Displaced Midshaft Clavicular Fractures Research Articles

Postoperative recreational sports and subjective shoulder function: a comprehensive analysis following intramedullary stabilization of displaced midshaft clavicular fractures.

Introduction Sports-related outcomes and the role of recreational sports activities for shoulder function after intramedullary stabilization (IMS) of displaced midshaft clavicular fractures (DMCFs) in the general population are not well known. In this study, we aimed to determine the sport-related outcomes (return-to-sports [RTS] rate, type of sports, time until RTS, and intensity) and to explore the role of sports after IMS of DMCFs. Materials and Methods This single-center, retrospective, cohort study included patients who underwent IMS of DMCFs between 2009 and 2022 at a Level II trauma center in Germany, experienced no major complications, and had completed at least 1 year of follow-up. Propensity score matching was conducted to obtain a balanced sample of patients who did not engage (cases) and engaged (controls) in postoperative sports activities by adjusting for age and fracture complexity. Groups were compared to assess the impact of regular sports activities on subjective shoulder functioning at follow-up, as evaluated using the Disabilities of the Arm, Shoulder, and Hand and Oxford Shoulder Score (OSS) questionnaires, after controlling for the patient- (i.e., sex and smoking) and treatment- (i.e., surgery duration and physical therapy) factors. Results Among the 199 patients included, the RTS rate was 97.5%, and 160 patients practiced regular postoperative activity, mostly in the same sport and intensity. In the matched cohort (39 cases and 39 controls), practicing regular sports activities postoperatively was the only independent factor associated with a higher OSS in the multiple regression analysis (unstandardized regression coefficient = 2.40; Bias-corrected and accelerated 95% confidence interval [0.28, 4.69]). Conclusions The sport-related outcomes after IMS of DMCFs in our cohort were comparable to those achieved after plate osteosynthesis, and IMS reported in the literature. Recreational sports activities benefitted subjective shoulder function, thereby encouraging further research and potentially influencing management policies. Level of evidence Grade IV-a retrospective observational cohort study.

5-Year Radiographic and Functional Outcomes of Nonoperative Treatment of Completely Displaced Midshaft Clavicular Fractures in Teenagers

Background: Optimal treatment of completely displaced midshaft clavicular fractures in adolescents remains controversial, with some favoring surgical management and others favoring a nonoperative approach. Few studies have comprehensively assessed longer-term nonoperative outcomes. Purpose: To prospectively assess patient-reported outcomes (PROs) and radiographic remodeling ≥5 years after injury in teenagers undergoing nonoperative treatment of completely displaced clavicular fractures. Study Design: Case series; Level of evidence, 4. Methods: Adolescent patients previously enrolled in a prospective study from a single institution with nonoperatively treated, completely displaced midshaft clavicular fractures ≥5 years from injury were eligible for the study. Patients were clinically evaluated for scapular dyskinesia and strength deficits. Bilateral clavicular imaging assessed residual shortening, displacement, and angulation. PROs included the American Shoulder and Elbow Surgeons (ASES), the shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH), Marx Shoulder Activity Scale, cosmesis, and return to sports data. Results: A total of 24 patients were available for the follow-up, of whom 17 (71%) consented to additional imaging. The mean cohort age at the time of injury was 14.5 ± 1.1 years, with 88% being male. At a mean follow-up of 6.1 years, all fractures had healed, with no patient requiring secondary interventions. Significant remodeling was observed across all measurements, with improvements of 70% in shortening (22.8 to 6.8 mm; P < .001), 73% in superior displacement (13.4 to 3.6 mm; P < .001), and 83% in angulation (10.4° to 1.8°; P < .001). Thirteen patients (72%) had a >2-cm initial shortening, and all remodeled to <2 cm. PROs were almost universally excellent, with mean ASES, QuickDASH, and Marx activity scores of 99 ± 3, 1 ± 3, and 20 ± 1, respectively, with 79% of patients reporting perfect scores in all 3 domains. Most patients (58%) were completely satisfied with their shoulder appearance, 38% were more satisfied than not, 1 patient (4%) was neither satisfied nor dissatisfied, and no patients were dissatisfied. All patients except 1 who were interested in sports returned to sporting activities. PROs were not associated with bony remodeling (P > .05). Conclusion: Teenaged patients with completely displaced clavicular fractures treated nonoperatively can expect excellent radiographic and clinical outcomes 5 years after injury.

