient Species of the Genus <i>Dvinosaurus</i> (Temnospondyli, Dvinosauria) from the Permian Sundyr Tetrapod Assemblage of Eastern Europe

From the Sundyr-1 reference locality of the Sundyr faunal assemblage of Eastern Europe (Upper Permian, Upper Severodvinian Substage, Suchonica vladimiri Assemblage Zone), the oldest species of the genus Dvinosaurus Amalitzky, 1921 Dvinosaurus gubini sp. nov. The diagnostic criterions for the new species are its smaller size compared to other dvinosaurs, the narrowest skull, short and wide zygomatic bone, parasphenoid body with a more wide base of the cultriform process and a well ossified basisphenoid, a strongly curved dentary with a well-defined symphyseal crest extending downward from the labial side of the symphysis and, in a several cases, with a single symphyseal canine, a large angle (135–152°) between the clavicular plate and the dorsal process of the clavicle, narrow areas of the interclavicle for insertion of the clavicles, narrow entepicondylus of the humerus. The size, narrowness of the skull, the presence of a single symphyseal canine, and hypocentrum structure bring together a new form closer to the basal Dvinosauria, in particular, with ancestral Trimerorhachidae.

Evaluating the Outcomes of Managing Displaced Clavicular Fractures by Using Precontoured Clavicular Plates.

Background and objective Midshaft clavicular fractures were managed conservatively in the past, with a significant incidence of nonunion and poor functional outcomes in displaced fractures. Anatomically precontoured clavicle plates, since their introduction, have proved to be a superior method for managing these fractures. While open reduction and internal fixation of displaced clavicular fractures with plates have produced successful functional outcomes, complications like plate prominence, scar, postoperative numbness, wound dehiscence, refracture, andinfection continue to discourage surgeons from plating these fractures. This study aimed to evaluate whether the precontoured 3.5-mm locking compression plate (LCP) for the clavicle is effective in the management of displaced clavicular fractures with minimum risk of complications. Methods A prospective observational study was conducted among 26 patients with displaced clavicular fractures that were managed with 3.5-mm precontouredLCP. The functional outcome was assessed by using the Constant-Murley Score (CMS)and healing was assessed radiographically six months postoperatively. Results Twenty-five patients were available for the final follow-up at the end of 24 weeks. All of them achieved excellent functional scores. The mean CMS was 94.9. No complication was observed in 85% of the cases. Implant failure was observed in both fractures of a bilateral clavicle fracture patient within a month of surgery. Implant irritation without prominence was seen in one patient and another had a prominent postoperative scar.The mean time for the radiological union was 13.8 weeks with union time ranging from three to five months. Conclusions Based on our findings, employing 3.5-mm precontoured clavicular LCPs is a useful technique that can provide good functional outcomes in displaced clavicular fractures.

Conformity of Three Pre-Contoured Clavicular Plates Compared Using Personalized 3D-Printed Models of Clavicles from Patients.

The human clavicle's unique S-shaped, three-dimensional structure complicates fracture management. This study evaluated the anatomical conformity of pre-contoured anatomical plates using 3D-printed clavicle models. CT scans from 30 patients (15 males and 15 females) were used to create these models. Three brands of distal clavicle plate systems (Acumed, Synthes, and Arthrex) were tested for fit. Measurements included the distance from the distal end of the clavicle to the plate's lateral end, the gap between the clavicle and the plate, and the overhang distance. Results showed significant differences in clavicle length between sexes, with men having a mean length of 156.1 ± 7.6 mm and women 138.4 ± 4.3 mm, both with normal distribution (p > 0.05). The mean lateral distance was 7.9 ± 1.7 mm, and the mean medial gap was 3.6 ± 3.0 mm, showing no significant differences between products or sexes. The mean overhang distance was 5.8 ± 4.6 mm, with larger values in women for the Acumed (p = 0.037) and Arthrex (p = 0.000) plates. Overall, pre-contoured plates exhibited notable discrepancies, especially in shorter clavicles.

