Displaced Midshaft Clavicle Fractures Research Articles

Comprehensive comparison between conservative therapy and surgical management for completely displaced and comminuted mid-shaft clavicle fractures.

It is still controversial whether complete displaced mid-shaft clavicle fractures should be treated with internal fixation or conservative therapy. This retrospective study aims to compare clinical outcomes of two treatment protocols. 105 patients with displaced and comminuted mid-shaft clavicle fractures were included in this study, among which 55 patients were treated conservatively and 50 patients accepted surgical fixation and were followed up for over 20 months on average. Rate of union, malunion, time taken for union, functional outcome, self-reported satisfaction and complications were compared. Union rate of operative group (n=49, 98.0%) was higher than thenon-operative group (n=48, 87.3%). Time taken for union in operative group (2.37±1.06 months) was shorter than thenon-operative group (3.69±1.01 months). Malunion and asymmetric were only seen in theconservative group. Numbness of theshoulder was only reported in theoperative group (n=23, 46.0%). Most of patients in theoperative group (n=45, 90%) accepted a second operation to remove the implant. No statistically difference was found in self-reported satisfaction, Quick-DASH and Constant-Murley score. Theoperative group returned to work faster (1.47±0.89 to 3.34±1.37 months), regained full range of motion earlier (1.66±0.78 to 3.83±1.24 months) and regained strength faster (3.86±2.45 to 8.03±2.78 months) than thenon-operative group. Complete displaced and comminuted mid-shaft clavicle fractures treated surgically have more reliable union and faster recovery when compared to conservatively treated fractures.

A Prospective Comparative Study: Comparing Titanium Elastic Nailing to Anatomical Plating for Displaced Midshaft Clavicle Fractures

A Prospective Comparative Study: Comparing Titanium Elastic Nailing to Anatomical Plating for Displaced Midshaft Clavicle Fractures

Comparable results of Superior vs Antero-inferior plating for the treatment of displaced midshaft clavicle fractures. A comparative study

BackgroundClavicle fractures represent up to 10 % of all fractures, affecting mainly a young population. Open reduction and internal plate fixation provide good results, but evidence on the best plate positioning is still unclear. Aim of this retrospective study was to compare superior and antero-inferior plating positioning in the surgical treatment of displaced midshaft clavicle fractures. Materials and Methods104 patients aged > 18 years, treated surgically with plate fixation (51 superior, 53 antero-inferior) for a midshaft clavicle fracture from January 2010 to April 2021 were included. At the time of the visit, mean follow-up time was 6.6 ± 2.6 years. Shoulder function was evaluated with the use of Constant–Murley Score (CMS) and Disabilities of the Arm, Shoulder, and Hand (DASH) score. Return to sport, aesthetic satisfaction, operative time, radiological outcomes, rate of implant removal, and overall patient satisfaction were documented as well. ResultsMean CMS was 94.1 ± 10.0 points in the superior plating group and 93.4 ± 11.6 points in the antero-inferior plating group. DASH score: 4.6 ± 11.0 superior, 5.1 ± 10.5 antero-inferior. Return to sport: 8.2 ± 2.9 superior, 8.2 ± 3.0 antero-inferior. Aesthetic satisfaction: 8.9 ± 1.6 superior, 8.8 ± 2.1 antero-inferior. Overall satisfaction: 9.1 ± 1.5 superior, 8.9 ± 1.7 antero-inferior. The comparison between groups showed no statistically significant differences (p = n.s.) for all outcome measures. Operative time: 101.6 ± 27.3 min superior, 113.0 ± 31.6 min antero-inferior (p = 0.05). Radiological follow-up documented one non-union and one mal-union in the antero-inferior plating group. Overall, 63 patients underwent plate removal: 58.8 % in the superior plating group and 62.3 % in the antero-inferior plating group (p = n.s.). Main reason for plate removal was pain/discomfort. ConclusionsBoth superior and antero-inferior plating provided excellent clinical, functional, and radiological results for the treatment of displaced midshaft clavicle fractures, without significant differences between groups. The superior plating group showed a statistically shorter operative time. High rate of re-interventions with implant removal was documented in both groups. Level of Evidence: III

Intramedullary Screw Fixation for Midshaft Clavicle Fractures

Operative fixation for acute displaced midshaft clavicle fractures provides improved functional outcomes and patient satisfaction over nonoperative treatment. Although open reduction and plate fixation is most commonly used, intramedullary fixation produces similar patient outcomes with fewer symptomatic hardware or scar complications. The purpose of this Technical Note is to detail a straightforward and cost-efficient method of intramedullary clavicle fracture fixation using a headless cannulated screw.

