INTRODUCTION: It is impossible to support and immobilize a fracture of middle 3rd of clavicle in an adult by external means with figure-of-eight bandages. Clavicle fractures accounts for approximately 2.6% of all fractures in adults2 10% to 15% in children and comprise about 30 -40% of all shoulder girdle injuries and 5% fractures occurs in medial end. The goal of clavicle fracture treatment is to achieve bony union while minimizing dysfunction, morbidity, and cosmetic deformity. Definitive indications for acute surgical intervention include skin tenting, open fractures, the presence of neurovascular compromise, multiple trauma, or floating shoulder. Outside of these indications, the management of displaced fractures of the mid shaft (Edinburgh type 2B) remains somewhat controversial. Recent literature is challenging the traditional belief that mid- shaft clavicle fractures uniformly heal without functional deficit. MATERIAL AND METHODS: Patients included were cases of mid shaft clavicle fractures. 30 patients with mid shaft clavicle fractures were included in the study.All patients above 18 years of age were included in the study falling into Robinson’s type 2 B1 (Mid shaft simple displaced and single butterfly fragment fracture), type 2 B2 (Mid shaft segmental fracture) classification. The patients were selected randomly and were divided in the following two groups of 15 patients each: Group A: 15 patients treated by anatomical locking compression plate (LCP) by open technique. Group B: 15 patients treated by minimal invasive percutaneous osteosynthesis (MIPO) technique. All patients were operated as early as possible once the patient was declared fit for the surgery by the physician. Open reduction and internal fixation with LCP was done. RESULTS: A total of 30 patients were included in the study. In group A 15 patients treated by anatomical locking compression plate (LCP) by open technique and in group B 15 patients treated by minimal invasive percutaneous osteosynthesis (MIPO) technique. In Group A, 7 (46.7%) patients had operative time of 80-100 minutes whereas 6 (40%) and 2 (13.3%) patients had operative time of 100-120 and 120-140 minutes respectively. The mean operative time was 104.9 ± 13.52mins. In Group B, 6 (40%) patients had operative time of 80-100 minutes whereas 8 (53.4%) and 1 (6.6%) patients had operative time of 100-120 and 120-140 minutes respectively. The mean operative time was 106.5 ± 11.72mins. The mean duration for radiological union in Group A was 12.7 ± 4.61 weeks. Majority of the patients (60%) achieved radiological union in <12 weeks while 6 (40%) patients achieved union in 12-24 weeks. In Group B, majority of the patients (66.7%) achieved radiological union in <12 weeks while 5 (33.3%) patients achieved union in 12-24 weeks. The mean duration for radiological union in Group B was 12.1 ± 6.68 weeks. CONCLUSION: MIPOs can used to preserve the biology at the fracture site, to maximise the healing potential of the bone, and to facilitate early and pain free recovery and MIPPO technique with the application of LCP offered an ideal combination in terms of bone fixation and soft-tissue sparing.
INTRODUCTION: Clavicle fractures are common injuries in adults, accounting for 5% of all fractures and 44% of all shoulder fractures. Furthermore, there is an increasing incidence of complex fracture patterns after high-energy trauma. Incidence in males is usually highest in second and third decade which decreases thereafter as per age. Clavicles mid shaft fractures have classically been treated non-operatively. However, factors including severity of displacement, degree of comminution, and greater than 2 cm of shortening have been reported in the literature to predispose patients to unsatisfactory outcomes with non-operative treatment. Minimally invasive surgery is increasingly being used for the treatment of mid shaft clavicle fracture. The two most commonly used implant are titanium elastic nail (TEN) and locking compression plate (LCP). Minimally invasive percutaneous plate osteosynthesis (MIPPO) is widely used for long bone fracture. MATERIAL AND METHODS: The patients were selected randomly and were divided in the following two groups of 15 patients each: Group A: 15 patients treated by anatomical locking compression plate (LCP) by open technique. Group B: 15 patients treated by minimal invasive percutaneous osteosynthesis (MIPO) technique. Follow up period were 1 months, 2months and 6months. Functional outcome was evaluated using the constant shoulder score, which is scored from 0 to 100, with a lower score representing a higher level of functional disability. RESULTS: Majority of the patients (40%) in Group A were in the age group of 31-40 years followed by 26.7% in the age group of 21-30 years, 20% in the age group 41-50 years and 13.3% in the age group of 51-60 years. The mean age of the patients was 36.2 ± 9.09 years. Majority of the patients in both groups were male. There were 80% and 73.3% male patients in Group A and Group B respectively whereas female patients constituted 20% and 26.7% of the study group respectively. In Group A, 7 (46.7%) patients had operative time of 80-100 minutes whereas 6 (40%) and 2 (13.3%) patients had operative time of 100-120 and 120-140 minutes respectively. The mean operative time was 104.9 ± 13.52mins. In Group B, 6 (40%) patients had operative time of 80-100 minutes whereas 8 (53.4%) and 1 (6.6%) patients had operative time of 100-120 and 120-140 minutes respectively. The mean operative time was 106.5 ± 11.72mins. There was no significant association between the groups as per Student t-test (p>0.05). CONCLUSION: Operative treatment with a LCP for clavicle shaft fractures can be used to obtain stable fixation. Particularly, MIPPO of displaced mid shaft clavicular fractures resulted in a better cosmetic than conventional open reduction, although the functional outcomes were no different between the two groups.
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