Fixation Of Clavicle Fractures Research Articles

Comparative study of stabilization of a displaced midshaft clavicle fracture with either an intramedullary nail fixation or a superiorly placed plate.

This retrospective study compares two techniques of fixation of midshaft clavicle fractures: nail fixation versus plate fixation. We compared titanium elastic nail fixation with plate fixation in patients with uncomplicated midshaft clavicle fractures. In total, 84 patients were included in our study: 35 in the nail fixation group and 49 in the plate fixation group. We compared the 12-month postoperative shoulder function and scar assessment. Primary outcome was measured by the DASH score and POSAS score. Secondary outcome was measured by Constant score, surgery complications, implant removal, hospitalization days, and size and quality of the scar. Here was no significant difference in DASH and Constant scores between the two groups. However, the nail group leads in the POSAS (12 (12 - 12) 25 (17 - 30) p < 0.001) and in all scar parameters (size, scar influence). There were no significant differences in the complications despite implant removal where more removals were noted in the nail group (16 (44.4%) 4 (8.3%) p < 0.001). Fixation of uncomplicated midshaft clavicle fractures with nail provides better cosmetic results and scar quality than fixation with plate, and presents no significant differences in functional ability or complications.

Smoking Is Markedly Associated With 30-Day Readmission and Revision Surgery After Surgical Treatment of Clavicle Fracture.

A recent database study found that 15.2% of clavicle fractures underwent surgical treatment. Recent evidence accentuates the role of smoking in predicting nonunion. The purpose of this study was to further elucidate the effect of smoking on the 30-day postoperative outcomes after surgical treatment of clavicle fractures. The authors queried the American College of Surgeons National Surgical Quality Improvement Program database for all patients who underwent open reduction and internal fixation of clavicle fracture between 2015 and 2020. Multivariate logistic regression, adjusted for notable patient demographics and comorbidities, was used to identify associations between current smoking status and postoperative complications. In total, 6,132 patients were included in this study of whom 1,510 (24.6%) were current smokers and 4,622 (75.4%) were nonsmokers. Multivariate analysis found current smoking status to be significantly associated with higher rates of deep incisional surgical-site infection (OR, 7.87; 95% CI, 1.51 to 41.09; P = 0.014), revision surgery (OR, 2.74; 95% CI, 1.67 to 4.49; P < 0.001), and readmission (OR, 3.29; 95% CI, 1.84 to 5.89; P < 0.001). Current smoking status is markedly associated with higher rates of deep incisional surgical-site infection, revision surgery, and readmission within 30 days after open reduction and internal fixation of clavicle fracture.

New Generation Superior Single Plating versus Low-Profile Dual Mini-Fragment Plating of Diaphyseal Clavicle Fractures - A Biomechanical Study

Abstract Background Recently, a new generation of superior clavicle plates was developed featuring the variable-angle locking technology for enhanced screw positioning and optimized plate-to-bone fit design. On the other hand, mini-fragment plates used in dual plating mode have demonstrated promising clinical results. However, these two bone-implant constructs have not been investigated biomechanically in a human cadaveric model. Aims To compare the biomechanical competence of single superior plating using the new generation plate versus dual plating with low-profile mini-fragment plates. Methods Sixteen paired human cadaveric clavicles were assigned pairwise to two groups for instrumentation with either a 2.7 mm Variable Angle Locking Compression Plate placed superiorly (Group 1), or with one 2.5 mm anterior plate combined with one 2.0 mm superior matrix mandible plate (Group 2). An unstable clavicle shaft fracture AO/OTA15.2C was simulated by means of a 5 mm osteotomy gap. All specimens were cyclically tested to failure under craniocaudal cantilever bending, superimposed with bidirectional torsion around the shaft axis and monitored via motion tracking. Results Initial stiffness was significantly higher in Group 2 (9.28±4.40 N/mm) compared to Group 1 (3.68±1.08 N/mm), p=0.003. The amplitudes of interfragmentary motions in terms of craniocaudal and shear displacement, fracture gap opening, and torsion were significantly bigger over the course of 12500 cycles in Group 1 compared to Group 2; p≤0.038. Cycles to 2 mm shear displacement were significantly lower in Group 1 (22792±4346) compared to Group 2 (27437±1877), p=0.047. Conclusion From a biomechanical perspective, low-profile 2.5/2.0 dual plates demonstrated significantly higher initial stiffness, less interfragmentary movements, and higher resistance to failure compared to 2.7 single superior variable-angle locking plates and can therefore be considered as a useful alternative for diaphyseal clavicle fracture fixation especially in unstable fracture configurations.

