Fracture of distal end clavicle: A review

Sambandam, Balaji; Gupta, Rajat; Kumar, Santosh; Maini, Lalit

doi:10.1016/j.jcot.2014.05.007

Cited by 85 publications

(102 citation statements)

References 54 publications

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“…However, there is no current gold standard for the treatment of these fractures. 3,12 Although nonsurgical treatment of Neer type II distal clavicle fractures has shown satisfactory outcomes for pain, function, and postinjury strength, there is a corresponding increase in the incidence of symptomatic nonunion, cosmetic deformity, and the need for delayed surgery. 13,14 A significant consideration with Neer type II fractures is the higher rate of nonunion.…”

Section: Discussionmentioning

confidence: 99%

“…4 Larger epidemiologic studies have shown that 69% to 85% of clavicle fractures involve the middle one-third of the clavicle, and distal clavicle fractures may occur in 10% to 28% of cases. 3,[5][6][7] Operative management of midshaft clavicle fractures leads to significant functional limitations in up to 25% of military patients 1 year postopera-abstract…”

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confidence: 99%

“…9 As a result, multiple techniques have been described with the use of a variety of implants in an attempt to optimize fixation and patient-reported function. 2, 3,[9][10][11][12] The purpose of this study was to characterize the surgical results of open reduction and internal fixation (ORIF) of type II distal clavicle fractures in a military cohort and to identify risk factors associated with suboptimal functional outcomes.…”

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confidence: 99%

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Predictors of Persistent Pain After Fixation of Distal Clavicle Fractures in an Active Military Population

Lanier¹,

Speirs²,

Koehler³

et al. 2018

Orthopedics

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Patients who undergo open reduction and internal fixation of distal clavicle fractures have a high rate of hardware removal and persistence of symptoms, particularly when attempting to return to high-demand activities. This study evaluated the outcomes of military servicemembers after surgical treatment of distal clavicle fractures. The authors performed a retrospective analysis of active duty servicemembers who underwent open reduction and internal fixation of Neer type II distal clavicle fractures between October 17, 2007, and July 20, 2012, with a minimum of 2-year clinical follow-up. The electronic health record was queried to extract demographic features and clinical outcomes, primarily persistence of pain, removal of hardware, and postoperative return to high-level activity. A total of 48 patients were identified, with mean follow-up of 3.8 years. A total of 44% of patients underwent subsequent hardware removal. All fractures achieved radiographic union, and 35% of patients had persistence of symptoms. Patients who were treated with hook plating had a 3.64-fold higher risk of persistence of pain compared with those treated with conventional plating techniques. A total of 35% of patients successfully returned to full military function and completed a postoperative military deployment. Coracoclavicular reconstruction did not improve outcomes. Persistence of symptoms and requirement for hardware removal were not associated with the rate of postoperative deployment. Achieving excellent functional outcomes with open reduction and internal fixation of distal clavicle fractures remains a challenge. Where possible, conventional plate fixation should be considered over hook plate fixation. However, subsequent hardware removal and continuing shoulder pain do not preclude a return to high-level activity. [Orthopedics. 2018; 41(1):e117-e126.].

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Predictors of Persistent Pain After Fixation of Distal Clavicle Fractures in an Active Military Population

Lanier¹,

Speirs²,

Koehler³

et al. 2018

Orthopedics

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“…Although this type of fracture (and the operative possibilities) is already described by Neer in 1963, till this date there is no universally agreed standard operative procedure for displaced distal clavicle fractures. 5 We found two reviews and a meta-analyses concerning the treatment of a distal clavicle fracture. Oh et al, found no statistical differences in union/non-union rates but more complications in the group treated with a hook plate or Kirschner wires in combination with Tension Band Wiring (TBW).…”

Section: Relevant Literature/discussionmentioning

confidence: 99%

A Distal Clavicle Fracture With Unusual Displacement of the Medial Part: A Case Report