Immediate Weight-bearing Through Walker or Crutches After Surgical Fixation of Clavicle Fractures in Patients With Lower Extremity Fractures: A Retrospective Cohort Study.

To assess the safety of immediate upper extremity weight-bearing as tolerated (WBAT) rehabilitation protocol after clavicle fracture open reduction internal fixation (ORIF). Retrospective cohort study. Three Level 1 trauma centers. Patients older than 18 years who had ORIF of mid-shaft clavicle fractures and lower extremity fractures who were allowed immediate WBAT on their affected upper extremity through use of a walker or crutches were included. All clavicles were fixed with either precontoured clavicular plates or locking compression plates. Included patients were those who had clinical/radiographic follow-up until fracture union, nonunion, or construct failure. WBAT patients were matched in a one-to-one fashion to a cohort with isolated clavicle fractures who were treated non-weight-bearing (NWB) postoperatively on their affected upper extremity. Matching was done based on age, sex, and temporality of fixation. After matching, treatment and control groups were compared to determine differences in possible confounding variables that could influence the primary outcome, including patient demographics, fracture classification, cortices of fixation, and construct type. All patients were assessed to verify conformity with weight-bearing recommendation. Primary outcome was early hardware failure (HWF) with or without revision surgery. Secondary outcomes included postoperative infections and union of fracture. Thirty-nine patients were included in the WBAT cohort; there were no significant differences with the matched NWB cohort based on patient demographics. Both the WBAT and the NWB cohorts had 2.5% chance of acute HWF that required surgical intervention ( P = 1.0). Additionally, there was no difference in overall HWF ( P = 0.49). All patients despite weight-bearing status including those who required revision ORIF for acute HWF had union of their fracture ( P = 1.0). Our data would support that immediate weight-bearing after clavicle fracture fixation in patients with concomitant lower extremity trauma does not lead to an increase in HWF or impact ultimate union. This challenges the dogma of prolonged postoperative weight-bearing restrictions and allow for earlier rehabilitation. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Low rate of secondary surgery and implant removal following superior, precontoured plating of midshaft clavicle fractures

Background Surgical fixation of midshaft clavicle fractures with a single 3.5 mm superior clavicular plate has been associated with a high rate of hardware removal due to symptomatic hardware. Because of this, dual-plating techniques with lower-profile implants have been proposed. However, dual-plating systems have disadvantages, including increased cost and increased surgical morbidity. The aim of this study was to define the rate of symptomatic hardware removal for all midshaft clavicle fractures. Methods We retrospectively reviewed information on all patients from 2014 to 2018 at a single level 1 trauma institution with surgeries performed by two fellowship-trained orthopedic trauma surgeons. Documented removal of hardware and the reason for removal were recorded. We then contacted all patients at their listed telephone number to confirm the hardware was still in place and to administer patient outcome questionnaires. If patients did not answer, attempts were made to contact them multiple times on multiple days. Those who were not reached but had documented hardware removal were included in the total number of patients with hardware removal. Results The search revealed 158 patients, of whom 89 (61.8%) were included in the study. Average follow up was 4.09 years (range 2.02–6.50 years). Five patients (5.56%) underwent hardware removal. Removal was for symptomatic or irritating hardware in two of these patients (2.22%). Average abbreviated Disability of Arm, Shoulder, and Hand score was 6.27, and average American Society of Shoulder and Elbow Surgeons shoulder score was 93.6. Conclusion In our series, the rate of symptomatic hardware removal was 2.22%, well below reported removal rates. Hardware removal rates for prominent symptomatic superior clavicular plates may be significantly lower than previously reported, and these fractures may be adequately treated with a single, superior plate.

What's New in Sports Medicine.

What's New in Sports Medicine.