Satisfactory results in five patients with septic clavicle nonunion using the modified Masquelet technique and structural iliac crest autograft

IntroductionIndications for clavicle fracture fixation have increased dramatically over the last 20 years. Chronic surgical site infection is a particularly severe complication arising from this procedure and can induce nonunion and clinical disability. In such cases, the Modified Masquelet technique using iliac crest autograft (cancellous or tricortical) enables treatment of any bone infection as well as reconstruction of the segmental defect. The aim of this study was to analyze clinical and radiological results of this procedure at mid-term follow-up. MethodsIn this monocentric retrospective study, patients suffering from a septic clavicle nonunion were treated with a Modified Masquelet technique and reviewed at a minimum follow-up point of two years. They were clinically assessed using active range of motion, pain score (Visual Analogic Scale VAS 0 to 10), Constant score, American Shoulder and Elbow Surgeon (ASES) score, and Subjective Shoulder Value score (SSV). Bone healing was measured using standard X-rays and CT scans. ResultsFive patients were included (mean age 49 years; range 30-62). C. acnes was involved in 80% (n=4) of these cases. Following the first stage of treatment, the mean bone defect was 3.4 cm (range 2.6-6.4 cm). The second stage, performed at a minimum of six weeks (mean 7±1 weeks), used an iliac crest bone autograft in all cases. At mean follow-up of 5±3 years, mean pain score was 0.3/10 points (0-1), mean Constant score was 86 points (78-96), mean ASES score was 98±2%, and the SSV score 91±11%, with two “forgotten shoulders” out of five. On CT scan analysis, bone healing was achieved in 100% of cases. One plate (20%) was removed one year following the procedure due to the patient’s discomfort; pain and discomfort at the iliac crest site was reported in 5/5 (100%) patients. ConclusionThe Modified Masquelet technique using iliac crest autograft is a reliable and effective technique for treating septic nonunion of the clavicle. It both treats the bony defect and eradicates infection when conducted in association with débridement and antibiotics. In the five cases reported here, this approach had satisfactory results, both subjectively and objectively, with a very low re-operation rate despite persistent pain from iliac bone harvesting.

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.

Outcomes following fixation of distal clavicle fractures utilizing arthroscopically assisted coracoclavicular ligament stabilization with a suspensory endobutton and cerclage tape

BackgroundDistal one-third clavicle fractures are frequently unstable and often require surgical fixation due to high rates of nonunion. Many common methods of fixation have high rates of union but are associated with hardware discomfort and need for secondary surgery. The purpose of this study was to evaluate outcomes of a fixation technique involving arthroscopically assisted open reduction internal fixation of unstable distal clavicle fractures via a coracoclavicular suspensory endobutton and cerclage tape. MethodsThis was a retrospective case series evaluating patients who underwent fixation of unstable distal clavicle fractures via arthroscopically assisted coracoclavicular stabilization by a single fellowship-trained shoulder and elbow surgeon between 2020 and 2022. Demographic and injury related data were collected via chart review. Preoperative and postoperative radiographs were reviewed to evaluate for signs of radiographic union. Primary outcome measures included fracture union, complications, and need for additional procedures. Patients were also contacted via telephone to obtain American Shoulder and Elbow Surgeons (ASES) scores. ResultsSix patients were eligible for inclusion in this study with mean age of 52.8 +/- 14.0 and mean follow-up of 2.0 years (range 1.6 – 2.7 years). Mean ASES scores were 86.2 +/- 21.8 (range 52 – 100). There were no postoperative complications, signs of symptomatic hardware, or need for secondary surgery at final follow-up among this cohort of patients. All patients had achieved and maintained full radiographic union at mean radiographic follow-up of 5.5 months (range 2.0 – 12.9 months). ConclusionsArthroscopically assisted coracoclavicular stabilization of distal clavicle fractures demonstrated high union rates while limiting complications or need for secondary hardware removal. Further analysis on a larger scale is recommended to determine long-term outcomes and direct comparison to other surgical techniques.

