Treatment Of Midshaft Clavicular Fractures Research Articles

Spin in the Abstracts of Meta-analyses and Systematic Reviews: Midshaft Clavicle Fracture.

Spin is a reporting bias that presents the beneficial effect of an experimental treatment as greater than what is found in the results of the study. This bias can result in patient care recommendations that are more subjective than objective. The purpose of this study is to identify the prevalence of spin in meta-analysis and systematic review abstracts regarding treatment of midshaft clavicle fractures. Electronic libraries (MEDLINE, Embase, Web of Science, Google Scholar) were systematically searched. Meta-analyses and systematic reviews regarding treatment of midshaft clavicular fractures were analyzed. The nine most severe types of spin commonly found in abstracts were used as an evaluation tool to assess the articles. Other variables analyzed include year of publication, journal impact factor, number of citations, and methodologic quality according to A Measurement Tool to Assess Systematic Reviews (AMSTAR-2). The database search resulted in 401 articles, of which 53 met inclusion criteria. After review, it was found that 52.8% (28/53) of the included articles contained spin within the abstract. Of the nine most severe types of spin found in abstracts, type 3 spin ("selective reporting of or overemphasis on efficacy outcomes or analysis favoring the beneficial effect of the experimental intervention") was found to be the most prevalent 28.3% (15/53). This study demonstrated the presence of spin in the majority of meta-analyses and systematic review abstracts pertaining to midshaft clavicular fractures. Orthopedic surgeons should be aware and recognize spin as they review articles when deciding the treatment course for such injuries. Level 3. See Instructions for Authors for a complete description of levels of evidence.

Intramedullary nailing versus plating fixation for the treatment of midshaft clavicular fractures: A meta-analysis of randomized controlled trials

PurposeThis study was to test the hypothesis that intramedullary (IM) nailing fixation of midshaft clavicle fractures could result in better clinical outcomes and lower complications rates than plating fixation. MethodsPubMed, Embase, and the Cochrane Library database were used to search all English language published randomized controlled trials (RCTs) of midshaft clavicle fractures using plating versus IM nailing. The characteristics of the study participants were collected. Outcomes of postoperative shoulder functional measurements, operative data and complications rates were meta-analyzed. ResultsEight hundred and ninety-five patients in ten RCTs and three quasi-RCTs were involved in the meta-analysis. The results of meta-analysis of these studies showed that the functional outcome evaluated by the Constant Shoulder and Disabilities of the Arm, Shoulder and Hand (DASH) scores after accepting IM nailing was significantly better than that of plating fixation at one year post-operatively (P < 0.01), with the heterogeneity of 43% and 91%, respectively. Sensitivity analyses of the pooled results of Constant and DASH scores displayed that the functional advantage of IM nailing fixation comes from the subgroup of locked IM nailing. Further, regarding the operative statistics, operative time, blood loss and wound length were significantly less in the IM nailing group than the plating group (P < 0.001). The rates of infection, major complications and complications-related revision surgery were significantly higher in the plating group than the IM nailing group; however, there were no significantly statistical differences in other complications, e.g., nonunion, refracture after hardware removal, implant failure, symptomatic hardware, etc. (P > 0.05). ConclusionThe observations in this review suggested that IM nailing, especially locked IM nailing, could provide better shoulder functional outcome at one-year follow-up. Moreover, IM nailing fixation could effectively reduce operative time, blood loss, rates of infection, major complications, and revision surgery than plating. Further high-quality clinical trials with large samples and consistent designs are still needed to verify the long-term functional advantage of locked and unlocked IM nailing for midshaft clavicle fractures. Level of evidenceLevel II.

