Management of Midclavicular Fractures: Comparison between Nonoperative Treatment and Open Intramedullary Fixation in 80 Patients

Grassi, Federico Alberto; Tajana, Maria Serena; D’Angelo, Fabio

doi:10.1097/00005373-200106000-00019

Cited by 134 publications

(77 citation statements)

References 17 publications

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“…Fractures of the clavicle are among the most common skeletal injuries, and they are usually treated conservatively [1,2]. Surgical treatment may be strongly indicated in cases with open fractures, vascular compromise, progressive neurological deficit and cases with floating shoulder.…”

Section: Introductionmentioning

confidence: 99%

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: Introductionmentioning

confidence: 99%

Intramedullary screw fixation for midshaft fractures of the clavicle

Khalil

2009

International Orthopaedics (SICOT)

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“…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. Reported rates for major complications like bonehealing problems and deep infections requiring implant removal were no higher than 7%.…”

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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“…Eight complications occurred in 16 patients: three cases of posterior skin breakdown due to prominent hardware, two cases of hardware breakage, two cases of decreased sensation over insertion site, and one case of persistent pain. Grassi et al [6] compared nonoperative treatment to open intramedullary fixation of midclavicular fractures and concluded nonoperative treatment was superior due to the much lower complication rate. The intramedullary fixation group experienced eight superficial infections, three refractures, two delayed unions with pin breakage, and two nonunions.…”

Section: Discussionmentioning

confidence: 99%

Excessive Complications of Open Intramedullary Nailing of Midshaft Clavicle Fractures With the Rockwood Clavicle Pin

Mudd

Quigley

Gross

2011

Clinical Orthopaedics &Amp; Related Research

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Management of Midclavicular Fractures: Comparison between Nonoperative Treatment and Open Intramedullary Fixation in 80 Patients

Abstract: According to our experience, we conclude that nonoperative treatment appears more advantageous than open intramedullary fixation for the management of most midclavicular fractures.

Cited by 134 publications

References 17 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

Excessive Complications of Open Intramedullary Nailing of Midshaft Clavicle Fractures With the Rockwood Clavicle Pin

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