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.

The application of inverted lateral clavicle locking compression plate for medial clavicle fractures: biomechanical study and clinical implementation.

There has been no absolute consensus on the optimal implant for fixation of medial clavicle fracture. The purpose of the present study was to test the biomechanical efficacy of inverted lateral clavicle locking compression plate (LCP-LC) in fixation of this specific fracture location by finite element analysis. Transverse and comminuted medial clavicle fracture simulated models stabilized by three different devices including inverted LCP-LC, superior clavicle LCP (LCP-SC), and dual reconstruction (LCP-RP) with LCP-SC were investigated biomechanical performance under three loading conditions, i.e., axial compression, inferior bending, and axial torsion. EQV stress exhibited on implant and elastic strain at fracture site under inferior bending was greater than other loading cases. LCP-SC construct represented the greatest EQV stress and elastic strain. The inverted LCP-LC construct demonstrated lower EQV stress than the LCP-SC construct and was comparable to dual plating. Under axial compression and axial torsion, elastic strain produced from the inverted LCP-LC construct was comparable to dual plating, but greater than dual plating when subjected to inferior bending. By the results of FE analysis, inverted LCP-LC could be a potential application for fixation of clavicle fracture with short medial fragment.

NEW-GENERATION SUPERIOR SINGLE PLATING VERSUS LOW-PROFILE DUAL MINI-FRAGMENT PLATING OF DIAPHYSEAL CLAVICLE FRACTURES: A BIOMECHANICAL STUDY

Recently, a new generation of superior clavicle plates was developed featuring the variable-angle locking technology for enhanced screw positioning and optimized plate-to-bone fit design. On the other hand, mini-fragment plates used in dual plating mode have demonstrated promising clinical results. However, these two bone-implant constructs have not been investigated biomechanically in a human cadaveric model. Therefore, the aim of the current study was to compare the biomechanical competence of single superior plating using the new generation plate versus dual plating with low-profile mini-fragment plates.Sixteen paired human cadaveric clavicles were assigned pairwise to two groups for instrumentation with either a 2.7 mm Variable Angle Locking Compression Plate placed superiorly (Group 1), or with one 2.5 mm anterior plate combined with one 2.0 mm superior matrix mandible plate (Group 2). An unstable clavicle shaft fracture AO/OTA15.2C was simulated by means of a 5 mm osteotomy gap. All specimens were cyclically tested to failure under craniocaudal cantilever bending, superimposed with bidirectional torsion around the shaft axis and monitored via motion tracking.Initial stiffness was significantly higher in Group 2 (9.28±4.40 N/mm) compared to Group 1 (3.68±1.08 N/mm), p=0.003. The amplitudes of interfragmentary motions in terms of craniocaudal and shear displacement, fracture gap opening and torsion were significantly bigger over the course of 12500 cycles in Group 1 compared to Group 2; p≤0.038. Cycles to 2 mm shear displacement were significantly lower in Group 1 (22792±4346) compared to Group 2 (27437±1877), p=0.047.From a biomechanical perspective, low-profile 2.5/2.0 dual plates demonstrated significantly higher initial stiffness, less interfragmentary movements, and higher resistance to failure compared to 2.7 single superior variable-angle locking plates and can therefore be considered as a useful alternative for diaphyseal clavicle fracture fixation especially in unstable fracture configurations.

Single-plate versus double-plate comparison in the surgical treatment of comminuted clavicle fractures: Is the secondary plate reliable?