No need to use both Disabilities of the Arm, Shoulder and Hand and Constant–Murley score in studies of midshaft clavicular fractures

Background and purpose — Most newer randomized studies examining plate fixation and nonoperative treatment of midshaft clavicular fractures utilize both Disabilities of the Arm, Shoulder and Hand (DASH) and Constant–Murley score (CS) in the evaluation of patient outcomes. Compared with DASH, the use of CS requires on-site trained personnel and patient visits to obtain the score. The use of both DASH and CS should provide extra value compared with the use of a single functional outcome score; if this value is not provided, the combined use is not necessary. We evaluated the agreement between DASH and CS in patients with displaced midshaft clavicular fractures. Patients and methods — We used prospectively collected data from 146 patients enrolled in a randomized study comparing operative and nonoperative treatment of midshaft clavicular fractures. We determined correlation between DASH and CS at all follow-up points and calculated mean bias in the Bland–Altman plot. Results — We found moderate to high correlation (from 0.82 at 6 weeks’ follow-up to 0.58 at 1-year follow-up) between DASH and CS score, and a small bias (2.21 [95% CI 0.22–4.20]) in the Bland–Altman plot. Interpretation — In patients with displaced midshaft clavicular fractures DASH and CS measures the same degree of disability. Unless specifically studying strength and range of motion, we recommend the sole use of DASH as it would eliminate potential observer-induced bias along with removing the economic and logistic burden of obtaining CS without compromising the value of the collected data.

Minimal Pain Decrease Between 2 and 4 Weeks After Nonoperative Management of a Displaced Midshaft Clavicle Fracture Is Associated with a High Risk of Symptomatic Nonunion.

The main long-term benefit of operative treatment of displaced midshaft clavicular fractures is the reduction in nonunion risk, and as this risk is generally low, the ideal approach would be to operate only patients at high risk of nonunion. However, most current surgical decision models use baseline variables to estimate the nonunion risk, and the value of these models remains unclear. Pain in the early weeks after fracture could be potentially be an indirect measurement of fracture healing, and so it is a potential proxy variable that could lead to simpler prediction models. (1) Is pain a possible proxy variable for the development of symptomatic nonunion after nonoperative treatment of midshaft clavicular fractures? (2) How reliable is the model we created that uses pain as a proxy variable for symptomatic nonunion of nonoperatively treated clavicle fractures? In this secondary retrospective analysis of an earlier randomized trial, we studied prospectively collected data from 64 nonoperatively treated patients aged 18 years to 60 years. In the original randomized trial, we compared operative and nonoperative treatment of displaced midshaft clavicular fractures. In all, 150 patients were included in the study, of whom 71 received nonoperative treatment. Patients were predominantly males (75%, 48 of 64) with a mean age of 38 ± SD 12 years; most fractures were comminuted and shortened more than 1 cm. All 71 patients who were nonoperatively treated were potentially eligible for this secondary analysis; of those, 11% (8 of 71) were lost to follow-up, leaving 63 patients from the nonoperative treatment arm and one patient from the operative treatment arm (who declined surgical treatment after randomization but was followed in this group according to the intention-to-treat principle) for analysis here. Nonunion was defined as lack of callus formation, persistent fracture lines and/or sclerotic edges of the bones at the fracture site on plain radiographs at 6 months follow-up. Nonunions were regarded as symptomatic if pain, tenderness, and local crepitation were present at the fracture site. Seventeen percent (11 of 64) of patients had symptomatic nonunions. After investigating differences in early pain scores between the union and nonunion groups, we defined the VASratio as the VAS pain score at 4 weeks divided by the VAS pain score at 2 weeks. Week 2 VAS pain score was chosen as baseline after visual inspection of a linear mixed model that showed increased divergence in pain scores between union and nonunion group at 2 weeks after fracture. Week 4 was chosen as the cutoff because we wanted a reasonable time frame for the detection of pain reduction and did not want to delay surgical treatment more than necessary. Odds ratios for various risk factors were calculated using logistic regression analyses. We used a receiver operating characteristic curve analysis to identify cutoff values for the VASratio. An increase in absolute pain score at 4 weeks after fracture (odds ratio 1.8 per 1 point increase [95% confidence interval 1.1 to 3.4]) was associated with an increased risk of nonunion 6 months after fracture. Likewise, we found that an increasing VASratio (OR 1.02 per 0.01 point increase [95% CI 1.002 to 1.06]) was also associated with nonunion. Receiver operating curve analysis found that the best cutoff value of VASratio was about 0.6. Patients with a VASratio above 0.6 had a relative risk of developing nonunion of 18 (95% CI 2 to 130) compared with patients with a VASratio below 0.6. Sparse-data bias could be present, as is evident from this wide confidence interval, though even at the low end of the confidence interval, the relative risk was 2, which may still improve surgical decision-making. A pain score that exhibits no or minimal change from 2 to 4 weeks after nonoperative treatment of a displaced midshaft fracture of the clavicle is associated with a high risk that symptomatic nonunion will develop. Patients with no or minimal change in pain in the early weeks may be candidates for surgery to reduce the risk of symptomatic nonunion. As this was a retrospective study, with a risk of sparse-data bias, the predictive value of the VASratio needs to be further investigated in large prospective studies before clinical use. Level III, diagnostic study.

