Abstract:Osteosynthesis using modified oblique locking T-plate and autogenous iliac bone graft results in good to excellent outcomes with the functional improvement for symptomatic nonunions of type II fractures of the distal clavicle. Our method may be primarily considered an useful alternative for symptomatic nonunions of type II distal clavicle fractures, and bone grafting should be considered in all cases.
“…[43] treated 30 patients with a locking T plate and supplementary PDS circlage suturing, achieving union within 10 weeks and good or excellent functional outcomes with a return to premorbid levels of activity in all cases. These results were supported in a recent report by Kang et al [50] in a group of 10 patients with non-unions of the distal lend of the clavicle. Mean time to union was 14 weeks, with all patients demonstrating good or excellent functional scores at final follow up of 24 months.…”
Section: Lateral End Fracturessupporting
confidence: 86%
“…The relatively recent introduction of contoured plates (such as the locking T plate) allows more screws to be placed in the distal fragment, which may improve stability [49]. Clinicial results with pre-contoured plating systems have been positive, with a number of authors reporting good functional outcomes and few complications [43, 50, 51]. Martetschlager et al .…”
Fractures of the clavicle are a common injury and most often occur in younger individuals. For the most part, they have been historically treated conservatively with acceptable results. However, over recent years, more and more research is showing that operative treatment may decrease the rates of fracture complications and increase functional outcomes. This article first describes the classification of clavicle fractures and then reviews the literature over the past decades to form a conclusion regarding the appropriate management.A thorough literature review was performed on assessment of fractures of the clavicle, their classification and the outcomes following conservative treatment. Further literature was gathered regarding the surgical treatment of these fractures, including the methods of fixation and the surgical approaches used. Both conservative and surgical treatments were then compared and contrasted.The majority of recent data suggests that operative treatment may be more appropriate as it improves functional outcome and reduces the risk of complications such as non-union. This is particularly evident in mid shaft fractures, although more high grade evidence is needed to fully recommend this, especially regarding certain fractures of the medial and lateral clavicle.
“…[43] treated 30 patients with a locking T plate and supplementary PDS circlage suturing, achieving union within 10 weeks and good or excellent functional outcomes with a return to premorbid levels of activity in all cases. These results were supported in a recent report by Kang et al [50] in a group of 10 patients with non-unions of the distal lend of the clavicle. Mean time to union was 14 weeks, with all patients demonstrating good or excellent functional scores at final follow up of 24 months.…”
Section: Lateral End Fracturessupporting
confidence: 86%
“…The relatively recent introduction of contoured plates (such as the locking T plate) allows more screws to be placed in the distal fragment, which may improve stability [49]. Clinicial results with pre-contoured plating systems have been positive, with a number of authors reporting good functional outcomes and few complications [43, 50, 51]. Martetschlager et al .…”
Fractures of the clavicle are a common injury and most often occur in younger individuals. For the most part, they have been historically treated conservatively with acceptable results. However, over recent years, more and more research is showing that operative treatment may decrease the rates of fracture complications and increase functional outcomes. This article first describes the classification of clavicle fractures and then reviews the literature over the past decades to form a conclusion regarding the appropriate management.A thorough literature review was performed on assessment of fractures of the clavicle, their classification and the outcomes following conservative treatment. Further literature was gathered regarding the surgical treatment of these fractures, including the methods of fixation and the surgical approaches used. Both conservative and surgical treatments were then compared and contrasted.The majority of recent data suggests that operative treatment may be more appropriate as it improves functional outcome and reduces the risk of complications such as non-union. This is particularly evident in mid shaft fractures, although more high grade evidence is needed to fully recommend this, especially regarding certain fractures of the medial and lateral clavicle.
“…The findings of Gilde et al [17] that non-locking plates result in a higher non-union rate in comparison to locking plates in the treatment of midshaft clavicular fractures confirm the relevance of angle stable implants. In addition locking plates lead to promising results even in high demanding clavicular non-unions such as long standing non-unions with poor bone stock [18] and non-unions of the distal clavicle [19]. Fig.…”
Background: Treatment of clavicular non-and malunion is still challenging. Current surgical procedures often result in frustrating functional outcome along with high-grade subjective impairment and increased rates of revision surgery. However, the combination of biological augmentation with vital bone graft and a biomechanically sufficient fixation system seems to be a promising concept of treatment. Methods: In this retrospective study, 14 patients with a mean age of 44 years (26-67 years) suffering from non-union (n = 11) and/or malunion (n = 3) of the clavicle were enrolled. All patients were surgically treated using an anatomical precontoured locking compression plate (LCP) and autologous iliac crest bone graft. Functional outcome was assessed using the age-and sex-specific relative Constant Score.
“…Acute clavicle shaft fractures occur frequently and account for 2%–5% of all fractures [ 1 , 2 ], and there is still an ongoing debate on how to treat these fractures. The decision for treatment should be drawn by addressing the fracture site and the fracture stability; a relative consensus should exist for a conservative treatment to address stable, minimally displaced fractures of the clavicle shaft, while a surgical intervention may be required in cases of neurovascular compromise, open fractures, significant fracture displacement [ 3 ] or lateral fractures [ 4 ]. Generally, a trend in favour of a surgical therapy can be observed and includes plating using low-contact plates or minimally invasive intramedullary devices such as titanium elastic nails [ 5 , 6 ].…”
Section: Introductionmentioning
confidence: 99%
“…Risk factors for non-union include a clavicle shortening of >2 cm [ 12 ], displaced and unstable lateral Neer type II fractures [ 4 ] and particularly in combination with initial severe soft tissue trauma [ 8 ].…”
BackgroundClavicle non-unions can occur after both conservative and operative treatment failure. Here, we investigated the outcome of patients with delayed fracture healing or non-unions of the clavicle. Patients underwent revision surgery by plate osteosynthesis of the clavicle with or without bone grafting. Our aim was to determine rates of bone healing and the functional long-term outcome.MethodsThe study population of 58 consecutive patients was divided into group 1 (n = 25; no bone graft) and group 2 (n = 33; iliac crest bone graft). Bone consolidation was determined by the Lane-Sandhu score preoperatively and after 2.2 ± 1.8 years, respectively. The functional long-term outcome was determined after 8.9 ± 2.7 years in all available patients (n = 30) by the Constant score, DASH (Disabilities of the Arm, Shoulder and Hand) score and SF-36, and clavicle length was measured by ultrasound as compared to the healthy side.ResultsClavicle consolidation was achieved in 54 out of 58 patients (93.1%) after revision surgeries. The radiographic score and bone consolidation rates were significantly higher in group 2 (93.3%) as compared with 72% in group 1 (p = 0.02), resulting in a significantly shorter time to bone consolidation in group 2. Similarly, the relative risk for additional surgery after the first revision surgery was 4.7-fold higher in group 1 (p = 0.02). The long-term results showed overall very good results in DASH score (14.9 ± 16.5) and good results in Constant scores (77.9 ± 19.9). The group analyses found significantly better Constant scores and better visual analogue pain scale (VAS) numbers in group 2. Clavicle shortening appeared to affect the clinical results, and a mild correlation between shortening and Constant scores (R = −0.31) was found.ConclusionsThis study shows high rates of bone healing and good functional outcomes after surgical revision of clavicle non-unions and further demonstrates that additional bone graft could significantly accelerate bone healing. This indicates that revision surgery of clavicle non-unions might preferably be done with additional bone graft, even if the surgeon considers that bone healing might be achieved without bone grafting.
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