The objective of this study is to retrospectively assess the use of single-plate (SP) and double-plate (DP) fixation in the open reduction and internal fixation of comminuted clavicle fractures, focusing on fracture union and complications. We retrospectively evaluated comminuted diaphyseal clavicle fractures (Arbeitsgemeinschaft für Osteosynthesefragen type 15.B1-3) treated with open reduction and internal fixation and having a minimum 1-year follow-up. Two patient cohorts were identified: DP (utilizing a superiorly located clavicle-specific plate and an anteriorly located tubular plate) and SP (utilizing a superiorly located clavicle-specific plate). These groups were compared in terms of union time, peri-incisional numbness, implant irritation, return to work time, union rates, re-operation rates, Disabilities of Arm, Shoulder and Hand (DASH), and American Shoulder and Elbow Surgeons (ASES) scores. The study included 27 SP and 23 DP patients meeting the inclusion criteria. There was no significant difference between the 2 cohorts in terms of union time, peri-incisional numbness, implant irritation, return to work time, union rates, re-operation rates, DASH, and ASES scores at the end of the first year (P = .889, P = 1.00, P = .122, P = 1.00, P = 1.00, P = .493, P = .736, P = .762, P = .937 respectively). However, it was observed that the DP group showed a significantly earlier return to work time and better DASH scores at 3rd and 6th months, whereas the SP group exhibited significantly better ASES scores at 3rd and 6th months (P = .034, P = .016, P = .032, P = .036, P = .021, respectively). No significant difference was observed in terms of union and complications in acute clavicle fractures treated with SP and DP fixation. The DP group demonstrated an earlier return to work and superior early functional scores compared to the SP group. Our findings suggest that a secondary plate can be reliably used, particularly in situations where clavicle fracture fixation is insufficient or in cases of comminuted clavicle fractures.

Functional Outcomes in Surgically Treated Clavicle Fractures: A Longitudinal Observational Study.

Introduction The clavicle is the most unique long bone and has a significant incidence in terms of fractures. Operative fixation for clavicle fractures has seen a steep rise in terms of technique as well as type of implant. Although extensive studies have been carried out in relation to clavicle fractures and their treatment modalities, no proper guidelines or approach has been identified as ideal, and hence, this study was carried out to evaluate operative fixation as a viable strategy. Objective The objective of this article was to assess functional outcomes of plate fixation in clavicle fractures. Materials and methods This longitudinal prospective observational study included 30 patients treated for clavicle fractures with plate fixation in the Orthopedics Department of Himalayan Institute Hospital Trust (HIHT), Jollygrant, Dehradun, over a period of one year. Functional outcomes were assessed as Constant-Murley shoulder scores, and complications were recorded. Radiological assessment was done on thebasis of time to union through follow-up skiagrams. Statistical analysis was performed using the SPSS statistical package version 17.0 (IBM Inc., Armonk, New York).Continuous variables are presented as mean±SD, and categorical variables are presented as absolute numbers and percentages.Continuous variablesand constant score values over time within the groups were analyzed using repeated measures analysis of variance (ANOVA) followed by Bonferroni's post hoc testing. A p-value of <0.05 was considered statistically significant. Results The mean age of patients undergoing surgical fixation of clavicle fractures was 36 ± 12.53 years, ranging from 18-65 years. Of the entire study group, 83.3% were males and 16.7% were females. Road traffic accident (RTA) was the most common cause of clavicle fracture, constituting 76.7% of the entire study population, followed by fall on the floor (20.0%), and one patient sustained trauma by being hit by a bull (3.3%). Our study demonstrated a mean Constant score of 73.87 ± 2.64, 82.80 ± 2.20, and92.40 ± 2.37 at one-month, two-month, and four-monthfollow-up times, respectively, which was found to be statistically significant in terms of progression (p value<0.001). The mean union time of clavicle fractures in our study population was 12.1 weeks. Two patients in our study developed implant impingement. Conclusion Our study revealed that patients with clavicle fractures treated with plate fixation had statistically significant good functional outcome (Constant) scores at sequential follow-ups, consistent with available literature. Mean union time was also comparable to existing literature. Non-union was not noted in our study, and only two cases developed implant impingement. Hence, we conclude that early primary plate fixation for displaced clavicle fractures is a promising technique with good overall functional outcomes and patient satisfaction, especially in young, active patients.

An Evidence-Based Approach to Managing Adolescent (Ages 10 to 19 Years) Diaphyseal Clavicle Fractures.

