Operative Treatment of Neer Type-II Distal Clavicular Fractures

Abstract

Deforming forces make it difficult to reduce and maintain reduction of Neer type-II distal clavicular fractures. » Contemporary surgical techniques are associated with high rates of union and good and excellent outcomes. » Plate fixation of distal clavicular fractures does not address horizontal and vertical instability. » Hook-plate fixation has the highest complication rate. » Augmentation of the coracoclavicular ligament is recommended to neutralize the opposing forces. Disclosure: No external funds were received in support of this work. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/ JBJSREV/A433).

What are the long-term patient-reported and clinical outcomes after lateral clavicle fractures? A cross-sectional study of 619 patients

“…Furthermore, operative treatment for displaced clavicle fractures yielded a high union rate of 97% in the present study. This is in line with union rates reported in the literature, ranging from 93 to 100% [ 35 ]. Even though operative treatment considerably reduces the rate of nonunions (3%), it was also associated with a high risk (54.4%) of a secondary intervention for elective implant removal.…”

“…Operative treatment for lateral clavicle fractures enables early mobilization, reduced pain and earlier return of function, but also carries the risk of surgery-related complications [23,[32][33][34]. Adverse events are uncommon and may vary between the different treatment options [35]. Complications associated with operative treatment may include fracture-related infection, implant failure, impingement and degenerative acromioclavicular alterations [8,36,37].…”

Platelet-Rich Plasma for Osteoarthritis and Achilles Tendinitis

“…8,11 However, PRP trials for OA and Achilles tendinitis have been mixed, with some studies supporting efficacy and others finding PRP no more effective than placebo. [12][13][14] Clinical trials of OA have generally compared PRP with hyaluronic acid injections, and few trials have compared PRP with intra-articular placebo injections. 13 While some prior trials that compared PRP with saline or hyaluronic acid products for treatment of knee OA were of high quality, others had important limitations, particularly failure to blind participants and outcome assessors.…”

“…[12][13][14] Clinical trials of OA have generally compared PRP with hyaluronic acid injections, and few trials have compared PRP with intra-articular placebo injections. 13 While some prior trials that compared PRP with saline or hyaluronic acid products for treatment of knee OA were of high quality, others had important limitations, particularly failure to blind participants and outcome assessors. 15 Given the heterogeneity in results of RCTs, the American College of Rheumatology and the Osteoarthritis Research Society International recommend against use of PRP for OA whereas the American Academy of Orthopaedic Surgeons provide a "limited" recommendation because of the paucity of high-quality studies and the mixed results of these trials.…”