Treatment of Severely Shortened or Comminuted Clavicular Fractures in Older Adolescent Athletes

Background: Recent evidence suggests that for completely displaced midshaft clavicular fractures, surgery offers no clear benefit over nonoperative treatment in a general adolescent population from 10 to 18 years of age. However, the comparative outcomes of comminuted and/or severely shortened clavicular fractures specifically in older adolescent athletes have not been explored in a focused, methodologically rigorous fashion. Hypothesis: The study hypothesis was that outcomes would be superior in older adolescent athletes who underwent operative treatment compared with nonoperative treatment for comminuted and/or severely shortened clavicular fractures. Study Design: Cohort study; Level of evidence, 2. Methods: A level 2, multicenter, prospective cohort study investigating the outcomes of midshaft fractures in adolescents between 2013 and 2017 was filtered to analyze the subcohorts of athletes 14 to 18 years of age with either fracture comminution or fracture shortening of ≥25 mm or both. Patient characteristics, injury mechanisms, fracture characteristics, and treatments were compared. Complications, rates, timing of return to sports (RTS), and patient-reported outcomes (PROs) were analyzed. Results: The 2 treatment groups, which included 136 older adolescent athletes (69 nonoperative, 67 operative), showed similar distributions of primary sport type, competition level, comminution, shortening, and 2-year PRO response rate (n = 99; 73%). The operative group demonstrated 3 mm–greater mean superior displacement, which was therefore statistically controlled for as a confounder in the comparative PRO analysis. No 2-year differences in nonunion, delayed union, symptomatic malunion, refracture, clinically significant complications, or rates of RTS were detected between treatment groups. The difference in timing of RTS (operative, 10.3 weeks; nonoperative, 13.5 weeks) was statistically significant. After controlling for the minor difference in superior displacement, regression analysis and matched comparison cohorts demonstrated no differences between the nonoperative and operative groups in mean or dichotomized PRO scores. Conclusion: In this prospective, multicenter cohort study investigating older adolescent athletes with comminuted and/or severely shortened clavicular fractures, contrary to the study hypothesis, there were no differences in complications, RTS, or PROs between nonoperatively and operatively treated patients at 2 years. Comparably excellent outcomes of severe clavicular fractures in adolescent athletes can be achieved with nonoperative treatment.

Assessment of Clavicular Shortening in Displaced Midshaft Clavicular Fractures Treated by Nonoperative Method, Plating, and Elastic Nailing: Comparative Functional Analysis\'A Case Series

Assessment of Clavicular Shortening in Displaced Midshaft Clavicular Fractures Treated by Nonoperative Method, Plating, and Elastic Nailing: Comparative Functional Analysis\'A Case Series