Diaphyseal clavicle fractures occur most frequently in adolescents (defined as ages 10 to 19 years by the World Health Organization). Multiple prospective comparative studies exist in the adult literature, whereas studies focusing on adolescents are limited. Given the notable differences in healing potential between pediatric, adolescent, and adult diaphyseal clavicle fractures, treatment algorithms tailored specifically to children, adolescents, and adults are required. In the past two decades, there has been a dramatic rise in surgical fixation of adolescent diaphyseal clavicle fractures, largely influenced by adult literature. The remodeling potential of the clavicle throughout adolescence and into early adulthood exceeds that of the adult population. Furthermore, prospective outcomes studies of displaced diaphyseal clavicle fractures have demonstrated that, when compared with surgical management, nonsurgical management portends equivalent functional outcomes but a nearly four times greater rate of complications. Even those injuries with comminution and notable shortening, nonsurgical treatment yields good functional outcomes, high rates of return to sport, and low incidence of complications, such as nonunion, symptomatic malunion, and refracture. In rare cases of unsatisfactory nonsurgical treatment, secondary surgical fixation most often results in union and good functional outcomes.

EARLY RESULTS OF OPEN REDUCTION AND INTERNAL FIXATION FOR CLAVICLE FRACTURES IN CAN THO UNIVERSITY OF MEDICINE AND PHARMACY HOSPITAL

Background: Clavicle fracture is one of the most common injuries of the shoulder girdle. Malunion with angulation or shortening following fractures could cause significant functional deficits of the shoulder. Many kinds of treatment, such as conservative treatments (figure-of-eight bandage, arm sling) or surgeries (fixation with an intramedullary nail, a Kirschner wire, or plates and screws), are described to have their pros and cons for clavicle fractures. Recently, surgeons have preferred open reduction internal fixation because it helps restore the clavicle’s anatomy and allows patients to rehabilitate sooner. Objectives: (1) To investigate the demographics, clinical characteristics, and radiographic images of patients having clavicle fractures; (2) To evaluate the early results of open reduction internal fixation in those patients. Materials and method: A cross-sectional study was conducted on patients having clavicle fractures and undergoing open reduction internal fixation in Can Tho University of Medicine and Pharmacy Hospital from December 2021 to November 2022. Results: A total of 70 patients were included in this study, with 53 (75.7%) male and 17 (24.3%) female. The average age was 37 ± 13.5 years old. Traffic accident (98.6%) was the most common reason, followed by falling on the ground. All patients had pain; 81.4% had bruises, 88.6% had clavicle discontinuation, and 71.4% had crepitus. Radiographic images showed transverse fractures, comminuted fractures, and oblique fractures accounting for 62.4%, 22.9%, and 14.3%, respectively, and only 1 case of segmental fracture. The average incision size was 7.00 ± 0.73 cm. There was no surgical wound infection afterward. VAS pain scores significantly improved by 5 points after surgery to 3.31 ± 1.0 (p &lt; 0.001). The average in-hospital stay was 5.93 ± 1.88 days. Most patients (62, 88.5%) felt extremely satisfied after surgical treatment. Conclusions: Early outcomes of open reduction internal fixation for clavicle fractures show significant postoperative pain relief, anatomical reduction achievement, a short in-hospital stay, and patient satisfaction achievement. A long-term follow-up should be considered for further outcome evaluation.

Is local anesthesia or general anesthesia preferable for plate removal after clavicle fracture surgery under general anesthesia? A comparative study using a patient questionnaire

IntroductionBecause we have a limited number of surgeries performed under general anesthesia, implant removal after plate fixation for clavicular fracture is often performed under local anesthesia. However, it is unclear whether local anesthesia or general anesthesia is preferred. Therefore, we conducted a questionnaire survey of patients who had undergone implant removal surgery under local or general anesthesia after clavicle fracture surgery to assess their impressions of each procedure and which anesthesia they would prefer if they were to undergo plate removal in the future. Materials and methodsA questionnaire survey was conducted on 239 patients. Fifty-six patients who had undergone plate fixation of a clavicle fracture in whom plate removal was conducted under local anesthesia in a university hospital, and one hundred and eighty-three patients in whom plate removal was conducted under general anesthesia in a general hospital. All participants had undergone plate fixation for clavicle fractures under general anesthesia. The participants were asked to complete a questionnaire including a question on which method of anesthesia they would prefer should they have to undergo similar surgery in the future. ResultsThe patients of both groups responded that they would prefer the same method of anesthesia as before to be used (87.1 % of the patients who underwent plate removal under local anesthesia, 78.9 % of the patients underwent plate removal under general anesthesia), with no significant difference between the groups (p > 0.33). ConclusionsPatients who underwent surgery under local anesthesia preferred local anesthesia if they were to undergo it next, even though most of them felt some pain. Though surgeons tend to focus only on the patient's distress during surgery, they also find that patients are often dissatisfied during the perioperative period, including bed rest and urinary catheters. Although clavicle plate removal may be performed under general anesthesia in many cases, it may be worth considering plate removal under local anesthesia to use general anesthesia surgery effectively, which is limited due to financial problems and facilities. Plate removal under local anesthesia was just as acceptable as general anesthesia for the patients.