Outcome after operative revision of clavicular nonunions

AbstractBackgroundOver the past decade, the treatment of midshaft clavicular fractures has increasingly shifted from conservative to operative therapy. The overall results seem to be better with surgery, although the problem of nonunion remains. The aim of this study was to report the functional results after operative revision of clavicular nonunions in two German level‑1 trauma centers.MethodsAll patients who underwent surgery for clavicular nonunions during the past 10 years were invited for a structured clinical follow-up examination. The major functional outcome parameter was the age- and gender-adjusted Constant score. Additionally, radiographic fracture union was assessed with the available X‑rays. Complications such as wound site infections were also monitored.ResultsIn total, 31 patients were available for assessment. The mean follow-up rate was 69.7 ± 31.2 months. The mean age of the patients was 52.3 ± 15.2 years. The nonunion was classified as atrophic in 26 cases and hypertrophic in five. A total of 25 (80.6%) patients were treated with angular stable plating combined with autologous bone grafting from the iliac crest. The age- and gender-adjusted Constant score was significantly decreased compared with the noninjured side (82.2 ± 17.1 vs. 95.6 ± 10). Radiographic union was achieved in 30 of the 31 patients (96.8%). Complications with need for surgical revision were recorded for two patients.ConclusionSurgery for clavicular nonunion is a safe and well-established procedure, which leads to radiographic union and good functional results for the majority of cases.

Comparison of curative effect of elastic locking intramedullary nail and anatomic locking plate in the treatment of mid-shaft clavicular fracture

Objective To compare the curative effect between Elastic Locking Intramedullary Nail (ELIN) and Anatomic Locking Plate (ALP) for the treatment of fracture in the mid-shaft of clavicle (Classification AO/OTA:2A/2B). Methods Data of 47 cases of 2A/2B clavicular fractures who were treated with operation from January 2014 to December 2016 were retrospectively analyzed. The patients were divided into ELIN group and ALP group according to different fixation methods. There were 23 cases in ELIN group, 14 male and 9 female, aged from 19 to 85 years (average, 55.26 years). 14 cases on the left side and 9 cases on the right side. There were 6 cases of type 2A and 17 cases of type 2B. There were 24 cases in the ALP group, 18 male and 6 female, aged from 15 to 71 years (average, 51.25 years). 16 cases on the left side and 8 cases on the right side. There were 9 cases of type 2A and 15 cases of type 2B. The operation time, intraoperative blood loss, length of skin incision, fracture healing time, extraction time of internal fixation, Constant-Murley score of shoulder joint, disabilities of the arm, shoulder, and hand (DASH) score, and complication incidence were compared between the two groups. Results All the operations were successfully performed. The mean follow-up for the patients in the ELIN group was 19.35 weeks (range, 14-23 weeks). The mean follow-up for the patients in the ALP group was 53.13 weeks (range, 28-76 weeks). In the ELIN group, the operative time was 20.78 ± 7.71 min, the intraoperative blood loss was 13.26±9.72 ml, the length of incision was 1.57±1.24 cm, the fracture healing time was 10.39±2.39 weeks, the extraction time of internal fixation was 13.17±2.37 weeks, the Constant-Murley score of shoulder joint was 99.09±1.86, and the DASH score was 1.20±2.47. In the ALP group, the operative time was 57.79±11.56 min, the intraoperative blood loss was 69.17±46.24 ml, the length of incision was 9.67±2.90 cm, the fracture healing time was 14.21±4.05 weeks, the extraction time of internal fixation was 47.38±10.46 weeks, the Constant-Murley score of shoulder joint was 98.00±2.17, and the DASH score was 0.89±1.65. The operation time (t=12.856, P=0.000), intraoperative blood loss (t=5.791, P=0.000) in the ELIN group were less than that of ALP group. The length of incision was significantly smaller in ELIN group than that of ALP group (t=12.549, P=0.000). The fracture healing time was earlier in ELIN group than that of ALP group (t=3.566, P=0.002). The extraction time of internal fixation was obviously earlier in ELIN group than that of ALP group (t=15.603, P=0.000). Constant-Murley score of shoulder joint and DASH score showed no significant difference. No delayed healing, no infection was found in the ELIN group, however skin irritation and tail bursitis were found in 6 cases, 3-6 weeks after the operation. The dressing was changed, kept clean. Skin irritation and tail bursitis disappeared, after the extraction of the internal fixation. There were 2 cases of delayed healing in the ALP group. After prolonged observation, the 2 cases healed. The healing time was extended to 24 and 27 weeks, respectively. There was 1 case of infection, 1 case of poor skin healing in the ALP group. The infected patient was treated with debridement and sensitive antibiotics, and the patient with poor skin healing was treated with dressing change. All the patients had wound healing about 4 weeks after surgery. 2 cases of skin irritation in the ALP group disappeared, after the extraction of the internal fixation. Conclusion Both ALP and ELIN are effective methods for the treatment of mid-shaft clavicular fracture. ELIN group has the advantages of more minimally invasive, faster union, shorter internal fixation time, better appearance, and lower medical cost. However, the ELIN group also had skin irritation and temporary bursitis. Key words: Clavicle; Fractures, bone; Fracture fixation, intramedullary