Unicortical versus bicortical plate fixation for midshaft clavicular fractures

BackgroundThe aim of this study was to compare the functional and radiological outcomes of unicortical vs bicortical fixation in patients with midshaft clavicular fractures who were treated using pre-contoured locking plates. MethodsWe performed a prospective multicenter study of 45 individuals who underwent open reduction and internal fixation of midshaft clavicular fractures with precontoured locking plates between March 2017 and December 2019. Twenty-five patients were treated with bicortical screws and 20 patients with unicortical screws. Functional outcomes were assessed at 6 months and 12 months after surgery using the Constant score, the 11-item version of the Disabilities of Arm, Shoulder and Hand (Quick- DASH) score and the Single Assessment Numeric Evaluation (SANE) score. Pain was evaluated using a visual analog scale (VAS). The rate of return to work and sports was also recorded. Radiologic evaluation was obtained in the immediate postoperative day, monthly until fracture consolidation, at 6 months and 12 months. All intraoperative and postoperative complications were documented. ResultsAt both 6 and 12 months, the follow-up rates were 100%, and the mean age was 28.5 years (range, 20 to 45 years). The mean postoperative Constant score, Quick DASH, and SANE score at 12 months were 93.5 (±6), 2.3 (±3), and 92% (±7), respectively. There were no significant differences in the functional scores between the groups neither at 6 months nor at 12 months. Of the 30 active workers, 97% were able to return to their previous working routine and from the 25 patients who practiced sports before the injury,92% returned to sports all at the same level. All the fractures healed in both groups. There were 6 complications (13%). ConclusionIn young, active patients with displaced midshaft clavicular fractures, both unicortical and bicortical locked plates achieved 100% bone consolidation, with excellent functional outcomes and a low rate of complications without significant differences between the groups. Therefore, locked plates with unicortical fixation could be a very good alternative for the management of young patients with midshaft clavicular fractures, potentially avoiding severe neurovascular complications. Level of evidenceProspective comparative (Level II)

Dual Mini-Fragment Plate Fixation of Midshaft Clavicle Fractures Reduces Risk of Reoperation Compared With Single-Plate Fixation Techniques

Background: Recent studies have highlighted dual plating as a method of reducing high rates of postoperative complication after operative management of displaced midshaft clavicular fractures. However, few studies have reliably characterized reoperation rates and magnitude of risk reduction achieved when using dual versus anterior and superior single-plate techniques. Hypothesis: There would be lower rates of reoperation among patients who underwent open reduction and internal fixation (ORIF) of displaced midshaft clavicular fractures via dual plating. Study Design: Cohort study; Level of evidence, 3. Methods: This was a retrospective analysis of patients who underwent ORIF for a displaced midshaft clavicular fracture between 2010 and 2021 at a level 1 trauma center with a minimum 12-month follow-up. Patients were separated into 3 cohorts based on fixation type: (1) orthogonal dual mini-fragment plate fixation, (2) superior plate fixation, and (3) anterior plate fixation. Data on patient characteristics, fracture pattern, and reoperations were documented. All-cause reoperation rates and hazard ratio (HR) estimates of dual, superior, and anterior plating were calculated using a multivariate multilevel mixed-effects parametric survival model. Significant confounders including high-risk fracture morphology and smoking status were controlled for in the final model. Results: A final cohort of 256 patients was identified with mean follow-up of 4.9 ± 3.8 years. In total, 101 patients underwent superior plating, 92 underwent anterior plating, and 63 underwent dual plating. Overall, 31 reoperations took place (18 in superior, 12 in anterior, 1 in dual plating) among 22 patients. Major contributors to reoperation included symptomatic hardware (n = 11), nonunion (n = 8), deep infection (n = 7), and wound dehiscence (n = 2). Superior plating revealed the highest reoperation rate of 0.031 per person-years, followed by anterior plating with 0.026 per person-years and dual plating with 0.005 per person-years. Overall, single plating (either anterior or superior placement) had a nearly 8-fold greater risk of reoperation than dual plating (HR, 7.62; 95% CI, 1.02-56.82; P = .048). Further broken down by technique, superior plating had an 8-fold greater risk of reoperation than dual plating (HR, 8.36; 95% CI, 1.10-63.86; P = .041), but anterior plating did not demonstrate a statistically significant difference compared with dual plating (HR, 6.79; 95% CI, 0.87-52.90; P = .068). Conclusion: Dual-plate fixation represents an excellent treatment for displaced midshaft clavicular fractures, with low rates of nonunion and reoperation. When compared with single locked superior or anterior plate fixation, dual mini-fragment plate fixation has a nearly 8-fold lower risk of reoperation.