Supraclavicular nerve sparing versus sacrifice during open reduction internal fixation of acute midshaft clavicle fracture

BackgroundThe branches of the supraclavicular nerve are often sacrificed during open reduction and internal fixation (ORIF) for clavicle fracture. No consensus exists on whether the supraclavicular nerve should be routinely identified and protected during ORIF.MethodsWe developed a simple method to make nerve sparing easier; Wide-Awake Local Anesthesia No Tourniquet (WALANT) solution is locally injected prior to the surgical incision being made. This retrospective study enrolled 340 patients and divided them into supraclavicular-nerve-sparing (n = 45) and supraclavicular-nerve-sacrifice (n = 295) groups. Surgical outcomes—including operative time, estimated blood loss, postoperative pain, union rate, time to union, functional score, paresthesia, complications, implant removal rate, and complication rate—were recorded.ResultsIncisional or anterior chest wall numbness and intraoperative blood loss were significantly less (p < 0.001) in the nerve-sparing group. The operative time was similar in the two groups. No significant differences were discovered in QuickDASH score, postoperative pain score, union rate, time to union, implant removal rate, complication rate, or revision rate.ConclusionsOur study demonstrated that the outcomes of supraclavicular nerve sparing during ORIF with WALANT can reduce postoperative incisional and anterior chest wall numbness and intraoperative blood loss without increasing the operative time or complication rate.

New generation of superior single plating vs. low-profile dual minifragment plating in diaphyseal clavicle fractures: a biomechanical comparative study

Recently, a new generation of superior clavicle plates was developed featuring the variable angle locking technology for enhanced screw positioning and a less prominent and optimized plate-to-bone fit design. On the other hand, mini-fragment plates in dual plating mode have demonstrated promising clinical results. The aim of the current study was to compare the biomechanical competence of single superior plating using the new generation plate versus dual plating using low-profile mini-fragment plates. Sixteen paired human cadaveric clavicles were pairwise assigned to two groups for instrumentation with either a superior 2.7 mm Variable Angle Locking Compression Plate (Group 1), or with one 2.5 mm anterior combined with one 2.0 mm superior matrix mandible plate (Group 2). An unstable clavicle shaft fracture (AO/OTA 15.2C) was simulated by means of a 5mm osteotomy gap. Specimens were cyclically tested to failure under craniocaudal cantilever bending, superimposed with bidirectional torsion around the shaft axis and monitored via motion tracking. Initial construct stiffness was significantly higher in Group 2 (9.28 ± 4.40 N/mm) compared to Group 1 (3.68 ± 1.08 N/mm), p=0.003. The amplitudes of interfragmentary motions in terms of axial and shear displacement, fracture gap opening and torsion, over the course of 12,500 cycles were significantly higher in Group 1 compared to Group 2, p≤0.038. Cycles to 2mm shear displacement were significantly lower in Group 1 (22792 ± 4346) compared to Group 2 (27437 ± 1877), p=0.047. From a biomechanical perspective, low-profile 2.5/2.0 dual plates can be considered as a useful alternative for diaphyseal clavicle fracture fixation especially in less common unstable fracture configurations. 2.7 single superior variable angle locking plates and can therefore be considered as a useful alternative for diaphyseal clavicle fracture fixation especially in less common unstable fracture configurations.

Utility of routine postoperative chest radiography in patients undergoing clavicle fixation: a retrospective chart review.