COMPARATIVE STUDY OF FUNCTIONAL AND RADIOLOGICAL OUTCOME BETWEEN ORIF WITH PLATE AND CRIF/ORIF WITH TENs FOR MIDSHAFT DISPLACED CLAVICULAR FRACTURE: A RETROSPECTIVE STUDY

Introduction-Clavicle fracture constitutes about 44% of shoulder injuries and 2.6%-10% of all fractures. Undisplaced and minimally displaced fracture of clavicle are acceptably treated conservatively with Arm pouch or triangular sling and clavicular brace or gure of eight bandage. Conservative treatment for displaced fracture has risk of malunion, nonunion and cosmetic unacceptability. Different surgical measures were popularised to address this problems. Fixation by Locking Plate or intra-medullary TENs are current gold standard . This study aims to compare TENs and Plate xation for midshaft displaced clavicular fracture in terms of rate of union and functional outcome and complications on either methods. This retrospective comparative study analysed result of 53 patients Material And Methods- of clavicular fracture treated by TENs (21) or Plating (32) done at Department of Orthopaedics , Bankura Sammilani Medical College, Bankura between November 2020 to February 2022. Radiological outcome measured with Rate and Time of union assessed by skiagram and functional outcome measured by DISABILITIES OF THE ARM ,SHOULDER AND HAND (DASH) score. When compared to plate xation, TE Results- Ns had lesser Time of union the Functional outcome measured showed TENs having better average score than Plate xation. Both nding were statistically signicant. TENs had Conclusionlesser union time ,better functional outcome and comparative complications rate to plate xation. So, Midshaft Clavicular Fractures managed with TENs have comparative better result than clavicular plating.

Coracoclavicular Ligament Reconstruction Using TightRope for Delayed Grade III Acromioclavicular Joint Injury After Ipsilateral Diaphyseal Clavicle Fracture Fixation: Surgical Technique and Review of Current Literature.

Athletes commonly sustain high-energy direct impact injuries to the shoulder, with acromioclavicular joint (ACJ) injuries accounting for over half. Ipsilateral ACJ injury and diaphyseal clavicle fracture occur nearly 7% of the time. There is limited literature offering treatment suggestions for this unique injury pattern and limited evidence providing guidance to suggest which injury patterns should be treated operatively or nonoperatively. Here, we present successful treatment of a high-level athlete utilizing a Knotless TightRope XP placed through a superior clavicle plate with successful return to full activity at 6 months postoperation. The TightRope technique offers the ability to augment through a preexisting superior clavicular plate in a low-profile manner and promote easy suture tensioning to obtain and maintain reduction of the injured ACJ.

TITANIUM ELASTIC NAILING SYSTEM IN MID-SHAFT CLAVICLE FRACTURE- A PROSPECTIVE STUDY.

Introduction: Young and active persons are liable for clavicle fractures, most common among Racing individuals ,sports persons and in athletes due to high velocity injury. Clavicle fractures are about 2.5% of all fractures and it is the most common .Satisfactory results with high union rates and less complications have been reported from various techniques for operating Clavicle fractures .The clavicle is a long bone with broad medial and at lateral end and is treated best with Intramedullary elastic devices. So, titanium elastic nailing system is the recommended procedure for all displaced midshaft clavicle fractures to reduce the rate of malunion , non-union, delayed union , symptomatic malunion, and Other complications. Aim Of The Study: To analyze the functional outcome of displaced middle third clavicle Fractures treated by titanium elastic nailing system that will keep the Anatomical shape and length of the clavicle. The study was provisionally approved by the institutionalMaterials And Methods: ethics committee, Andhra medical College, visakhapatnam. This prospective study of displaced midshaft Clavicle fractures treated by titanium elastic nail system was done at the Department of Orthopedics, King George Hospital, Andhra Medical college, Visakhapatnam, from September 2019 to September 2021. Over a period of 2 years with in my academic years from may 2019 to may 2022. Titanium elastic nailingConclusion: system for displaced midshaft clavicle fracture is a safe minimally invasive technique with good functional and radiological outcomes and has better cosmetic appearance . Clavicular fractures which are displaced at middle third are best treated with titanium elastic nailing system with less operative time of 30-45 minutes compared with clavicular plating which takes more than 60-90 minutes. This procedure has better functional outcome than conservative treatment . A good reliable sophisticated minimally invasive technique for midshaft clavicular fractures are xed by Closed nailing or minimal open reduction at fracture site.

