Fixation of mid-third clavicular fractures with Knowles pins: 78 patients followed for 2-7 years

Chu, Cheng-Mien; Wang, Shyu-Jye; Lin, Leou-Chyr

doi:10.1080/000164702753671696

Cited by 63 publications

(38 citation statements)

References 21 publications

(29 reference statements)

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“…Nearly the same high rates of union and low disability scores were recorded [6][7][8]11], but these methods lack two main features which are fulfilled in our study. First, they do not possess a lag effect as an integral part of their design as does the partially threaded cancellous screw.…”

Section: Discussionmentioning

confidence: 71%

“…There have been many reports [4,[6][7][8][9][10][11][17][18][19][20]] addressing intramedullary fixation with wires and pins. Nearly the same high rates of union and low disability scores were recorded [6][7][8]11], but these methods lack two main features which are fulfilled in our study.…”

Section: Discussionmentioning

confidence: 99%

“…Other relative indications include cases with polytrauma, shortening or displacement more than 20 mm, impending skin disruption, inability of the patient to tolerate prolonged conservative treatment, and symptomatic non-union [3][4][5][6]. Surgical procedures include intramedullary pinning with Kirschner wires [7,8], Rush pins [4], Knowles pins [6], Steinmann pins [9], Hagie pins [10], elastic stable intramedullary nails [11], external fixation [12], and compression plating [13]. Each method has its own merits.…”

Section: Introductionmentioning

confidence: 99%

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Intramedullary screw fixation for midshaft fractures of the clavicle

Khalil

2009

International Orthopaedics (SICOT)

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Open intramedullary fixation of 37 fresh midshaft clavicular fractures in 35 patients was performed using a 6.5 partially threaded cancellous screw. Mean age was 38 years (range 18-65). The screw was inserted from the medial fragment after retrograde drilling of that fragment. Average follow-up period was 21 months (range 9-36). Radiological evidence of union was apparent in all cases within six to eight weeks after surgery (mean 7.8). Two cases had intraoperative failure of fixation, nine complained of subcutaneous prominence of the screw head, five experienced decreased sensation over the site of incision, and three had symptoms of frozen shoulder. In conclusion, the technique is simple, affordable and it does not require special instrumentation or implants. It allows intramedullary compression, stability, stress sharing, minimal periosteal stripping, and early recovery after surgery.Résumé Fixation intramédullaire des fractures diaphysaires de la clavicule. 37 fractures de la partie médiophysaire de la clavicule chez 35 patients ont été traitées par une fixation intramédullaire par voie ascendante, en utilisant une vis spongieuse, de diamètre 6,5. L'âge moyen des patients était de 38 ans (entre 18 et 65). La vis a été insérée à partir du fragment interne après mêchage rétrograde. Le suivi moyen a été de 21 mois (entre 9 et 36 mois). Une consolidation radiologique a été effectuée dans tous les cas à partir de 6 à 8 semaines après l'intervention (moyenne de 7,8 semaines). 2 cas ont présenté un défaut de fixation peropératoire et 9 patients se plaignaient d'une gène secondaire à la proéminence de la vis, 5 de sensations désagréables au niveau de l'incision et 3 avaient des signes d'épaules gelées. En conclusion, cette technique simple et abordable ne nécessite pas d'instrumentation particulière, ni d'implants particuliers et permet une compression intramédullaire avec une bonne stabilité, une bonne répartition des contraintes et d'un dépériostage à minimum ainsi qu'une récupération rapide après l'intervention.

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Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Intramedullary screw fixation for midshaft fractures of the clavicle

Khalil

2009

International Orthopaedics (SICOT)

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“…Intramedullary fixation, n = 6 13,[20][21][22] and 11 studies that included additional morbidity (e.g., floating shoulders, rib fractures) but in which the authors made no distinction between complications after isolated clavicle fractures and fractures with additional injury. 14,[23][24][25][26][27][28][29][30][31][32] In addition, 6 studies included treatment of nonunions or delayed unions and did not make a distinction with the treatment of acute fractures when describing the complications, 16,33-37 2 studies were surgical technique papers, 38,39 1 study reported on plate fixation, 40 1 study lacked a definition for dislocation, 41 1 study did not make a distinction between angulation and comminution, 42 1 study included fewer than 10 patients 15 and, in 1 study, 11 authors reported on a previously reported patient population.…”