Although uncommon, pneumothorax is a potentially serious complication following open reduction and internal fixation (ORIF) of clavicle fractures. In many centres it is routine practice to obtain postoperative chest radiographs following ORIF of clavicle fractures to assess for iatrogenic pneumothorax. Given the need to contain health care costs, the low sensitivity for detecting small pneumothorax and a desire to decrease patient radiation exposure, the practice of ordering chest radiographs following ORIF of clavicle fractures may be unnecessary. All patients undergoing ORIF of clavicle fractures with plate and screw fixation at Kingston Health Sciences Centre between April 2009 and June 2020 were identified from the Discharge Abstract Database (inpatient) and National Ambulatory Care Reporting System (outpatient) using relevant Canadian Classification of Health Intervention procedure codes. Charts were manually reviewed to confirm diagnosis and procedure, and patients with preoperative pneumothorax were excluded. The frequency of postoperative chest radiograph and pneumothorax detection were calculated. Among the 292 patients who underwent ORIF of clavicle fractures during the study period, 17 were excluded for having a pneumothorax on preoperative chest radiograph. Of the remaining 275 patients, 101 (36.7%) had postoperative chest radiographs, of whom none were found to have postoperative iatrogenic pneumothorax. Since 2009, the rate of routine postoperative chest radiography following ORIF of clavicle fractures is 36.7% at our centre. During this time period, none of the 101 patients who had postoperative chest radiographs had a postoperative iatrogenic pneumothorax. To our knowledge, this is the largest series of patients available, and our findings confirm those of several smaller studies. Owing to the low rate of postoperative iatrogenic pneumothorax, we conclude that postoperative chest radiography is unnecessary following ORIF of clavicle fractures.

Early Internal Fixation of Concomitant Clavicle Fractures in Severe Thoracic Trauma Prevents Posttraumatic Pneumonia.

Severe thoracic trauma can lead to pulmonary restriction, loss of lung volume, and difficulty with ventilation. In recent years, there has been increasing evidence of better clinical outcomes following surgical stabilization of clavicle fractures in the setting of this combination of injuries. The aim of this study was to evaluate surgical versus non-surgical treatment of clavicle fractures in severe thoracic trauma in terms of clinical and radiological outcomes in order to make a generalized treatment recommendation based on the results of a large patient cohort. This retrospective study included 181 patients (42 women, 139 men) from a European level I trauma centre with a median of 49.3 years in between 2005 and 2021. In 116 cases, the clavicle fracture was stabilized with locking plate or hook plate fixation (group 1), and in 65 cases, it was treated non-surgically (group 2). Long-term functional outcomes at least one year postoperatively using the disabilities of the arm, shoulder and hand (DASH) questionnaire and the Nottingham Clavicle Score (NCS) as well as radiological outcomes were collected in addition to parameters such as hospital days, intensive care days, and complication rates. The Injury Severity Score (ISS) was 17.8 ± 9.8 in group 1 and 19.9 ± 14.4 in group 2 (mean ± SEM; p = 0.93), the time in hospital was 21.5 ± 27.2 days in group 1 versus 16 ± 29.3 days in group 2 (p = 0.04). Forty-seven patients in group 1 and eleven patients in the group 2 were treated in the ICU. Regarding the duration of ventilation (group 1: 9.1 ± 8.9 days, group 2: 8.1 ± 7.7 days; p = 0.64), the functional outcome (DASH group 1: 11 ± 18 points, group 2: 13.7 ± 18. 4 points, p = 0.51; NCS group 1: 17.9 ± 8.1 points, group 2: 19.4 ± 10.3 points, p = 0.79) and the radiological results, no significant differences were found between the treatment groups. With an overall similar complication rate, pneumonia was found in 2% of patients in group 1 and in 14% of patients in group 2 (p = 0.001). This study could demonstrate that surgical locking plate fixation of clavicle fractures in combination with CWI significantly reducing the development of posttraumatic pneumonia in a large patient collection and, therefore, can be recommended as standard therapeutic approach for severe thoracic trauma.