Relationship Between Subacromial Bone Erosion and Hook Position of Clavicular Plate in Distal Clavicle Fractures.

To evaluate the influence of posterior hook position on subacromial bone erosion during surgical treatment of distal clavicle fractures with locking compression plate clavicle hook plate (CHP). Single-center retrospective study. Level V trauma center (university hospital). Twenty-one patients (mean age, 45.8 years) treated with CHP were included. One, 3, 15, and 2 patients had Neer type I, IIa, IIb, and V fractures, respectively. Open reduction and internal fixation were performed with locking compression plate CHP. All implants were removed after a mean of 6.1 months postoperatively. Japanese Orthopaedic Association shoulder scores were used to assess recovery. Radiographically, the coracoclavicular distance was measured as the distance between the tip of the coracoid process and the undersurface of the clavicle. Three-dimensional computed tomography was performed to identify bone erosion at the hook tips after implant removal. The distance from the acromioclavicular joint center to the bone erosion was divided into 5 areas at 5-mm intervals, and the position and depth of bone erosion were measured in each area. The mean follow-up period was 17.4 months; mean ± SD Japanese Orthopaedic Association score was 75.9 ± 4.7 at the final follow-up, whereas the mean duration of bony union was 4.4 ± 1.0 (SD) months. Delayed bony union was observed in one patient, whereas a second surgery was required in another due to acromion cut-out. Radiography showed overreduction in 95% of cases. The correlation coefficient showed a difference between coracoclavicular distance and the position of bone erosion measured by CT (Rs = 0.32, P = 0.006). Erosion under the acromion surface was found in all patients. The depth of erosion correlated with the posterior hook position (Rs = 0.29, P = 0.023). Posterior hook tip placement increased the likelihood of bone erosion and complications due to overreduction. CHP should be set more anteriorly beneath the acromion to prevent complications. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Operative Versus Nonoperative Treatment of Acute Displaced Distal Clavicle Fractures: A Multicenter Randomized Controlled Trial.

To evaluate the differences in patient outcomes after operative or nonoperative treatment of displaced, type II distal clavicle fractures. Multicenter, prospective, randomized controlled trial. Level I trauma centers. Patients with completely displaced type II distal clavicle fractures were included. Fifty-seven patients were randomized: 27 to the operative group and 30 to the nonoperative group. Patients randomized to nonoperative care received a standard shoulder sling, followed by pendulum or gentle range of motion shoulder exercises at any time as directed by the attending surgeon. Patients randomized to the operative group received plate fixation with a precontoured distal clavicular plate or a "hook" plate within 28 days from injury. Disabilities of the Arm, Shoulder and Hand scores at 1 year. There were no between-group differences in Disabilities of the Arm, Shoulder and Hand or Constant scores at 1 year. More patients in the operative group went on to union (95% vs. 64%, P = 0.02) within 1 year. Twelve patients in the operative group underwent a second operation for implant removal (12/27, 44%). In the nonoperative group, 6 patients (6/30, 20%) subsequently underwent 8 operative procedures. Although this study failed to demonstrate a difference in functional outcomes between operative and nonoperative treatment of Neer type II distal clavicle fractures, nonoperative management led to more complications including a moderate rate of nonunion, which often required secondary surgery to correct, a higher rate of early dissatisfaction with shoulder appearance, and a delayed return to activities in the first 6 months. Operative management provided a safe and reliable treatment option with few complications, but often required secondary implant removal, especially with hook plate fixation. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

A comparative study of plate fixation versus titanium elastic nail in treatment of displaced midshaft clavicle fractures