Clinical effect of nice knot-assisted minimally invasive titanium elastic nail fixation to treat Robinson 2B midshaft clavicular fracture

BackgroundThe treatment of completely displaced midshaft clavicle fractures is still controversial, especially Robinson 2B fractures. Titanium elastic nail (TEN) fixation is a good option for simple fractures, but no reports exist on its use in complex fractures. This study aimed to present a surgical method using the Nice knot-assisted TEN fixation to treat Robinson 2B midshaft clavicular fractures.MethodsA retrospective analysis of 29 patients who underwent fixation with TEN and had a 1-year postoperative follow-up between 2016 and 2020 was performed. The fractures were classified as Robinson type 2B1 in 17 cases and type 2B2 in 12 cases. Length of the incision, postoperative shoulder function Disability of Arm Shoulder and Hand (DASH) score and Constant score, complications rate, and second surgical incision length were recorded.ResultsThe length of the incision was 2–6 cm (average 3.7 cm). All incisions healed by first intention, and no infection or nerve injury occurred. The Constant score was 92–100 (average 96) and the DASH score was 0-6.2 (mean, 2.64). TEN bending and hypertrophic nonunion occurred in one case (3.4%) and implant irritation occurred in four cases (13.8%) Fixation implants were removed at 12–26 months (mean, 14.6 months) after surgery, and the length of the second incision was 1-2.5 cm (average 1.3 cm).ConclusionsIntramedullary fixation by TEN is approved as a suitable surgical technique in clavicular fracture treatment. Nice knot-assisted fixation provides multifragmentary fracture stabilization, contributing to good fracture healing. Surgeons should consider this technique in treating Robinson 2B midshaft clavicular fractures.Trial registrationRetrospectively registered. This study was approved by the Ethics Committee of Wuxi Ninth People’s Hospital (LW20220021).

Comparison of Functional Outcome of Conservative Management and Operative Treatment for Displaced Mid-Shaft Clavicle Fractures

Objective: To compare functional outcomes of conservative management and operative treatment for Displaced Mid-shaft Clavicle fractures. Study Design: Prospective comparative study. Place and Duration of Study: Department of Orthopaedics Combined Military Hospital, Rawalpindi, Pakistan, from Dec 2020 to Sep 2021. Methodology: In a cohort of 80 patients with displaced midshaft clavicle fractures, 40 patients were managed conservatively with an arm sling, and 40 were managed operatively with an anatomical clavicle plate. All these patients were followed up for three months. The functional efficacy of different treatment options in displaced midshaft clavicle fractures was assessed using a Disability of Arm, Shoulder and Hand (DASH) score. Results: The DASH Score showed Functional outcomes were significantly better (p<0.01) in the Operative-Group at 4 weeks, 2 months and 3 months. At two-month follow-up, the Conservative Group had a DASH score of 21.2±2.1, whereas the Surgical Group had a DASH score of 11.7±1.8. The DASH score at three months follow-up was 5.5±1.3 and 12.5±1.9 for the Operative and Conservative Groups, respectively. Conclusion: Plate fixation improves the functional results for individuals with a displaced mid-shaft clavicle fracture. This study showed that DASH scores are lower in the operative Group. When it comes to non-displaced mid-shaft clavicle fractures, conservative management has always been the best option.

The use of precontoured plates for midshaft clavicle fractures is not always the best course of treatment.