Section: Discussionmentioning

confidence: 99%

Systematic review of complications after intramedullary fixation for displaced midshaft clavicle fractures

et al. 2013

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Background:The number of displaced midshaft clavicle fractures treated surgically is increasing, and open reduction and intramedullary fixation is an emerging surgical treatment option. The study quality and scientific levels of published evidence in which possible complications of this treatment are presented vary greatly. Methods:We performed systematic computer-based searches of EMBASE and PubMed/MEDLINE. Studies included for review reported complications after intramedullary fixation alone or in comparison to either treatment with plate fixation and/or nonoperative treatment. The Level of Evidence rating and Quality Assessment Tool were used to assess the methodological quality of the studies. Included studies were ranked according to their levels of evidence.Results: Six articles were eligible for inclusion and final quality assessment; 3 studies were graded the highest level of evidence. Major complications like bone-healing problems and deep infections requiring implant removal were reported at a rate no higher than 7%. Reported rates for minor complications, such as wound infection and implant irritation that could be resolved without further surgery, were as high as 31%. Conclusion:The noted rates for major complications requiring additional surgery were low, but implant-related problems that require additional surgery might present with high prevalence. Owing to routine implant removal, treatment with intramedullary fixation often requires an additional surgical procedure.Contexte : Le nombre de fractures déplacées de la diaphyse claviculaire traitées chirurgicalement est en hausse et la réduction ouverte avec fixation intramédullaire est une option chirurgicale émergente. La qualité des études et le niveau scientifique des preuves publiées concernant les complications possibles de ce traitement varient beaucoup.Méthodes : Nous avons procédé à une interrogation systématique des bases de données informatiques EMBASE et PubMed/MEDLINE. Les études retenues pour examen faisaient état de complications après le recours à la fixation intramédullaire seule ou comparée à un traitement par plaque et vis et(ou) un traitement non chirurgical. Nous avons utilisé le classement par niveaux de preuve ou un outil d'évaluation qualitative pour mesurer la qualité méthodologique des études. Les études retenues ont été classées selon leur niveau de preuve.Résultats : Nous avons retenu 6 articles pour inclusion et évaluation finale de leur qualité; 3 des études présentaient le niveau de preuve le plus élevé. Les complications majeures, notamment des problèmes de cicatrisation de l'os et d'infection profonde nécessitant le retrait de l'implant, ont été signalés selon un taux n'excédant pas 7 %. Les taux de complications mineures rapportées, telles qu'infection de plaie et irritation due à l'implant, qui ont pu rentrer dans l'ordre sans autre chirurgie, se sont élevés à 31 %. Conclusion :Les taux signalés de complications majeures ayant nécessité une autre chirurgie ont été faibles, mais les problèmes relatifs aux implants ay...

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“…[2] Several fixation methods have been reported including plate fixation, [3] intramedullary pin fixation and placement of intramedullary threaded k-wires and elastic intramedullary nails. [4][5][6] Indications for surgery include the need for earlier functional mobilization in the patient with an isolated injury, in addition to open fractures, floating shoulders and patients with polytrauma. [7] In recent times, operative indications includes significant shortening or distraction (>1.5 centimeters), [8] Plate fixation can provide immediate rigid fixation, helping to facilitate early mobilization.…”

Section: Introductionmentioning

confidence: 99%

A Study of Clinical Outcome of Precontoured Plate & Screw Fixation in Fracture Midshaft Clavicle

Ghosh¹,

Banerjee²,

Dasgupta³

et al. 2018

AIMDR

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Variations in the arterial pattern of the upper limb are very common as observed in many cadaveric and angiographic studies. Knowledge of variations in the origin and course of the radial artery is important because they are used for many diagnostic procedures as well as vascular and reconstructive surgeries like coronary angiography, percutaneous coronary intervention and coronary artery bypass surgery. During routine dissection in our institute, we observed a case of high origin of the radial artery in a 33 year old male cadaver. It was found to be unilateral; on left side, radial artery was taking origin from 3 rd part of the axillary artery at the lower border of pectoralis minor before the origin of subscapular artery and anterior circumflex humeral artery. It had a superficial course in the arm crossing the median nerve from medial to lateral side. The further course of this superficial radial artery in the forearm was normal and it terminated by forming a deep Palmar arch in hand. These variations may be of great clinical implications for vascular and plastic surgeons and radiologists. Superficial course of radial artery makes it vulnerable to accidental injuries and elevates the risk of bleeding.

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Fixation of mid-third clavicular fractures with Knowles pins: 78 patients followed for 2-7 years

Cited by 63 publications

References 21 publications

Intramedullary screw fixation for midshaft fractures of the clavicle

Intramedullary screw fixation for midshaft fractures of the clavicle

Systematic review of complications after intramedullary fixation for displaced midshaft clavicle fractures

A Study of Clinical Outcome of Precontoured Plate & Screw Fixation in Fracture Midshaft Clavicle

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