Background: In the last few decades, there has been an increasing trend towards operative treatment for displaced midshaft clavicular fractures. These fractures are managed by plate fixation and titanium elastic nailing system, but the optimal fixation method for these types of fractures remains a topic of debate. The aim of this study is to compare functional outcome of displaced midshaft clavicle fractures treated with locking compression plate and titanium elastic nail system and its associated complications.Material and Method: 40 patients treated with plating and titanium elastic nailing system between October 2019 and March 2021 were analyzed. They were randomized in two groups (20 in plate group and 20 in titanium elastic system group). Clinical and radiological assessments were performed at the 6th week, 3rd and 6th month postoperatively. The functional outcome was assessed by Constant- Murley score. Both surgical techniques were compared in terms of radiological union, clinical functions and complications associated. Result: Earlier union and functional outcome scores were better for the Titanium elastic nail system group than plating group (p < 0.01). The rate of complications was higher in the plate group compared with the Titanium elastic nail system group.Conclusion: In treating displaced midshaft clavicle fractures Titanium elastic nailing system is superior to clavicular plating. Titanium elastic nailing system technique is safe, minimally invasive and has better functional outcome, faster union, fewer complication and cosmetically more acceptable than plating.

Biomechanical analysis of a novel clavicular hook plate for the treatment of acromioclavicular joint dislocation: A finite element analysis

BackgroundClavicular hook plates are frequently used in clinical orthopedics to treat acromioclavicular joint dislocation. However, patients often exhibit acromial osteolysis and peri-implant fracture after hook plate fixation. To solve the above problems, we developed a novel double-hook clavicular plate and used finite element analysis (FEA) to investigate its biomechanical properties. MethodsA finite element (FE) model was constructed and validated. Then, a double-hook clavicular plate, a single-hook clavicular plate, and an anatomical double-hook clavicular plate was implanted into the acromioclavicular joint and fixed with screws in groups 1, 2 and 3, respectively. Finally, a load was applied, and some indicators were recorded and analyzed. ResultsFor both the proximal clavicular rotation angle and the distal clavicular displacement, the range of motion in groups 1 and 3 was more than 90% lower than that in group 2. The maximum von Mises stress of the clavicle in groups 1 and 3 was more than 45% lower than that in group 2. The maximum stress of the acromion in group 2 was significantly higher than that in groups 1 and 3, and that in group 3 was less than that in group 1, for both cortical and cancellous bone. ConclusionsThe double-hook clavicular plate could immediately reconstruct the stability of the acromioclavicular joint, effectively reducing the stress of the bone around the clavicle and screws. Additionally, the double-hook clavicular plate could reduce the peak stress of the acromion and produce a more uniform stress distribution.

Precontoured Locking Compression Plate with Titanium Alloy Cable System: In Treatment of Neer Type IIb Distal Clavicle Fracture.

ObjectiveTo describe a new method which involves anatomical distal clavicle plate fixation and titanium alloy cable system‐augmented coracoclavicular ligament reconstruction to manage Neer type IIb distal clavicle fracture.MethodsBetween January 2013 and June 2018, 28 patients with acute Neer type IIb lateral clavicle fracture were treated by a new method – precontoured locking compressive distal clavicular plate fixation of the fracture combined with titanium alloy cable system‐augmented reconstruction of the coracoclavicular ligament. There were 11 females and 17 males treated in this way. There were 15 cases of the right side and 13 of the left. The mean age of the patients was 48.5 years (range, 18–78 years). The mean time from injury to surgery was 3.9 days (range, 1–7 days). After completing the preoperative examinations and evaluations, surgeries were performed for all these patients, anatomical distal clavicle plates were used for fractures, and titanium alloy cables were implanted for the augmented reconstruction of coracoclavicular ligaments. Postoperative protocols, including arm sling management and rehabilitative activities, were unified and recommended to all the patients. These patients were followed up for at least 1 year. The mean duration of postoperative follow‐up was 23.3 months (range, 12–52 months). At the last follow‐up, the coracoclavicular distances were recorded and shoulder functional outcomes were assessed by the Constant scores and the Fudan University Shoulder Scores (FUSSs) questionnaires.ResultsRadiographic bony unions were achieved in all patients within 20 weeks. Functional and radiographic outcomes were retrospectively evaluated. The mean coracoclavicular distance was 9.61 ± 0.61 mm on the injured side vs 9.62 ± 0.57 mm on the contralateral uninjured side. The mean Constant score and mean FUSS were 90.1 ± 6.6 (range, 68–98) and 86.1 ± 7.2 (range, 64–95) respectively, which indicating good restoration of function and high level of satisfaction for both the patients and their physical therapists. There were a few major complications, including one delayed healing of the skin, one severe shoulder stiffness, three incidences of moderate shoulder stiffness, and five incidences of symptomatic hardware. There is no deep infections, neurovascular injuried, delayed union or nonunion, peri‐implant fracture, loss of reduction, implant malposition or failure, or other severe complications.ConclusionThis combined method for the treatment of Neer type IIb distal clavicle fracture could yield high bony union rate, good functional outcome, and low complication rate. Further prospective randomized controlled studies are needed to confirm the benefits of this method of treatment.

