Fracture union and complication following internal fixation of clavicle by plate and screw

Abstract

INTRODUCTIONClavicle is the only bone that is most neglected in a polytrauma patient. But its importance was more convincing after dealing floating shoulder injuries. When there was both clavicle and scapular fracture more attention was given to clavicle fracture to maintain the leverage action of shoulder. Clavicle fracture amounts to 2.6% of all fractures and accounts for 34% to 45% of shoulder girdle injuries in adults.1-3 Of all clavicle fractures it is most common in middle one third i.e. about 69% to 81%, lateral one-third 17% and medial one-third 2%. 4,6 Most of the clavicles fractures are treated nonoperatively, results vary from good union, mal-union to non-union. Even united or not most patients have good functional outcomes and a high level of patient satisfaction except few where there is functional disability following nonunion. 2,7-11As nonoperative treatment are not as favourable as once thought, there is increase trend for internal fixation. 12-13Besides non-union was lower in operated group as compared to conservative group, pooled data showed that 14% of 452 patients in the nonoperative group developed non-union, which is significantly higher (p=0.00001) than the 1.7% rate of non-union in the 507 patients of the ABSTRACT Background: Among all long bones clavicle is the only bone placed horizontally and has membranous ossification. Clavicle fractures accounting for about 2.6% of total body fractures and 34% to 45% of total shoulder girdle injuries in adults. Most fractures occur in middle third of clavicle and common in young male patients. It has wide range of management from conservative to variant internal fixation. Each procedure has its own outcome and complications. We tried to find out the outcome and complications following internal fixation of clavicle with plate and screws. Methods: In a prospective study 50 patients of fracture mid shaft clavicle who were treated with plate and screw were followed for a period of two years. Only adults more than 18 years were included in the study. All patients were followed at 2 nd post-operative day 5 th post-operative day 14 th post-operative day and at 1, 2, 6, 12 and 24 months. Only two parameters were observed i.e. union of fracture and post-operative complications. Results: Of all patients operated with plate and screw 48 patients had good radiological union by six months. Only two patients had non-union and one with implant failure at 12 months. Of complications one had stitch abscess and seven had hardware discomfort. Conclusions: Clavicle fracture in adults has multimodal treatment option. Though conservative management has good results it has high chance of mal-union and non-union. Operative fixation should be opted for adult individuals where chance of non-union is high. Plate and screw fixation has good results in terms of union with least complication.

Effectiveness of plate osteosynthesis in accomplishing the union of middle third clavicle fracture

“…Middle 3 rd clavicle fracture is most common. Clavicle fractures accounting for about 2.6% of total body fractures and 34% to 45% of total shoulder girdle injuries in adults [1] . There are many complications related with conservative management of middle third clavicle fracture.…”

“…Plate osteosynthesis should be considered as the management of choice in middle 3 rd clavicle so that desired outcomes should be achieved Comparison of union achieved through surgical and conservative management After considering the recent studies done regarding achieving the union through various management of middle 3 rd clavicle fracture. Most of the studies including our study shows that union and early activities are mostly achieved by surgical intervention [1][2][3] . The union was assessed through radiographic assessment and functional outcomes were assessed by Constant and Murley Scoring.…”