Clavicular Refracture at the Site of Angular Malunion in Young Athletes

Furey, Matthew J.; Zdero, Radovan; McKee, Michael D.

doi:10.1097/bot.0000000000000765

Cited by 10 publications

(8 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…23 In the NFL, players with nonoperatively managed, displaced midshaft fractures had a reported refracture rate of 57% compared with 5% with plate fixation. 26 Likewise, refracture at the site of a united angular malunion has been reported in adult athletes 11 and pediatric patients at a significantly increased incidence. 22 A recent systematic review of primarily level 2 and level 3 studies reported significantly longer return times and longer return to preinjury level of sport for nonoperatively managed displaced midshaft fractures compared with surgically managed fractures confirmed by meta-analysis of the study results.…”

Section: Discussionmentioning

confidence: 99%

Low-Profile Dual Small Plate Fixation Is Biomechanically Similar to Larger Superior or Anteroinferior Single Plate Fixation of Midshaft Clavicle Fractures

Ziegler¹,

Aman

Storaci

et al. 2019

Am J Sports Med

View full text Add to dashboard Cite

Background: Limited biomechanical data exist for dual small plate fixation of midshaft clavicle fractures, and no prior study has concurrently compared dual small plating to larger superior or anteroinferior single plate and screw constructs. Purpose: To biomechanically compare dual small orthogonal plating, superior plating, and anteroinferior plating of midshaft clavicle fractures by use of a cadaveric model. Study Design: Descriptive laboratory study. Methods: The study used 18 cadaveric clavicle specimens (9 pairs total), and 3 plating techniques were studied: anteroinferior, superior, and dual. The dual plating technique used smaller diameter plates and screws (1.6-mm thickness) than the other, single plate techniques (3.3-mm thickness). Each of the 9 clavicle pairs was randomly assigned a combination of 2 plating techniques, and randomization was used to determine which techniques were used for the right and left specimens. Clavicles were plated and then osteotomized to create an inferior butterfly fracture model, which was then fixed with a single interfragmentary screw. Clavicle specimens were then potted for mechanical testing. Initial bending, axial, and torsional stiffness of each construct was determined through use of a randomized nondestructive cyclic testing protocol followed by load to failure. Results: No significant differences were found in cyclical axial ( P = .667) or torsional ( P = .526) stiffness between plating groups. Anteroinferior plating demonstrated significantly higher cyclical bending stiffness than superior plating ( P = .005). No significant difference was found in bending stiffness between dual plating and either anteroinferior ( P = .129) or superior plating ( P = .067). No significant difference was noted in load to failure among plating methods ( P = .353). Conclusion: Dual plating with a smaller plate-screw construct is biomechanically similar to superior and anteroinferior single plate fixation that uses larger plate-screw constructs. No significant differences were found between dual plating and either superior or anteroinferior single plating in axial, bending, or torsional stiffness or in bending load to failure. Dual small plating is a viable option for fixing midshaft clavicle fractures and may be a useful low-profile technique that avoids a larger and more prominent plate-screw construct. Clinical Relevance: Plate prominence and hardware irritation are commonly reported complaints and reasons for revision surgery after plate fixation of midshaft clavicle fractures. Dual small plate fixation has been used to improve cosmetic acceptability, minimize hardware irritation, and decrease reoperation rate. Biomechanically, dual small plate fixation performed similarly to larger single plate fixation in this cadaveric model of butterfly fracture.

show abstract

Section: Discussionmentioning

confidence: 99%

Low-Profile Dual Small Plate Fixation Is Biomechanically Similar to Larger Superior or Anteroinferior Single Plate Fixation of Midshaft Clavicle Fractures

Ziegler¹,

Aman

Storaci

et al. 2019

Am J Sports Med

View full text Add to dashboard Cite

show abstract

“…Shortening, in particular, has been suggested to Copyright @ 2020 JPOSNA www.jposna.org correlate with decreased range of motion, scapular dyskinesis, and decreased functional scores in adults, though controversy remains as to the degree to which shoulder function is truly affected. [55][56][57][58][59] Malunion has been associated with increased risk of refracture in young adults 60 but likely requires further analysis in children and adolescents. Skeletally immature patients with clavicle fracture malunions do not appear to develop clinically significant loss of shoulder motion, strength, or discomfort.…”