Strength Characteristics of the Bone−Implant−Bone System in Midshaft Clavicular Fracture Osteosynthesis

A method of surgical treatment of midshaft clavicular fractures and a compression interlocking nail for osteosyn-thesis of the clavicle were developed. Strength characteristics of various bone−implant−bone systems in osteosyn-thesis of midshaft clavicular fractures were compared. It was shown that none of the tested fixation techniques provides stability under conditions of axial loading comparable to that of an intact clavicle. The developed design can be recommended as a method of choice for osteosyn-thesis of midshaft clavicular fractures, as it demonstrated strength characteristics comparable to those of other systems.

Plating versus conservative treatment in mid shaft fractures of clavicle: A Systematic Review

Multiple meta-analyses have been performed to compare surgical and conservative interventions for treating midshaft clavicular fractures. The purposes of this search were to conduct a systematic review of meta-analyses comparing surgical and conservative interventions for the treatment of midshaft clavicular fractures, to help decision makers interpret and choose among discordant met- analyses, and to provide treatment recommendations through the best available evidence. Fourteen studies were identified meeting the inclusion criteria. Conservative treatment was found to result in poor clinical outcomes and a high incidence of secondary defects, including nonunion, symptomatic malunion, neurological symptoms and overall complications. Extracted data showed that 16% of nonoperative group developed a nonunion, which is significantly higher than the 1.9% rate of nonunion in the operative group. Symptomatic malunion was also significantly more common in the nonoperative group (22% in the nonoperative group versus 1.9% in the operative group). Functional outcome differences are probably multifactorial because most individuals who developed nonunion or symptomatic malunion had significantly lower outcome scores. Conservative treatment commonly leads to more instability , nonunion and malunion.

Nonoperative Treatment of Midshaft Clavicle Fractures in Adults.

Clavicle fractures are among the most common skeletal injuries accounting for 2-5% of all adult fractures. Historically, nonoperative treatment of midshaft clavicular fractures was considered the gold standard of care. Furthermore, nonoperative treatment has been challenged by an increasing popularity and rate of surgical fixations in recent years despite a lack of clear evidence in the current literature. Most fractures are suitable for conservative treatment. There is solid evidence in favour of nonoperative treatment for fractures with a displacement of less than 2cm and remaining contact of the bone fragments. Clear indications for conservative treatment versus surgical fixation of displaced midshaft fractures have not finally been established yet, leaving some questions and problems unanswered. Furthermore, there are no evidence-based recommendations concerning the kind and duration of shoulder immobilisation with no clear advantage for any treatment modality.