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.&#x0D; 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.&#x0D; 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.&#x0D; Conclusion: Midshaft clavicle fractures can be safely fixed intramedullarily utilising TENS, and in our experience, this procedure yields both good functional and aesthetic benefits.&#x0D; Keywords: Clavicle, Intramedullary, Tens, Fracture

Nonoperative vs Operative Treatment of Displaced Mid-Shaft Clavicular Fractures: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Nonoperative vs Operative Treatment of Displaced Mid-Shaft Clavicular Fractures: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Factors affecting duration of inability to work after intramedullary stabilization of displaced midshaft clavicular fractures

BackgroundDuration of inability to work (DIW) after displaced midshaft clavicular fractures (DMCF) is an important clinical and socioeconomic treatment outcome. However, evidence on DIW after DMCF intramedullary stabilization (IMS) is still limited. We aimed to examine DIW and identify medical and socioeconomic predictors with direct or indirect impact on DIW after IMS of DMCF. HypothesisSocioeconomic predictors can explain the unique proportion of the DIW variance after IMS of DMCF above the variance explained by medical predictors. Patients and methodsUsing a retrospective cohort unicentric design, we included patients surgically treated with IMS after DMCF from 2009–2022 with employment status subject to compulsory social security contributions, and without major postoperative complications, in one level II trauma center in Germany. In total, we tested the impact of 17 different medical (i.e., smoking, body mass index [BMI], operative duration, etc.) and socioeconomic predictors (i.e., health insurance type, physical workload, etc.) on DIW. Statistics included multiple regression and path analyses. ResultsA total of 166 patients met the eligibility criteria, with DIW 35.1±31.1days. Operative duration, physical workload, and physical therapy prolonged the DIW (p<0.001). In contrast, enrollment in private health insurance reduced the DIW (p<0.05). Furthermore, the effect of BMI and fracture complexity on DIW was fully mediated by operative duration. The model explained 43% of the DIW variance. DiscussionSocioeconomic factors were found to directly predict the DIW, even after controlling for medical predictors, which confirmed our research question. This is in line with previous findings and highlights the relevance of socioeconomic predictors in this context. We believe that the proposed model can serve surgeons and patients as an orientation guide to estimate the DIW after IMS of DMCF. Level of evidenceIV – retrospective observational cohort study with no control group.

The Role of Elastic Stabilising (Flexible) Intra-Medullary Nails in the Stabilisation of Displaced Midshaft Clavicular Fractures in Adolescents: A Case Series

Ravi, Subhashree; Al-Khateeb, Hesham Dr MFSEM MAcadMEd, MFSTEd, MScHCM, FRSA FRCS; Abdunabi, Murad A Dr CCST Author Information

Displaced Midshaft Clavicular Fractures among Patients with Clavicular Fracture Admitted to the Orthopaedic Department of a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Midshaft clavicular fractures are common among young adults. Open reduction and internal fixation of displaced midshaft clavicular fractures with plate and screws have been shown to decrease nonunion, symptomatic malunion, and residual shoulder disability compared with non-operative treatment allowing early pain-free movement and early return to work. The aim of this study was to find out the prevalence of displaced midshaft clavicular fractures among patients with clavicular fractures admitted to the orthopaedics department of a tertiary care centre. A descriptive cross-sectional study was conducted in the Department of Orthopedics of a tertiary care centre from 31 January 2016 to 31 December 2019 after receiving ethical approval from the Institutional Review Committee (Reference number: 659/2021 P). Data were collected using hospital-based records from patients of the age group 18 to 50 years. Convenience sampling method was used. Point estimate and 95% confidence interval were calculated. Among 120 patients, the prevalence of displaced midshaft clavicular fractures was 40 (33.33%) (24.90-41.76, 95% Confidence Interval). Among them 39 (90%) were males and 4 (10%) were females and the mean age of 31.45 years. The average Constant-Murley score were 95.68±5.59. The prevalence of displaced midshaft clavicular fractures among patients with clavicular fractures admitted to the Department of Orthopedics was lower than the other studies done in similar settings. clavicle; fracture; open fracture reduction; orthopedics.

