Operative Fixation of Displaced Middle Third Clavicle (Edinburg Type 2) Fracture with Superior Reconstruction Plate Osteosynthesis

Abstract

BackgroundConservative management of middle third clavicle fracture has been recently reported with suboptimal outcomes. Despite higher nonunion rates in initial open reduction and internal fixation, understanding the problem better and taking in accounts of previous shortcomings, such fractures can be optimally treated by open reduction and internal fixation with reconstruction plate. ObjectiveTo study the outcome of middle third clavicle fracture treated with superior reconstruction plating in terms of function using Constant shoulder score, union time and rate, complications and patient satisfaction. MethodsTwenty patients with displaced middle third clavicle fracture (Edinburg type 2) treated with open reduction and internal fixation with reconstruction plate implanted in superior surface were prospectively followed for at least one year after surgery. ResultsThere were 20 patients, 16 males and 4 females. The mean age of the patients was 31.5 years with SD 11.5 years (range 15-60 years) and 5 patients (25%) had associated injuries. All fractures united in 16 weeks or less in near anatomic position with complication in 2 (5%) patients, one deep infection and one frozen shoulder which on subsequent management recovered well. There was no nonunion or implant failure. The average Constant score was 97.45 in one year follow up and the patients were relatively satisfied with the treatment.The most common indication (25%) for hardware removal was young age of the patient, hardware prominence and occasional discomfort ConclusionThis small series shows that displaced midshaft clavicle fracture can be optimally treated with operative fixation implanting the reonstruction plate in superior surface with six cortical purchases on either side and supervised physiotherapy, although subsequent surgery for implant removal might be necessary. KEY WORDSmiddle third clavicle fracture, reconstruction plate.

Analysis of Displaced Middle Third Clavicular Fractures Treated By Plate Osteosynthesis

“…In a study by Dhoju et al out of 20 patients 16 were males and 4 were females. From this we can conclude that it is more common in active individuals 18,20 .…”

Symptomatic Nonunion After Fracture Clavicle, What Is the Functional Outcome After Open Reduction and Internal Fixation With a Curved Reconstruction Plate?

“…Traditionally, mid-shaft clavicle fractures have been managed conservatively, even when substantially displaced. Recent literature has highlighted the high non-union rate of displaced mid-shaft clavicle fractures, with a nonunion rate up to 15% 2,7,10 . Nonunion of midclavicular fractures usually leads to shoulder pain, weakness and asymmetry, thus compromising function and cosmetic appearance.…”

“…The disadvantages of plate fixation including, it requires larger incisions and also in thin patients with low body fat, the plate will be palpable under the skin but this is not a problem for most patients. The plates may also require removal in the future 2,6 . In the series by Manske et al 6 , Mukhopadhaya et al 7 and Dhoju et al 2 , the authors suggests that, the plate fixation on the superior surface of the clavicle is a reliable and predictable method of repair and management of clavicle fracture nonunion.…”

“…The role of locking plate fixation for these nonunion had been not well defined in these studies, but in their opinion, they found that the, current locking pelvic reconstruction plates may be too thin for use in all but except with the slightest patients and they concluded that plate fixation applied superiorly is an effective treatment for clavicle nonunion. The autogenous bone graft is not routinely necessary, except when clavicle atrophic nonunion or shortening cannot be corrected without intercalary grafting 2,3,5,6,7,8,10,11 .…”

“…The causes of the fractures were varied from a motorcycle accident in 12 patients, falling from a height in 6 patients or sliding on the floor in 2 patients. The mechanism of injury, where falls onto the affected shoulder with direct impact were in 17 patients, and falling onto an outstretched hand with an indirect impact were in 3 patients, table (1), (2). We included only the symptomatic patients with nonunion, who characterized by, mobility at the fracture site on clinical examination and fracture gap with inadequate callus formation on radiographic examination and there were a significant disability due to pain and inability to use their limbs to normal function.…”