Analysis of the accuracy of fit of five anatomically precontoured clavicle plate systems

Acommon method in surgical treatment of midshaft clavicular fractures is the clavicle plating system. In addition to traditional osteosynthetic devices, anatomically preformed plate systems also exist. Advantages are described in greater accuracy of fit and less irritation of surrounding soft tissues. The purpose of this study was to compare the anatomical fit of five different precontoured clavicle plating systems. The anatomical fit of five different types of anatomical precontoured clavicle plates, 3 timesVariaxSystem® (Stryker, Kalamazoo, MI), Meves® Plate (Ulrich medical Ulm, Germany) and LCP clavicle plate (Synthes, Bettlach, Switzerland) were investigated in 20embalmed human cadaveric clavicles. An imprint of the space between the well-positioned plate and the clavicle was obtained using asilicone mass and the silicone imprint was digitally measured. Additionally, the anatomical fit was evaluated by three investigators following astandardized protocol (+2 to -2points at lateral, midshaft and medial clavicle portions). The first three ranks went to the Stryker Variax-plates. They showed the least distance (Stryker 628027: 7‑hole 1.44 mm, low curvature 0.93 mm-2.36 mm, 2. Stryker 628028: 8‑hole low curvature 1.68 mm, 1.03 mm-2.4 mm and 3. Stryker 628128: 8‑hole high curvature 1.87 mm, range 1.09 mm-3.1 mm) The evaluation of the anatomical fit by the investigators was in agreement with the measurement results. Although there was no complete congruency between the plates and the clavicle, all clavicle plates investigated in this study presented areasonable anatomical shape. The 7‑hole VariAx Stryker plate with slight curvature showed the best anatomical fit. Alow profile and optimized anatomical precontouring can minimize irritation of the surrounding soft tissues and should be considered in plate design and implant choice.

Plating for midshaft clavicular fractures: The impact on quality of life and functional outcome

IntroductionSeveral studies report on functional outcome after operative treatment for midshaft clavicular fractures. According to the published data not much is known about the quality of life after operative treatment. The purpose of this study is to investigate long term patient reported quality of life (QoL) and functional outcome after plating for midshaft clavicular fractures. MethodsPatients between 16 and 65 years of age, with a midshaft clavicular fracture which were treated with plate fixation between 2006 and 2014, were included. Information was extracted from hospital records and all patients were asked to participate in an online survey. Primary outcome was QoL (SF-36 and EQ-5D-5L). Secondary outcomes were complications, reoperation rate, patient– and cosmetic satisfaction, pain, and functional outcome (DASH). ResultsIn a retrospective cohort design, 164 patients were included, 101 completed the online survey. Patients reported a good QoL and functional outcome. The mean physical- and mental SF36 score were 53.9±7.3 and 52.3±9.9 (0–100), the EQ-5D-5L score was 0.88±0.17 (−0.59 to 1.0) and the average DASH was 8.45±14.0 (0–100). Furthermore, there was a strong correlation between the functional outcome and QoL (p<0,001). Seventeen patients developed at least one complication (10%) and seventy-seven patients got a reoperation, with isolated implant removal as the leading cause of reoperation (80,5%). ConclusionPatients which received operative treatment for a midshaft clavicle fracture have an excellent QoL, and a good functional outcome. Furthermore, there is a strong relationship between functional outcome and the QoL.

Clavicle reductor homeopathic traction and minimally invasive plate osteosynthesis for treatment of displaced midshaft clavicular fractures