Plate fixation has become the preferred approach for treating displaced midshaft clavicle fractures. However, plate fixation of the clavicle presents several unique challenges, including its complex bony architecture and its immediate subcutaneous location. In many cases, we have observed that precontoured implants do not conform to the clavicular anatomy, and many patients complain of postoperative implant-related discomfort. A total of 111 clavicles, both left and right sides, were examined to match two commonly used designs of anatomical pre-contoured superior anterior clavicle plates, with and without lateral extension. The anteroposterior (AP) plane congruence of the plate to the underlying bone, the vertical gap between the bone and plate, and the length of the plate that was off the bone either anteriorly and/or posteriorly at both ends of the clavicle were measured. The scoring system was used to determine the fit of the implant on the clavicle as anatomic, good, or poor. We found that the maximum superior bow of the clavicle was lateral to the midline by 30.75 mm and 30.5 mm on the right and left sides, respectively. The magnitude of the bow was 4.28 mm and 4.46 mm on the right and left sides, respectively. We also found that the plate was a poor fit in 75.86% of cases on the left side and 73.5% of cases on the right side. Manipulating the plates during surgery was very difficult in the AP plane.

Precontoured dynamic compression plate using patient-specific 3D-printed models in minimally invasive surgical technique for midshaft clavicle fractures.

This study introduced a novel approach for the treatment of midshaft clavicle fractures, utilizing patient-specific 3D-printed models for accurate preoperative contouring of dynamic compression plates (DCPs) and an alternative minimally invasive plate osteosynthesis (MIPO) technique with precontoured DCPs through small vertical separated incisions. Mirror image 3D clavicular models were reproduced from 40 patients with acute displaced midshaft clavicle fractures who underwent MIPO using precontoured DCPs inserted through small, vertical separated incisions. Exclusion criteria included patients with open fractures, pathological fractures, ipsilateral limb injury, skeletal immature patients, and those who had previous clavicle fractures or surgery. Postoperative evaluation was conducted using clinical and radiographic review. The Constant-Murley and American Shoulder and Elbow Surgeons Shoulder Scores were used for clinical evaluations, and the Patient and Observer Scar Assessment Scale was used to assess surgical scars. The average time to union of all fractures was 12.88weeks (range, 8-15) without loss of reduction. The patient-specific precontoured DCPs fitted well in all cases, with fracture consolidation and minimal three cortical sides connecting the fracture fragment. No hardware prominence and skin complications occurred, and clinical evaluation showed no existing difference compared with the contralateral sides. The average Constant-Murley and American Shoulder and Elbow Surgeons Shoulder Scores were 96.33 ± 3.66 and 93.26 ± 5.15, respectively. Two patients requested their implant removal, and scar qualities were satisfactory. Our study demonstrated that the use of a patient-specific precontoured DCP, in combination with 3D printing technology, provides accurate preoperative planning, effective fracture reduction, and improved postoperative outcomes in displaced midshaft clavicle fractures. The MIPO with a patient-specific precontoured DCP through separated vertical incisions along the Langer's lines appears to be a promising option, regarding appearance, avoiding associated complications, and obviating the need for reoperation. These results suggest that this technique has merit and can be a viable option for the treatment of midshaft clavicle fractures.

A Case Series on Tens Nailing in Fracture Clavicle

Introduction: One of the most frequently fractured bones, the clavicle accounts for 2.6–4% of all fractures. 73% of these are displaced midshaft clavicular fractures, and 69 to 82% of these occur in the middle portion of the clavicle. For displaced clavicle fractures, including one with NV compromise and skin tenting, surgery has been recommended. Peroni published the first description of intramedullary treatment for clavicular fractures in 1950. The adoption of a TENS nail has benefits such as less soft tissue damage, a shorter surgical procedure, better cosmetic outcomes, load sharing fixation with relative stability, and abundant callus production.
 Material and Methods: A prospective study of 20 patients who had TENS nailing treatment after presenting to our institute between January 2022 and June 2023 with displaced midshaft clavicle fractures was conducted. Constant Murley and DASH scores were completed for each patient at 6 and 12 weeks.
 Results: All the patients achieved clinical and radiological union at a mean of 7.6 ± 2.89 weeks and 18.8 ± 5.87 weeks respectively.85% of the patient had excellent Constant Murley score on follow up. Based on the assessment parameters (Disability of Arm Shoulder and Hand) Score, the mean DASH score was 24.90 ± 3.21and16.45 ± 3.33at the end of 6 and 12 weeks respectively.
 Conclusion: Midshaft clavicle fractures can be safely fixed intramedullarily utilising TENS, and in our experience, this procedure yields both good functional and aesthetic benefits.
 Keywords: Clavicle, Intramedullary, Tens, Fracture