A Standardized Formula to Analyse the Neurovascular Safety in Clavicular Plating; An Anatomical Study

A Standardized Formula to Analyse the Neurovascular Safety in Clavicular Plating; An Anatomical Study

Treatment of dislocation of acromioclavicular joint with TightRope fixation through a small incision in the base of coracoid process

To explore the method and effect of small incision TightRope fixation in the treatment of fresh acromioclavicular joint dislocation. From January 2016 to May 2018, 28 cases of fresh acromioclavicular dislocation were treated, including 20 males and 8 females, aged 26 to 87 years with an average age of 51.3 years. The modified Rockwood classification included 1 case of typeⅡ, 22 cases of typeⅢand 4 cases of type V. The average time from injury to operation was 2.4 days. The operative time, shoulder function recovery time and postoperative complications were recorded, and the immediate reduction effect and Karlsson function of shoulder joint were evaluated. In 28 patients, only one Rockwood typeⅡ was used to reconstruct the pyramidal ligament, and the other 27 were used to reconstruct the pyramidal ligament and the trapezoid ligament. The average operation time was (66.50±12.62) min (including intraoperative fluoroscopy time). Twenty-eight cases were followed up for 11 to 20 (16.7±4.6) months. The recovery time of shoulder function was 2 to 7 months with an average of 4 months. During the follow-up period, 1 case had osteolysis and loss of reduction at the clavicular plate site, and the rest had no complications such as re-dislocation and button plate prolapse. Immediate reduction effect after operation:6 cases with reduction insufficiency, 17 cases with complete reduction and 5 cases with excessive reduction;Karlsson function evaluation of shoulder joint in the last follow-up:excellent in 21 cases, good in 6 cases and poor in 1 case;Pearson analysis r=0.060, suggesting that the immediate reduction effect of fresh acromioclavicular dislocation operation has no significant correlation with Karlsson function evaluationof shoulder joint in the last follow-up. TightRope fixation through a small incision in the base of coracoid process is a simple and effective method for the treatment of dislocation of acromioclavicular joint. There was no significant correlation between the slight difference of immediate reduction effect within 5 mm and Karlsson function evaluation of shoulder joint in the last follow-up. It is suggested to pay attention to the loss of reduction and osteolysis of clavicular plate in clinical follow-up.

Operative Fixation of a Displaced Midshaft Clavicle Fracture.

Midshaft clavicle fractures are frequently encountered orthopaedic injuries. Significant displacement portends a higher likelihood of nonunion and symptomatic malunion after nonoperative treatment. Surgical fixation has been shown to reduce the rate of these adverse outcomes. However, the benefit of surgery is narrowly defined and the decision to offer operative treatment involves a careful analysis of patient clinical factors, expectations, and concomitant injuries. In North America, fixation is most commonly performed with a precontoured plate and screw construct. Frequently, fracture patterns are amenable to direct reduction and primary bone healing, but the plate may also be used as a bridging construct for comminuted fractures. This video demonstrates the superior approach to clavicular plating. We detail the exposure, reduction, and fixation using lag screws and stabilization with a plate and screw construct.