Anatomical pre-contoured locking plate versus reconstruction plate in the management of displaced midshaft clavicular fractures

Anatomical pre-contoured locking plate versus reconstruction plate in the management of displaced midshaft clavicular fractures

A fluoroscopic view for midshaft clavicular fracture reduction and internal fixation: posteroanterior 25° skyline projection

BackgroundOpen reduction and internal fixation have been frequently applied for displaced midshaft clavicular fracture. Plate and screw fixation of clavicular fractures could provide rigid fixation and rotational control. Proper implant positioning in surgical fixation is critical to prevent iatrogenic complications. Fluoroscopy plays an important role in the intraoperative evaluation of implants. This study aimed to introduce a new fluoroscopic projection to evaluate the positioning of plates and screws.MethodsAdult patients with a diagnosis of acute displaced midshaft clavicular fracture were included in this study. The slope angle of the midshaft clavicle was measured on sagittal reconstructions of preoperative computed tomography (CT) scans. The incidence of screw revision based on intraoperative standard posteroanterior (PA) and PA 25° cephalic skyline projections was compared. The interobserver agreement for the two projections was calculated.ResultsTwenty-nine patients with midshaft clavicular fractures were enrolled from January 2020 to June 2021. The PA 25° skyline projection could clearly display the tangential line of the plate and inferior border of the clavicle. The slope angle on the superior surface of the midshaft clavicle was 26.0 ± 5.8° (range: 18.5–38.3°). The incidence of screw revision using the PA projection (72.4%) was significantly different from that using the PA 25° skyline projection (34.5%) (P < 0.05). The concordance of the screw revision rate based on the standard PA and PA 25° skyline projections was strong, with kappa coefficients of 0.680 (95% CI: 0.394–0.968) and 0.776 (95% CI: 0.537–0.998).ConclusionThe PA 25° skyline projection corresponds to the slope angle of the midshaft clavicle. It can provide more accurate information regarding the proper screw length and be applied as a routine method for intraoperative evaluation.

Tens Nailing in Fracture Clavicle – A Case Series

INTRODUCTION: Clavicle is one of the most commonly fractured bones accounting for 2.6 – 4 % of all the fractures. 69 – 82% of these occur in middle third of clavicle, 73 % of which are displaced midshaft clavicular fractures). Surgery has been indicated for displaced fractures of clavicle, one with NV compromise and skin tenting. Intramedullary fixation for clavicular fractures was first described by Peroni in 1950. The use of a TENS nail carries advantages of less soft tissue compromise, less operative time, better cosmetic results, load sharing fixation with relative stability that encourages copious callus formation. MATERIAL AND METHOD: A prospective review of 20 patients who presented to our institute between January 2021 and June 2022 with displaced midshaft clavicle fractures and treated with TENS nailing was carried out. All the patients had Constant Murley score and DASH score, which were done at 6 and 12 weeks. RESULTS: All the patients achieved clinical and radiological union at a mean of 19.6 ± 6.67.80% 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 25.03 ± 3.36 (range 20-30), 18.56 ± 3.46 (range 14-25) at the end of 6 weeks and 12 weeks respectively. CONCLUSION: The intramedullary fixation using TENS of midshaft clavicle fractures is a safe minimally invasive technique in indicated cases and in our hands, it provides good functional outcome and cosmetic results. KEYWORDS: Tens, Clavicle, Fracture, Intramedullary

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.