Poster 181: Dual plating as a Cost-Effective Treatment Option for Operatively Indicated Midshaft Clavicle Fractures

Objectives: Many studies have highlighted lower rates of secondary operations with dual-plating compared to single-plating. Despite higher upfront costs associated with the dual-plating construct, the observed reduction in secondary operations compared to single-plating may make it a more cost- effective treatment option. The objective of this study was to assess the cost-effectiveness of dual-plate fixation compared to single-plate fixation in patients with operatively indicated displaced midshaft clavicle fractures. We hypothesized dual-plating would be a more cost-effective surgical option than single-plating, given its lower rates of postoperative complications. Methods: We developed a decision tree to model the occurrence of postoperative complications (hardware issues, wound healing issues, deep infection, non-union, and symptomatic hardware) associated with secondary surgeries. Complication-specific risk estimates were summarized for both plating techniques. The time horizon was two years, and the analysis was conducted from the healthcare payer’s perspective. The costs included direct medical costs, while the benefits were measured in quality-adjusted life-years (QALYs). We assumed that dual-plating would be $300 more expensive than single-plating upfront. We conducted probabilistic and one-way sensitivity analyses. Results: The model predicted reoperation in 6% of patients in the dual-plating arm compared to 14% of patients in the single-plating arm. In the base case analysis, the dual-plating increased QALYs by 0.007 and costs by $70 per patient yielding an incremental cost-effectiveness ratio (ICER) of $10,600 per QALY gained. The sensitivity analysis demonstrated that the cost-effectiveness of dual plating is driven by the cost of index surgery, risk of non-union, and symptomatic hardware complications in single- and dual- plating. At a willingness to pay threshold of $100,000 per QALY gained, 92% of simulations suggested dual-plating is cost-effective compared to single-plating (Figure 1). Conclusions: When indicated, operative management of displaced midshaft clavicle fractures with dual- plating is cost-effective compared to single-plating. Despite its higher initial upfront hardware costs, dual plating appears to offset added costs via lower rates of reoperations and improved patient quality of life.

Paper 56: Dual Plate Fixation of Midshaft Clavicle Fractures May Reduce Reoperation Rates Compared to Single Plating with Anterior or Superior Fixation Techniques

Objectives: Dual plate fixation has been proposed as a solution to the high rates of reoperation secondary to operative management of displaced midshaft clavicle fractures. Previous studies have recommended dual plating for patients specifically at higher risk of reoperation. Therefore, the purpose of this study was to compare reoperation rates among patients who underwent single superior, single anterior, and dual plating while adjusting for risk factors including age, smoking status, and high-risk fracture morphology. We hypothesized lower rates of reoperation among patients who underwent dual plate fixation. Methods: This was a retrospective cohort study of all patients who presented with a midshaft clavicle fracture and underwent ORIF between 2007 and 2021 to our trauma/sports divisions. Patient demographics, fracture pattern, plating technique, postoperative complications, date of surgery, reoperation status, date of last follow up, and date of reoperation were documented. We report hazard ratio (HR) estimates using a multivariate multilevel mixed-effects parametric survival model, which accounted for patients with multiple reoperations and adjusted for covariates. Results: A cohort of 395 patients (mean age 38.5±14.4 years, 81.7% male) were identified with average follow-up of 5.5±8.6 months. There were 77 z-type, 157 transverse, and 161 oblique fractures. With regards to plating technique, 152 underwent single superior plating, 149 experienced single anterior plating, and 94 had dual plating. After initial operation, there were 8 total instances of non-union (2.0%), 0 in the dual plating cohort (0%), 4 in the superior plating cohort (2.6%), and 4 in the anterior plating cohort (2.7%) (p=0.35). A total of 28 reoperations took place among 19 patients (4.8%), with 6 patients experiencing multiple reoperations. Single plating with superior placement revealed the highest reoperation rate of 0.26 per person-years, followed by anterior placement with 0.17 per person-years, and finally dual plating with 0.02 per person-years ( Figure 1). Patients who underwent single plating (either anterior or superior placement) revealed a greater rate of reoperation when compared to patients who underwent dual plating (HR: 8.3, p=0.045). Patients who underwent single plating with superior placement had a rate of reoperation ten- times greater than patients who underwent dual plating (HR:10.1, p=0.03). Patients who underwent single plating with anterior placement had a rate of reoperation six-times greater than patients who underwent dual plating (HR: 6.4, p=0.09), although not statistically significant. Conclusions: Dual plate fixation of displaced midshaft clavicle fractures has an eight-fold lower risk of reoperation compared to single plate fixation, while accounting for age, smoking, and high-risk fracture morphology. More specifically, dual plating had lower rates of reoperation than both single plating with anterior and superior placement. When operative management is indicated for a midshaft clavicle fracture, dual plating may be an excellent treatment alternative in patients at high risk for reoperation.