Objective To investigate the effect of displaced midshaft clavicular fractures treated by clavicle reductor homeopathic traction and minimally invasive plate osteosynthesis (MIPO). Methods A prospective case control study was made on 84 cases of unilateral displaced midshaft clavicular fractures admitted from January 2014 to June 2014. According to the random number table, the patients were allocated to experiment group (43 cases) and control group (41 cases). Subjects in experiment group were treated by homeopathic traction using the self-designed clavicle reductor and MIPO, including 36 male and seven female cases aged 32(24.0, 47.0) years. In contrast, control group were treated by traditional open reduction and internal fixation, including 37 male and four female cases aged 32(26.0, 44. 5)years. According to the OTA classification, 22 cases were type 15-B1, 13 type 15-B2 and eight type 15-B3 in experiment group, while 22 type 15-B1, 12 type 15-B2 and seven 15-B3 in control group. Operation duration, fluoroscopy time, complications and bone healing was recorded. Constant-Murley score was employed to test the functional outcomes. Results Operation duration was 45(36.0, 54.0)min in experiment group and 49 (40.0, 67.5)min in control group (P 0.05). Conclusion MIPO technique assisted with clavicle reductor homeopathic traction in treatment of displaced midshaft clavicular fractures has similar efficacy with the traditional open reduction and internal fixation, but the former technique is associated with relatively shorter operation time and smaller wound. Key words: Clavicle; Fractures, bone; Surgical procedures, minimally invasive

Meta-analysis of differences in Constant-Murley scores for three mid-shaft clavicular fracture treatments.

There is no consensus on the optimal treatment for mid-shaft clavicular fracture. We conducted a meta-analysis to compare the effectiveness of non-operative treatment, plate fixation, and intramedullary pin fixation in terms of the Constant-Murley Score (CMS) for treatment of mid-shaft clavicular fracture. Comprehensive search of the Embase, Cochrane Library and PubMed was conducted to retrieve relevant randomized controlled trials (RCTs). A random-effect network meta-analysis was conducted within a Bayesian framework using Markov Chain Monte Carlo (MCMC) in OpenBUGS 3.2.2. Differences in CMS among the three treatments analyzed were evaluated with weighted mean difference (WMD) and surface under the cumulative ranking curves (SUCRA). Eleven studies met our inclusion criteria and were included in our network meta-analysis. Our results revealed that in terms of CMS followed-up for six months, the efficacies of plate fixation and intramedullary pin fixation were higher than non-operative treatment (plate fixation: WMD = 4.70, 95% CI = 1.21 ∼ 7.83; intramedullary pin fixation: WMD = 6.71, 95% CI = 3.20 ∼ 10.39), and intramedullary pin fixation had better efficacy than plate fixation, had better efficacy. However, no differences were found between the efficacies of the three treatments in pairwise comparisons with respect to CMS followed-up for six weeks, three months, 12 months and 24 months. In addition, the cluster analysis showed that intramedullary pin fixation had the best efficacy for patients with mid-shaft CF, followed by plate fixation and non-operative treatment. These analyses suggest intramedullary pin fixation may be the optimal therapeutic approach for mid-shaft clavicular fracture patients.

Comparison of two minimally invasive internal fixation methods for the treatment of midshaft clavicular fractures

Objective To evaluate and compare the treatment outcomes of two minimally invasive internal fixation methods for midshaft clavicular fractures. Methods A retrospective study was conducted of 62 patients with midshaft clavicular fractures treated between January 2010 and August 2014. Among them 34 patients were treated with minimally invasive percutaneous locking reconstruction plate fixation (plate group), while 28 patients were treated with percutaneous elastic intramedullary nail fixation (nail group). Intraoperative parameters, pain score at postoperative day 3, bone union time, clinical outcomes and complications were compared between the two groups. Results There were no statistically significant differences in intraoperative fluoroscopy time, postoperative pain score and bone union time for type A fractures between the two groups. Surgery time was significantly shorter in the nail group. Bone union time for type B fractures was significantly shorter in the plate group. DASH score or Constant-Murley score for type A fractures were not different between the two groups at 6 months, but significantly higher in the plate group for type B fractures. At 12 months no significant differences in DASH or Constant-Murley scores were noted between the two groups for either type A or type B fractures. A higher rate of skin irritation was seen in the nail group. There were no significant differences between the two groups with regard to infection, loosening or migration of internal fixation and re-fracture. Conclusion Both percutaneous locking reconstruction plate fixation and percutaneous elastic intramedullary nail fixation are effective minimally invasive methods for treating midshaft clavicular fractures. For type B comminuted midshaft clavicular fractures, percutaneous locking reconstruction plate fixation is a better option due to its shorter bone union time, better function scores and lower complications. Key words: Clavicle; Fracture fixation, internal; Locking reconstruction plate; Elastic stable intramedullary nail