Functional outcomes and adverse effects following three interventions for displaced midshaft clavicular fractures: A Bayesian network meta-analysis of randomized controlled trials

IntroductionThe efficacy of the most commonly used interventions for clavicle fractures remains controversial. These interventions are: open reduction and plate fixation (ORPF), non-surgical intervention (NSI), and use of an intramedullary nail (IMN). In adult patients with clavicle fractures, choosing which intervention might be best is challenging. Materials and methodsPubMed, Journals@Ovid Full Text, Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, and Embase were performed to search English-language studies from the inception to February 2020. Randomized controlled trials (RCTs) comparing any of these three interventions were included. Patient and baseline characteristics, nonunion, major complications, Constant-Murley score (CMS), and Disabilities of the Arm, Shoulder and Hand score (DASH) were extracted. Then, we evaluated the functional outcomes and adverse effects after use of these three interventions for the management of displaced midshaft clavicle fractures in a Bayesian network meta-analysis. ResultsA Bayesian random-effects model was conducted, and nonunion and major complications were evaluated with: risk ratio (RR) and 95% confidential interval (CI); while CMS and DASH were evaluated with mean differences (MD) and the corresponding 95% confidential interval CI. The rank probability of each endpoint was assessed on the basis of the surface area under the cumulative ranking curve (SUCRA). DiscussionORPF is most likely to be successful in achieving objective functional outcomes as captured by the CMS, and IMN demonstrates significant efficacy for subjective functional outcomes, as captured by DASH scores. Compared with the other interventions examined, IMN was associated with decreased risk for adverse effects. Levels of evidenceI; meta-analysis.

Acute plate fixation of displaced midshaft clavicular fractures is not associated with earlier return of normal shoulder function when union is achieved.

AimsIt is unclear whether acute plate fixation facilitates earlier return of normal shoulder function following a displaced mid-shaft clavicular fracture compared with nonoperative management when union occurs. The primary aim of this study was to establish whether acute plate fixation was associated with a greater return of normal shoulder function when compared with nonoperative management in patients who unite their fractures. The secondary aim was to investigate whether there were identifiable predictors associated with return of normal shoulder function in patients who achieve union with nonoperative management.MethodsPatient data from a randomized controlled trial were used to compare acute plate fixation with nonoperative management of united fractures. Return of shoulder function was based on the age- and sex-matched Disabilities of the Arm, Shoulder and Hand (DASH) scores for the cohort. Independent predictors of an early recovery of normal shoulder function were investigated using a separate prospective series of consecutive nonoperative displaced mid-shaft clavicular fractures recruited over a two-year period (aged ≥ 16 years). Patient demographics and functional recovery were assessed over the six months post-injury using a standardized protocol.ResultsData from the randomized controlled trial consisted of 86 patients who underwent operative fixation compared with 76 patients that united with nonoperative treatment. The recovery of normal shoulder function, as defined by a DASH score within the predicted 95% confidence interval for each respective patient, was similar between each group at six weeks (operative 26.7% vs nonoperative 25.0%, p = 0.800), three months (52.3% vs 44.2%, p = 0.768), and six months post-injury (86.0% vs 90.8%, p = 0.349). The mean DASH score and return to work were also comparable at each timepoint. In the prospective cohort, 86.5% (n = 173/200) achieved union by six months post-injury (follow-up rate 88.5%, n = 200/226). Regression analysis found that no specific patient, injury, or fracture predictor was associated with an early return of function at six or 12 weeks.ConclusionReturn of normal shoulder function was comparable between acute plate fixation and nonoperative management when union was achieved. One in two patients will have recovery of normal shoulder function at three months, increasing to nine out of ten patients at six months following injury when union occurs, irrespective of initial treatment.Cite this article: Bone Jt Open 2021;2(7):522–529.

Conservative Vs operative management of displaced midshaft clavicle fracture: A comparative study