Clinical outcome of internal fixation of middle third clavicle fractures using locking compression plate: comparison between conventional open plating and minimally invasive plate osteosynthesis

Objective: To compare the outcomes of conventional open plating and minimally invasive plate osteosynthesis (MIPO) for treatment of displaced middle third clavicle fractures. Methods: A retrospective cohort study. From January 2016 to December 2020, a total of 42 patients with middle third clavicle fractures treated with locking compression plates in the Department of Orthopedics, Nanping First Hospital Affiliated to Fujian Medical University were analyzed retrospectively, including 27 males and 15 females with a mean age of (36.5±8.7) years (19-61 years). According to the different treatment methods, the patients were divided into 2 groups: the traditional incision group (n=20) were treated with conventional open plating and the MIPO group (n=22) were treated with the MIPO technique. The supraclavicular nerve was preserved in those patients. The two groups were compared in terms of operation time, intraoperative blood loss, incision length, fracture healing time, and the ratio and length difference with the uninjured clavicle. The shoulder joint function was evaluated with Constant score and Disability of the Arm, Shoulder and Hand score (DASH) at the last follow-up. The incidence of numbness around the incision was evaluated at 6 weeks, 12 weeks and 1 year after operation, and the complications of the two groups were compared. Results: The patients were followed-up for an average of 16.5 months (ranged from 13 to 35 months). The operating time [(68.4±12.7) min vs (55.3±10.2) min], intraoperative blood loss[(72.5±16.9) ml vs (52.8±13.5) ml], as well as incision length [(8.7±2.3) cm vs (4.5±1.2) cm] were all significantly greater in traditional incision group than those in MIPO group (all P<0.05). There was no significant difference between the two groups in the time of fracture healing, the length of contrast with the contralateral clavicle, and the constant score and DASH score of shoulder joint function at the last follow-up (all P>0.05). The incidence of numbness around the incision after operation at 6 weeks [60.0%(12/20) vs 27.3%(6/22)] and 12 weeks [45.0%(9/20) vs 13.6%(3/22)] were obviously higher in traditional incision group than those in MIPO group (both P<0.05), but there was no significant difference between the two groups at 1 year after operation [15.0%(3/20) vs 4.5%(1/22), P=0.531]. There was no significant difference in postoperative complications incidence between the two groups (P>0.05). Conclusions: It is showed that both conventional open plating and MIPO are effective and safe treatment methods for displaced middle third clavicle fractures with locking compression plates. MIPO can reduce operating time, intraoperative blood loss and the incidence of early postoperative numbness around the incision.

Clavicle fixation to reduce short-term analgesia and improve respiratory function in patients with chest wall injuries

IntroductionThe objective of this study was to determine if operative fixation of clavicle fractures in patients with non-operatively treated ipsilateral rib fractures is associated with a lower overall analgesic requirement and improved respiratory function.Materials and methodsA retrospective matched cohort study was conducted involving patients admitted to a single tertiary trauma centre having sustained a clavicle fracture with ipsilateral rib fracture/s between January 2014 and June 2020. Patients were excluded if brain, abdominal, pelvic, or lower limb trauma was identified. 31 patients with operative clavicle fixation (study group) were matched 1:1 to 31 patients with non-operative management of the clavicle fracture (control group) based on age, sex, number of rib fractures and injury severity score. The primary outcome was the number of analgesic types used, and the secondary outcome was respiratory function.ResultsThe study group required a mean of 3.50 types of analgesia prior to surgery which decreased to 1.57 post-surgery. The control group required 2.92 types of analgesia, reducing to 1.65 after the date of surgery in the study group. A General Linear Mixed Model indicated that the intervention (operative vs. non-operative management) had statistically significant effects on the number of required analgesic types (p < 0.001, eta_{{text{p}}}^{2} = 0.365), oxygen saturation (p = 0.001, eta_{{text{p}}}^{2} = 0.341, 95% CI 0.153–0.529) and temporal decline in daily supplemental oxygen requirement (p < 0.001, eta_{{text{p}}}^{2} = 0.626, 95% CI 0.455–0.756).ConclusionThis study supported the hypothesis that operative clavicle fixation reduces short-term in-patient analgesia use and improves respiratory parameters in patients with ipsilateral rib fractures.Level of evidenceLevel III therapeutic study.