Rijn¹,

Kaas²,

Beumer³

et al. 2016

Emerg Med Open J

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Citation Case ReportPage 39 ABSTRACT Introduction: A 22-year-old man came to the emergency department after a fall on right shoulder. The radiographs showed a distal clavicle fracture with apparent disruption of the acromioclavicular joint (AC-joint). The CT-scan however showed an intact AC-joint with a Neer type IIb fracture pattern, except for a dislocation of the medial fragment to dorsocaudal. Intervention: Ten days after trauma the patient was treated with open reduction and internal fixation using a hook plate. Outcome: Six weeks after surgery the patient had no pain and full range of motion of the arm. Discussion: There are two ways to classify a distal clavicle fracture; the Craig's classification or the Neer classification. In both classifications there is the medial part of the clavicle is elevated in a type IIb distal clavicle fracture. The X-ray in this case was misleading, appearing as a disruption of the AC-joint. In this case there probably was a blow to the shoulder and the medial part of the clavicle was pushed caudally and got captured under the distal fragment of the clavicle. There are two systematic reviews and one meta-analysis about the treatment of a distal clavicle fracture. They all state that a hook plate is the most frequently used fixation technique, although it seems to have the highest complication rate.

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“…The site of fracture also depends upon the age of the patient and mechanism of injury. 6 Elderly men-proximal third clavicle fracture Children-middle third clavicle fracture, undisplaced. Adolescents -middle third clavicle fracture, displaced Middle aged patient-distal third clavicle fractures.…”

Section: Incidence Of Injurymentioning

confidence: 99%

Operative Tr Eatment of Clavicular Fractures: A Prospective Study

Reddy¹,

Reddy²,

Reddy³

et al. 2015

jemds

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BACKGROUND:Fractures of clavicle constitute one of the commonest fractures in orthopaedic practice and till recently most of these fractures were treated conservatively. The advent of various implants for the fixation of these fractures along with safe surgical practices made the surgery more widely accepted and the definite indications for open reduction and internal fixation were formulated. MATERIAL & METHODS: In this prospective study, conducted in the department of orthopedics and Traumatology of Osmania General Hospital, Hyderabad, 4o patients who were operated for fracture clavicle were included. The study period was from September 2012 to September 2014. CONCLUSIONS: Operative treatment of fracture clavicle offers a definitive method of treatment in some specific instances. It reduces the time of union, stiffness of the adjoining joints and morbidity. KEYWORDS: Fracture clavicle, Operative fixation of clavicle, Plate synthesis for clavicle. INTRODUCTION:Clavicle is the bony link from thorax to shoulder girdle and contributes to movements at shoulder girdle. Clavicle fracture is a common traumatic injury around shoulder girdle due to their subcutaneous position. It is caused by either low-energy or high-energy impact. Fracture of the clavicle accounts for approximately 2.6% to 5% of all fractures and up to 35% of injuries to the shoulder girdle. About 70% to 80% of these fractures are in the middle third of the bone and less often in the lateral third (12% to 15%) and medial third (5% to 8%). 1,2 Fractures of the clavicle have been traditionally treated non-operatively. Although many methods of closed reduction have been described, it is recognized that reduction is practically impossible to maintain and a certain amount of deformity and disability is expected in adults. More recent data based on detailed classification of fractures, suggest that the incidence of nonunion in displaced comminuted clavicular fractures in adults is between 10 and 15%. All fractures with initial shortening of >2cm resulted in nonunion. 3,4 Several studies have examined the safety and efficacy of primary open reduction and internal fixation for completely displaced fractures clavicle and noted high union rate with a low complication rate. There are various methods for treating clavicle mid shaft fractures such as pre contoured clavicular locking plates, reconstruction plates, dynamic compression plates, intramedullary nails etc. 5 For lateral third clavicular fracture operative treatments include transacromial Kirschner wire, cancellous compression screw and coracocalvicular screw. AO/ASIF group has recommended the use of tension band wire construct for fixation of displaced lateral third clavicle fracture.The purpose of this study is to gain experience with the surgical management of fresh displaced, comminuted middle third clavicle fractures with plate and screws and Kirschner wires with tension band construct for displaced lateral third clavicle fractures.

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Fracture of distal end clavicle: A review

Cited by 85 publications

References 54 publications

Predictors of Persistent Pain After Fixation of Distal Clavicle Fractures in an Active Military Population

Predictors of Persistent Pain After Fixation of Distal Clavicle Fractures in an Active Military Population

A Distal Clavicle Fracture With Unusual Displacement of the Medial Part: A Case Report

Operative Tr Eatment of Clavicular Fractures: A Prospective Study

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