A COMPARATIVE STUDY OF SURGICAL AND FUNCTIONAL OUTCOMES IN PATIENTS TREATED WITH INTRAMEDULLARY NAILING AND PLATING FOR MID-SHAFT CLAVICULAR FRACTURES

Introduction: Traditionally, mid-shaft clavicular fractures were treated non-operatively; however, they have been associated with higher non-union rates and poor functional outcomes in certain types of fractures. We aimed to objectively compare the surgical outcomes in patients with mid-shaft clavicular fracture treated either with nailing or plating and assess their functional outcomes over a follow up period of one year.&#x0D; Methodology: Our prospective sample was chosen from a pool of patients visiting casualty of our Hospital for fracture clavicle between March 2015 and March 2017. Patients either underwent open reduction and plate fixation with a 3.5 mm superior clavicular plate or a 2.0 mm to 3.5 mm titanium nail. Intraoperative parameters and postoperative functional outcomes over a period of 12 months were compared between the two patient groups. &#x0D; Results: During the study period 65 patients with clavicular fracture were operated in our department, 35 patients with dynamic compression plating and rest intramedullary fixation and nailing. Patients undergoing nailing had a significantly lesser operative time, incision length, blood loss and hospital stay as compared to plating (p value &lt; 0.001). Mean Constant Murley score throughout the follow up period was higher in the group of patients undergoing plating, though the difference was not significant at any follow up point. Nailing was associated with more frequent implant migration and irritation of skin and there was need of significantly more number of intraoperative image intensifier shoots, resulting in higher radiation exposure, as compared to plating. Nailing and plating resulted in mean shortening of clavicle length by 0.5 cm (range 0.4 to 2.1 cm) and 0.2 cm (range 0.2 to 1.8 cm) respectively.&#x0D; Conclusions: We found no difference in the functional outcome and nonunion rates between nails and plates fixation for displaced midshaft clavicular fractures but nailing was associated with higher rates of complications.&#x0D; Keywords: Clavicle fracture, midshaft, intramedullary fixation, plate fixation, osteosynthesis, trauma

A Comparative Study of Interscalene Block Vs. Interscalene Block with Superficial Cervical Plexus Block for Clavicular Plating

Background: Regional anaesthesia for fixation of clavicle fracture is a new concept. Various techniques of regional anaesthesia are being tried to find the optimal type. Combined interscalene and superficial cervical plexus block is widely accepted.&#x0D; Aim of Study: This study aims to compare the efficacy of interscalene block (ISB) with combined interscalene block and superficial cervical plexus block (ISB+ SCPB) for clavicular plating.&#x0D; Material and Methods: This prospective, hospital based comparative study was conducted from March 2019 to October 2019, in the department of anaesthesiology, Nepalgunj Medical College. 60 ASA category I and II patients undergoing clavicular plating and belonging to age group 16-65 years were enrolled. Patients were divided into two groups: Group I: ISB (n=30), Group II: ISB+ SCPB (n=30). Blocks were given using landmark technique. Primary outcome measures were conversion to general anesthesia (GA), requirement of supplemental analgesia and patient satisfaction. Secondary outcome measures were sensory and motor block, duration of analgesia and complications. These outcome measures were compared between the groups.&#x0D; Results: No patient required conversion to GA. The number of patient requiring supplemental analgesia was significantly higher in ISB group in comparison to ISB+ SCPB. Patient satisfaction was excellent in both groups. No statistically significant complications were seen in either group.&#x0D; Conclusion: Interscalene block combined with Superficial Cervical Plexus Block (ISB + SCPB) has better efficacy than Interscalene block (ISB) alone for clavicular plating. Nevertheless, both techniques avoid GA and provide excellent patient satisfaction level.

CORR Insights®: Patient Position Is Related to the Risk of Neurovascular Injury in Clavicular Plating: A Cadaveric Study.

CORR Insights®: Patient Position Is Related to the Risk of Neurovascular Injury in Clavicular Plating: A Cadaveric Study.