Section: Complicationsmentioning

confidence: 99%

Evaluation and Management of Midshaft Clavicle Fractures in Adolescents

Jasty

Heyworth²

2020

Journal of the Pediatric Orthopaedic Society of North America

View full text Add to dashboard Cite

The rate of operative fixation for completely displaced mid-shaft clavicle fractures in adolescents has been increasing yearly over the last decade, largely driven by studies of adult populations, in whom the rate of nonunion is approximately 15% with non-operative treatment. However, nonunion and symptomatic malunion in younger populations remain rare. Recent studies suggest that functional outcomes are similar between conservative management and operative fixation in adolescents, with higher rates of complications and slightly decreased time to return to sport with operative fixation. Implant-related symptoms after surgery remains an important consideration, due to potential for reoperation for implant removal. Additionally, the cost of operative fixation is significantly higher than that of non-operative management. The aim of this review is to summarize the salient historical and more recent literature regarding displaced mid-shaft clavicle fractures in order to better understand treatment considerations and the natural history of these fractures in the adolescent.

show abstract

“…Two patients with delayed surgical treatment were excluded from the study leaving 17 males (80.9%) and four females (19.1%). The mean age at onset was 15.9 (11)(12)(13)(14)(15)(16)(17)(18)(19) years. Radiographic union was achieved in all patients by the 6-week follow-up.…”

Section: Resultsmentioning

confidence: 99%

“…Masnovi et al demonstrated significantly increased refracture rates (26%) in angulated fractures compared with completely displaced fractures (6%) and clavicle fractures as a whole (1.6%) in pediatric clavicle fractures [10]. Furey et al recently published a study in adolescent athletes who had refractures at the site of angular malunion following nonoperative treatment [11]. Refracture rates with nonoperative…”

Section: Discussionmentioning

confidence: 99%

Plate osteosynthesis of midshaft clavicle fractures in adolescent contact sports athletes - adolescent clavicle fracture

Kamaci

Bess

Glogovac

et al. 2020

Journal of Pediatric Orthopaedics B

View full text Add to dashboard Cite

Surgical treatment of mid-shaft clavicle fractures via anatomical plates in adult athletes is documented to be safe and effective. Functional and cosmetic outcomes in adolescent contact sports athletes have not been well documented. Adolescent athletes (age 11-19) surgically treated for mid-shaft clavicle fractures between 1 May 2011 and 30 October 2017 were included in this study. Twenty-one adolescent athletes with a mean follow-up of 44 months were reviewed. Retrospective chart reviews were performed. Functional and cosmetic outcomes, return to sports time/rate were analyzed using Nottingham Clavicle Scores and a 'Custom Questionnaire'. Return of function and healing, evidenced on radiographs, was achieved in all 21 patients. All patients returned back to competitive sports. The mean time to return back to training was 45.9 ± 16 (24-76) days. Sixteen (76.1%) of the patients reported Nottingham Clavicle Scores with a mean score of 91.7 (85-98). In the Custom Questionnaire, 16 patients who participated in the phone interview were satisfied with the cosmetic outcomes. The most common complaint was implant prominence and irritation in 6 (40%) patients, subsequently requiring implant removal in 3 (18.8%). Surgical fixation of mid-shaft clavicle fractures can lead to excellent union and cosmetic outcomes and a rapid return to sports in adolescent contact sport athletes. However, one should consider the outcomes of implantrelated complaints and the possibility of implant removal surgery in the future.

show abstract

Clavicular Refracture at the Site of Angular Malunion in Young Athletes

Abstract: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Cited by 10 publications

References 7 publications

Low-Profile Dual Small Plate Fixation Is Biomechanically Similar to Larger Superior or Anteroinferior Single Plate Fixation of Midshaft Clavicle Fractures

Low-Profile Dual Small Plate Fixation Is Biomechanically Similar to Larger Superior or Anteroinferior Single Plate Fixation of Midshaft Clavicle Fractures

Evaluation and Management of Midshaft Clavicle Fractures in Adolescents

Plate osteosynthesis of midshaft clavicle fractures in adolescent contact sports athletes - adolescent clavicle fracture

Contact Info

Product

Resources

About