An Institutional Standardised Protocol for the Treatment of Acute Displaced Midshaft Clavicle Fractures (ADMCFs): Conservative or Surgical Management for Active Patients?

Background and Objectives: The treatment of acute displaced midshaft clavicle fractures (ADMCFs) is still under debate. The aim of this study was to verify the effectiveness of our institutional protocol by comparing the clinical and radiographic outcomes of two groups of patients with ADMCFs treated operatively and non-operatively. Materials and Methods: active patients with a traumatic, isolated non-pathological ADMCF with at least 1-year clinical and radiographic follow up were included. Surgical treatment was performed in the cases where the residual displacement was higher than 140% after the application of a figure-of-eight bandage (F8-B). All other cases were treated conservatively with a F8-B. A total of 134 patients were enrolled and divided into two groups: surgical and conservative groups, with 59 and 75 patients, respectively. Radiological and clinical parameters were evaluated. Results: Good clinical (Constant-Murley Score, the Quick Disability of the Arm, Shoulder and Hand score, and VAS satisfaction) and radiographic outcomes (initial and residual shortening, initial and residual displacement) were obtained for ADMCFs in both groups. Multivariate analysis showed that patients treated conservatively had better clinical outcomes compared to surgically treated patients (p < 0.001). Return to sports was longer in those treated with surgery. Initial shortening was found to impact clinical outcomes as well as initial displacement. None of the patients showed signs of non-union in both groups. Conclusions: Very good mid-term clinical results can be obtained in adult patients with ADMCFs, conservatively or operatively managed, by applying our institutional treatment protocol based on objective radiographic parameters evaluated in the ER.

Skin Tenting Associated with Completely Displaced Midshaft Clavicle Fractures in Adolescents: Results from the FACTS Multi-Center Prospective Cohort Study

Skin Tenting Associated with Completely Displaced Midshaft Clavicle Fractures in Adolescents: Results from the FACTS Multi-Center Prospective Cohort Study

Comparative study of patients with midshaft clavicle fracture fixed with a locked plate via an open versus percutaneous approach

ObjectiveTo compare the results of surgical treatment of midshaft clavicle fractures, treated with the technique of minimally invasive plate osteosynthesis (MIPO) with locking compression plate versus open reduction and internal fixation (ORIF) with locked plate. MethodsQuasi-randomized comparative study, evaluating displaced midshaft clavicle fractures treated with MIPO versus ORIF, with procedures performed by a single surgeon. We evaluated patients at 12 months using the University of California at Los Angeles (UCLA) scale and radiographically at 8, 12, 26 and 52 weeks, in addition to describing complications. ResultsWe evaluated 44 patients; 22 submitted to MIPO and 22 to ORIF. The median UCLA scores at 12 months were 35 in the ORIF group and 35 in the MIPO group (p = 0.712). All patients had fracture healing at 3 months (p > 0.999). The mean surgery time was 87.5 min in the ORIF group and 47.5 in the MIPO (p < 0.001) group. As complications, 1 suture dehiscence (4.5%), 2 protruding plates (9.1%) and 1 change in sensitivity around the surgical wound (4.5%) were observed in the MIPO group, while in the ORIF group, 15 changes in sensitivity (68.2%) and 3 hypertrophic scars (13.6%) were observed. The only complication that showed a difference between the groups was the change in sensitivity (p < 0.001). No cases of pseudarthrosis or failure of osteosynthesis were identified in either technique. ConclusionThis study demonstrated that the two treatments, ORIF and MIPO, are equally effective in the treatment of displaced middle third clavicle fractures. However, MIPO is superior to ORIF in regard to reduced surgical time and preservation of supraclavicular nerve sensitivity.