Plate fixation versus intramedullary nailing for midshaft clavicular fractures: a prospective rndomized controlled trial

Objective To compare the clinical effects of closed reduction and intramedullary nailing versus open reduction and plate fixation in the treatment of displaced midshaft clavicular fractures. Methods A prospective, randomized, controlled trial was performed between July 2012 and May 2014 in 194 patients with acute displaced midshaft clavicular fracture. They were 136 males and 58 females, from 16 to 65 years of age. They were randomly divided into 2 groups to received either closed reduction and intramedullary nailing(n= 98)or open reduction and plate fixation(n= 96). We recorded operation time, intraoperative blood loss, hospitalization expenses, fracture healing time and complication rate. Functional assessments were conducted at 3, 6 and 12 months using the Disabilities of the Arm, Shoulder and Hand(DASH)and Constant-Murley scores. The preoperative general data showed no statistical significance between the 2 groups(P> 0. 05). Results All the 194 patients were followed up for 12 to 27 months(average, 15. 6 ±3. 1 months). The operation time(27. 7 ±16. 3 min), intraoperative blood loss(18. 6 ±14. 4 mL), hospitalization expenses(12, 462. 0 ±3, 263. 4 yuan), and fracture healing time(12. 1 ±3. 0 weeks)in the intramedullary nailing group were significantly better than those(62. 3 ±19. 4 min, 40. 3 ±17. 4 mL, 24, 760. 0 ±3, 320. 4 yuan, and 16. 9 ±2. 8 weeks)in the plate fixation group(P 0. 05). The complication rate in the intramedullary nailing group(25.5%, 25/98)was significantly higher than in the plate fixation group(9.4%, 9/96)(P<0. 05). Conclusions In the treatment of displaced midshaft clavicular fractures, compared with open reduction and plate fixation, closed reduction and intramedullary nailing has advantages of less invasion, lower cost and faster fracture healing, but a disadvantage of higher complication rate. The 2 treatments may lead to similar functional recovery of the shoulder. Key words: Clavicle; Fracture fixation, internal; Bone plates; Bone nails

Intramedullary nailing of clavicular midshaft fractures in adults using titanium elastic nail

ObjectiveStudies showed elastic stable intramedullary nailing (ESIN) of displaced midclavicular fractures has excellent outcomes, as well as high complication rates and specific problems. The aim was to discuss ESIN of midshaft clavicular fractures. MethodsTotally 60 eligible patients (aged 18-63 years) were randomized to either ESIN group or non-operative group between January 2007 and May 2008. Clavicular shortening was measured after trauma and osseous consolidation. Radiographic union and complications were assessed. Function analysis including Constant shoulder scores and disabilities of the arm, shoulder and hand (DASH) scores were performed after a 15-month follow-up. ResultsESIN led to a signifcantly shorter time to union, especially for simple fractures. In ESIN group, all patients got fracture union, of which 5 cases had medial skin irritation and 1 patient needed revision surgery because of implant failure. In the nonoperative group, there were 3 nonunion cases and 2 symptomatic malunions developed requiring corrective osteotomy. At 15 months after intramedullary stabilization, patients in the ESIN group were more satisfied with the appearance of the shoulder and overall outcome, and they benefited a lot from the great improvement of post-traumatic clavicular shortening. Furthermore, DASH scores were lower and Constant scores were significantly higher in contrast to the non-operative group. ConclusionESIN is a safe minimally invasive surgical technique with lower complication rate, faster return to daily activities, excellent cosmetic and better functional results, restoration of clavicular length for treating mid-shaft clavicular fractures, resulting in high overall satisfaction, which can be regard as an alternative to plate fixation or nonoperative treatment of mid-shaft clavicular fractures.

Meta-analysis of plate fixation versus intramedullary fixation for the treatment of mid-shaft clavicle fractures.