Background: Clavicle fracture is one of the common fractures accounting for 2.6-12% of all fractures and 44-66% of shoulder fractures. Mid-clavicle fractures account for almost 80% of clavicle fractures. Most of the these fractures were treated conservatively in past but recently there has been an increasing tendency for operative management. Though many studies have been conducted to assess the benefit of primary surgical management against conservative management, no consistent results have been obtained to show which one is better. So, this study was carried out to compare the radiological and functional outcome following conservative management to that of operative management with open reduction and internal fixation (ORIF) with plating for displaced midshaft clavicle fractures. Methods: In a single centre, prospective clinical trial, 60 patients with displaced midshaft fracture of the clavicle were systematically randomized (alternate patient) into either operative treatment with plate fixation or non-operative treatment with clavicle brace and arm sling. Outcome was analysed in terms of functional outcome and radiological union by standard follow-up, Constant and Murley shoulder score and plain radiographs. All sixty patients completed six month follow up and there was no difference between two groups with respect to patient demographics, mechanism of injury and fracture pattern. Result: There was no significant difference in Constant shoulder score between the two groups. The mean time of union was 14.57 weeks in operative group compared to 16.04 weeks in nonoperative group (p value=0.191). There were two non-union in nonoperative group compared to none in operative group. The complications in operative group were mainly hardware related (four had loosening of screw, two had implant failure and one had infection). At six months after surgery patient were more likely to be satisfied with the results in operative group compared to nonoperative group (p=0.02). Conclusion: Six months after a displaced midshaft clavicular fracture, nonoperative treatment resulted in higher malunion and non-union rate but similar functional outcome and union time compared to operative management. However, patients were more likely to be satisfied in operative group compared to nonoperative group.

Technique of minimally invasive plating in mid clavicular fractures and its results

Aim: In this study we wanted to study the technique and pitfalls in minimally invasive plate osteosynthesis technique for displaced midshaft clavicular fractures (DMCFs) and assess its outcome.Materials and Methods: The proposed study is a prospective non randomized control study on the management and treatment of clavicle fractures centered in K.R Hospital attached to the Government Medical College and research institute, Mysore during the term between January 2019 to December 2019.A Total of 31 Cases of Patients underwent internal fixation by MIPO using Pre-contoured locking compression plate. Patients were functionally assessed at the end of follow up period as per the CONSTANT MURLEY Shoulder outcome scoring system.Results: Out of 31 patients, 87.1% of patients were below the age of 40years in our study with Males (87.1%) and Females (12.9%). Most of the patients were operated within 3 days and Right sided fractures were more common than left sided (54.8% vs 45.2%).Average time of union was 13 weeks. Most of the cases did not have any complications except for hypertrophic scar in 2 patients, implant prominence in 3 patients, superficial infection in 1 patient.Conclusion: Closed biological fixation using MIPO technique with locking Pre-contoured plate can preserve the blood supply of the fracture site and minimize soft-tissue related complications. Although it needs surgical expertise and proper technique for better results. MIPO technique with locking reconstruction plate is a feasible and worthwhile alternative for DMCFs.

Fixation of Displaced Midshaft Clavicular Fracture in Adult by Intramedullary Elastic Rod

Background: Intramedullary elastic rod fixation of midshaft clavicular fracture results in rapid free movement of the shoulder and an earlier return to daily activities than the conservative treatment. In comparison with plate fixation, the procedure is less invasive, with no loss of fracture haematoma, rapid union, and less infection. No major surgery for removal with less injury to surrounded neurovascular structures. A smaller incision is required with superior cosmesis. Objective: To study the short-term results of treatment of displaced fractures of the middle third of the clavicle using percutaneous elastic intramedullary nails Patient and Methods: This prospective study was carried out on twenty patients with displaced fractures of the middle third of the clavicle presented to the Hospital and treated by percutaneous elastic intramedullary rod between November 2019 and May 2020. Results: At the end of the follow-up period, the mean score was 89.70 ± 13.55 ranging from 48 to 100 according to the modified Constant and Murley shoulder score. Fourteen patients (70%) had excellent results, four patients (20%) had good results, one patient (5%) had a fair result, and one patient (5%) had a poor result. Conclusion: Elastic stable intramedullary nailing (ESIN) is an image dependant procedure indicated best for young medically free patients with acute simple 2 part middle third clavicle fracture. Delay in surgery may necessitate open reduction. Hammering is not recommended to avoid dorsolateral cortex perforation.