Outcomes of young active patients with displaced clavicle fractures treated with Rockwood pin.

Various fixation techniques have been described for midshaft clavicle fractures in the literature. We hypothesized that use of the Rockwood pin for fixation of displaced midshaft clavicle fractures would result in favorable outcomes in a young active cohort. Patients aged 10-35years who underwent Rockwood clavicle pin fixation at a single institution were identified. Preoperative and postoperative radiographs were reviewed and assessed for fracture characteristics, postoperative alignment, and radiographic union. Postoperative outcome scores were obtained. A total of 39 patients (age 17.3 ± 3.9years) with clavicle fracture treated with Rockwood pin were identified. Radiographic review demonstrated that 88% of fractures were 100%, or more, displaced, and surgery achieved near-anatomic reduction in 92% of cases. Average time to radiographic union was 2.3 ± 0.8months, and average time to clinical union was 2.5 ± 0.3months. One patient required revision for nonunion (3%). Complete outcome responses were obtained for 24 patients, with an average 40 ± 27.7months of follow-up. Mean Total Clavicle Functional score was 2.75 ± 3.6 for minor patients. For adult patients, Nottingham Clavicle score was 90.7 ± 10.7, mean American Shoulder and Elbow Society score was 92.4 ± 11.2, and mean Single Assessment Numerical Evaluation score was 88.8 ± 21.5. 77% of adults reported no long-term functional limitation; 54% reported a bump at the prior fracture site, but 100% reported satisfaction with shoulder appearance. In our cohort of young active patients, treatment with Rockwood pin allowed for anatomic reduction, healing with a low nonunion rate, and favorable patient reported outcomes.

Comparative Study of Operative and Non-Operatively Treated Displaced Mid-Shaft Clavicle Fractures in Adults

Background: A displaced mid-shaft clavicle fracture in an adult is a break in the collarbone, which is the long bone that runs from the shoulder to the chest. Mid-shaft fractures occur in the middle portion of the collarbone and the displaced fracture means that the broken pieces have moved out of their normal alignment. Study design: It is a comparative study conducted at Orthopedics Department of Pakistan Railway General Hospital, Rawalpindi for the duration of six months from Jan 2022 to June 2022. Material and Methods: The patients who were treated without operation were compared with operative patients for better results. Both groups contained 60 patients. The average age of the patients was 29.9±7.8 in the control group and 32.1±8.1 in the non-operative group. There were 32 and 28 patients in control group that had right and left side of injury respectively. This study was approved by the ethical and the review board committee of the hospital. The data was collected and statistical analysis was performed. Results: The functional outcome of the patients is constant score fracture was calculated and clavicle shortening was carefully observed. The average shortening of clavicle was 0.71±8.1 cm. After a follow-up of 3 months’ clavicle shortening was calculated. The outcome was linked to amount of clavicle shortening among patients Conclusion: The study was done to find the functional outcome of non-operatively treated displaced mid-shaft clavicle fractures in the adult as compared with the operatively treated patients. The results showed that non-operative management of minimally displaced mid shaft clavicle fracture also had good functional outcome. Keywords: Clavicle fracture and the non-operative treatment.

Anteroinferior plating is an independent factor for decreasing symptomatic implant removal rates after plate fixation for midshaft clavicle fractures.