BackgroundThis systematic review and meta-analysis aims to critically compare the outcomes of plate fixation (PF) versus intramedullary fixation (IF) for the treatment of mid-shaft clavicle fractures.MethodsRelevant original studies were searched in electronic databases of Medline, Embase, Cochrane central database and CNKI (all through October 2014). The study was performed according to the PRISMA statement. Studies that investigated the comparing effectiveness or complications between both groups and provided sufficient data of interest were included in this meta-analysis.ResultsThirteen studies fulfilling inclusion and exclusion criteria were included in this meta-analysis, which included 479 participants in PF group and 457 in IF group. Compared to PFs, IFs outperformed PFs associated with a reduced surgery time, a shorter incision, rapid union time, better shoulder function recovery at 6 months and fewer complications of symptomatic hardware, refracture after hardware removal and hypertrophic scar. In other aspects such as functional recovery at 12 months and 24 months follow-up, shoulder motion range, complications of superficial infection,temporary brachial plexus lesion, nonunion, malunion, delayed union, implant failure, major revision needed, both techniques were comparable.ConclusionsThe present evidence from this meta-analysis suggested that IF was a more advantaged method for the treatment of midshaft clavicle fractures. This present study might aid surgeons in making evidence-based decision about optimal surgical treatment of mid-shaft clavicular fracture.Electronic supplementary materialThe online version of this article (doi:10.1186/s13049-015-0108-0) contains supplementary material, which is available to authorized users.

Treatment of Midshaft Clavicular Fractures with Elastic Titanium Nails

Background:One of the modern techniques for the treatment of clavicle fracture (Fx) is elastic titanium intramedullary nailing. But, there are different opinions about this technique. We studied this technique in 12 patients with clavicle Fx and assessed its outcome.Objectives:We aimed to study the prognosis of midshaft clavicular Fx treated via minimally invasive stable elastic intramedullary nailing.Patients and Methods:We operated on 13 clavicle Fx in 12 patients from 2008 through 2012. We used a new technique called minimally invasive titanium elastic intramedullary nailing for operating patients with midshaft clavicular Fx.Results:Clinical union was achieved 3-5 weeks after the operation with no pain over Fx sites upon physical examination. Radiologic union appeared at 6 to 12 weeks .We did not encounter nonunion or infection, but one of the comminuted Fx united 1 cm shorter; however, it had a solid union with a good score. All but two patients had good scores.Conclusions:Although controversy exist regarding intramedullary nailing of clavicle Fx, our results using this technique for minimally comminuted midshaft clavicular Fx were very good.

Comparison of Operative Treatment for Midshaft Clavicular Fractures at Our Hospital-Plate Versus Intramedullary Fixation

Comparison of Operative Treatment for Midshaft Clavicular Fractures at Our Hospital-Plate Versus Intramedullary Fixation

The relationship between trauma mechanism, fracture type, and treatment of midshaft clavicular fractures

The debate on whether midshaft clavicular fractures should preferably be treated operatively or nonoperatively still continues. Several patient-related factors may influence this treatment decision. A retrospective study was carried out to determine the relation between fracture type and trauma mechanism, age and sex, and the influence of these factors on the choice of primary treatment. Data on the trauma mechanism and treatment of 232 adult patients, who presented with a midshaft clavicular fracture in two hospitals in the Netherlands during the years 2006-2009, were collected. The extent of clavicular shortening, displacement, and fracture type on the primary radiograph were scored. Traffic accidents are the main cause of midshaft clavicular fractures. After correction for age, no relation was found between the trauma mechanism and the fracture type. Older age correlated with more comminuted and displaced fractures. Extensive shortening (>20 mm) was identified as the main clinical indication for primary surgery, whereas displacement and fracture classification seemed less relevant. Operative treatment was increasingly favored from 5% in 2006 to 44% in 2009, which could not be explained by an increase in more complex fractures or by age-related or trauma mechanism-related factors. Age has a major influence on the fracture type, whereas the trauma mechanism does not. The choice for the surgical treatment of midshaft clavicular fractures is primarily determined by the amount of axial shortening of the clavicle, rather than by the overall displacement or fracture type. Over the years, the choice of treatment seems to have been increasingly influenced by the patient's and surgeon's preferences.