The factors that significantly influence the symptomatic implant removal rates after plate fixation for midshaft clavicle fractures remain controversial. The purpose of this study was to compare the symptomatic implant removal rates between 2 different types of plating technique and to evaluate independently associated factors. Retrospective cohort study. Acute care center. A total of 71 patients 16 years or older who were diagnosed with displaced midshaft clavicle fractures from April 2016 to March 2020. Thirty-nine patients were treated with superior plating (Group SP), and the remaining 32 patients were treated with anteroinferior plating (Group AIP). Symptomatic implant removal rates after plate fixation for midshaft clavicle fractures. Symptomatic implant removal rates were significantly lower in Group AIP (28.1%) than in Group SP (53.8%) (P = 0.033). Multivariate analyses showed that symptomatic implant removal rates were significantly decreased by three independent factors, namely AIP (odds ratio [OR] = 0.323) (P = 0.037), greater age (45 years or older) (OR = 0.312) (P = 0.029), and high body mass index (≥25 kg/m2) (OR = 0.117) (P = 0.034). AIP significantly and independently decreased the symptomatic implant removal rate. Among the three explanatory factors showing significant difference, plating technique is the only factor that can be altered by medical institutions. Therefore, we recommend this technique for displaced midshaft clavicle fractures to reduce a second surgery such as symptomatic implant removal. Level 3, retrospective cohort study.

New interlocking intramedullary nail for treating acute midshaft clavicular fractures in adults: A retrospective study.

The aim of this study was to retrospectively examine the radiological and functional results of midshaft clavicle fractures that were treated with a new, interlocking intramedullary nail, and employing a different locking option. Between January 2018 and January 2020, 24 displaced midshaft clavicle fractures were operated with new, interlocking intramedullary nail. Fractures were classified according to the AO/orthopedic trauma association classification, according to which there were 22 15.2.B (wedge) and 2 15.2.C (comminuted) fractures. The mean patient age was 35.5±14.2 (range: 18-63) years. Eighteen (75%) of the patients were male and six (25%) were female. Follow-up data were recorded at a minimum of 1 year (range 12-36 months), with an average of 21.5 months (SD±8). The mean interval between the injury and surgery was 4.1 (SD±2.3; range: 1-9) days. Full shoulder movements had been achieved by all patients, relative to the contralateral side. The mean constant score was 95.6 (SD±4.2; range 90-100), and the mean visual analog scale score was 0.8 (SD±0.8; range: 0-3). Union was achieved in all patients. The mean union time was 9.5 (SD±1.8; range 6-12) weeks as assessed by radiograph. Average shortening of the clavicle relative to the contralateral side was 3.4% (SD±1.1; range 1.1-6.3). One patient experienced implant irritation, implant removal was performed after 14 months. No implant migration, hardware loosening, implant breakage, or neurovascular damage occurred. One hypertrophic scarring developed. One wound detachment developed at the 3rd post-operative week. We think that this new intramedullary nail is a good alternative for wedge type fractures in adult, acute, displaced, and midshaft clavicle fractures.

Shoulder &amp; Elbow

The December 2022 Shoulder &amp; Elbow Roundup360 looks at: Biceps tenotomy versus soft-tissue tenodesis in females aged 60 years and older with rotator cuff tears; Resistance training combined with corticosteroid injections or tendon needling in patients with lateral elbow tendinopathy; Two-year functional outcomes of completely displaced midshaft clavicle fractures in adolescents; Patients who undergo rotator cuff repair can safely return to driving at two weeks postoperatively; Are two plates better than one? A systematic review of dual plating for acute midshaft clavicle fractures; Treatment of acute distal biceps tendon ruptures; Rotator cuff tendinopathy: disability associated with depression rather than pathology severity; Coonrad-Morrey total elbow arthroplasty implications in young patients with post-traumatic sequelae.

Management of Displaced Midshaft Clavicle Fractures in Pediatrics and Adolescents: Operative vs Nonoperative Treatment.

The purpose of the current review is to describe the management of displaced midshaft clavicle fractures in pediatric and adolescent patients. Midshaft clavicle fractures are relatively common in pediatric and adolescent patients. They most commonly occur from direct trauma and are often related to sports participation in adolescents. Recent literature in the management of adult midshaft clavicle fractures has supported operative management due to improved functional outcomes, decreased time to union, leading to early return to activity. A similar trend of increasing frequency in operative management has been seen in pediatric and adolescent patients with no consensus in the literature on optimal management. Nonoperative treatment consists of with a brief period of sling immobilization followed by range of motion. Operative management may be considered for open fractures, fractures with significant neurovascular compromise and soft tissue complications. Studies have shown comparable mid- to long-term functional and patient-reported outcomes after operative and nonoperative management of midshaft clavicle fractures in pediatric patients.