Plate fixation of fresh displaced midshaft clavicle fractures

Shen, Wun-Jer; Liu, Tsung-Jen; Shen, Young-Shung

doi:10.1016/s0020-1383(99)00140-0

Cited by 159 publications

(127 citation statements)

References 13 publications

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“…4,[15][16][17] However, recent studies have demonstrated higher rates of nonunion and poor functional outcomes after nonoperative treatment, while the results of primary operative treatment have improved considerably. 8,18,19 The deforming force of sternocledomastoid is very strong and cannot be overcome by external supports provided by arm sling or figure of eight bandage. 20 Neer's nonunion rate of 1% is misleading as more recent studies show higher rates of nonunion in displaced midshaft clavicle fracture treated conservatively.…”

Section: Discussionmentioning

confidence: 99%

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

Dhoju¹,

Shrestha²,

Parajuli³

et al. 2012

Kathmandu Univ. Med. J.

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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.

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Section: Discussionmentioning

confidence: 99%

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

Dhoju¹,

Shrestha²,

Parajuli³

et al. 2012

Kathmandu Univ. Med. J.

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“…Time take for the wound healing was 12 days (10-15 days). Average time taken for union in non-operative cases was 16.3 (12-30) weeks, whereas in operative group it was 10.75 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) weeks. In non-operative group there were 3 (8.75%) cases of non-union, 15 (42.8%) mal-union, 5 (14.2%) had muscle wasting, 4 (11.4%) had pressure symptoms in upper limb ( which recovered automatically after loosening the brace), 2 (5.71%) had stiffness of shoulder(which recovered with physiotherapy), 8 (22.85%) patients complaint of pain after union (all of these had marked shortening of clavicle >15mm).…”

Section: Observation and Resultsmentioning

confidence: 99%

“…2 Clavicle act as strut to keep upper limb away from the trunk and transmit forces from upper limb to trunk, so displaced fracture of clavicle may result in non-union, mal-union with poor functional outcome and cosmetic deformity. [7][8][9] So the pendulum of the management is shifting towards operative management for clavicle fractures, but operative treatment has its own complication like cost of treatment (particularly in developing countries), infection, complication of anaesthesia and injuries to nerve and vessel. Fortunately injury to major nerve is very rare except injury to supraclavicular nerve which is a common complication with 10-29% incidence, [7][8][9] this leads to cutaneous hypoesthesia in the infraclavicular region shown to be as high as 55.3%.…”

Section: Introductionmentioning

confidence: 99%

“…[7][8][9] So the pendulum of the management is shifting towards operative management for clavicle fractures, but operative treatment has its own complication like cost of treatment (particularly in developing countries), infection, complication of anaesthesia and injuries to nerve and vessel. Fortunately injury to major nerve is very rare except injury to supraclavicular nerve which is a common complication with 10-29% incidence, [7][8][9] this leads to cutaneous hypoesthesia in the infraclavicular region shown to be as high as 55.3%. 10 So there is no uniform consensus o treatment of clavicle fracture.…”

Section: Introductionmentioning

confidence: 99%

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Observational study to compare the outcome of non-operative and operative management of displaced fracture clavicle: A retrospective study

2020

IJOS

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Introduction: For centuries fracture of clavicle has been treated conservatively non-union of clavicle fracture is rare, Mal-union was considered to be of radiographic importance only. The scenario has changed and there has been a shift towards operative treatment on union, cosmesis, early recovery grounds. Both the methods is compared taking into account the union, cosmesis, early recovery, functional outcome and satisfaction of the patient. Materials and Methods: Total 70 patients of displaced fracture of clavicle (AO B1 & B2) were divided into two groups that is non-operative and operative. The informed consent was taken. The patient were explained about both modalities & procedure, cost, outcome and complications of each modality. After the decision of the patient he was allotted to Group I (conservative) & Group II (operative) the study was carried out till 35 patients were included in each group. The follow-up of both group's patients were done at 6 weeks, 3 months, 6 months using patients subjective evaluation, DASH score, range of motion, radiological assessment and complication if any. Observation and Result: Of all 70 patients the age varied between 20-66 years with mean age was 34.5 years. In the conservative group 23(65.7%) and in operative group 26 (74.2%) had dominant side involvement. In non-operative group there were 3(8.75%) cases of non-union, 15 (42.8%) mal-union, 5 (14.2%) muscle wasting, and 4 (11.4%) pressure symptoms in upper limb 2 (5.71%) stiffness of shoulder, 8 (22.85%) pain after union. Of 15 cases of mal-union only 7 (20%). 5 (14.28%) patients complaint of hardware prominence and irritation. Total 4 (11.42%) patients needed implant removal (2 due to infection and 2 due to hardware problem). 6 (17.14%) patients complaint of postoperative infraclavicular hypoesthesia. The DASH score was superior in Group II over I at 6 weeks and at 3 months. Overall in non-operative patients 22 (62.85%) were satisfied (17.14%) were not satisfied in operative group 28(80%) were satisfied while 7 (20%) were unsatisfied. The average follow-up period was 9.5 months (6-18 months). Conclusion: Though operative treatment is better in terms of early mobilization, union, absence of mal-union, cosmetically well accepted, it has its own complication which should also be taken into consideration while choosing between the two modalities. Seeing at satisfaction level in patient related to functional outcome the conservative treatment plays a vital role in poor patients.

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“…Older studies suggested that clavicle fracture, even when significantly displaced, was an essentially benign injury with inherently good prognosis when treated non operatively. 4,5 Proponent of early fixation of fresh clavicle fracture is to prevent complication, like non-union, malunion, shoulder ABSTRACT Background: Clavicle fracture is one of common bony injury; which is more common in young active individual. It has been traditionally treated with non-operative method.…”

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confidence: 99%

Functional outcome of open reduction and internal fixation of clavicle fracture

Pillai

2016

Int J Res Med Sci

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INTRODUCTIONClavicle is the bony link between thorax and shoulder girdle which contributes movement at shoulder girdle. Clavicle fracture is one of the common bony injury around the shoulder joint due to their subcutaneous position. It is more common in young active individual, who participate in activities or sports where high speed fall (e.g. Bicycling, motorcycle) or violent collision (e.g. Football, hockey) are frequent, road traffic accident, fall from height, fall directly over the shoulder or fall on outstretched hand (indirect trauma). Fracture clavicle accounts for approximately 5% to 10% of all fracture and up to 44% of injuries of shoulder girdle. Majority of clavicle fracture occur in mid-shaft of the bone around 80% to 85% where the typical compressive forces applied to the shoulder and the narrow cross section of the bone combine and result in bony failure. Distal third accounts for 20%14-18 and medial third fracture are rarest 5%. 1-3Fracture clavicle have been traditionally treated conservatively with closed manipulation and various method of immobilization; figure of eight splint most commonly used. Older studies suggested that clavicle fracture, even when significantly displaced, was an essentially benign injury with inherently good prognosis when treated non operatively. 4,5 Proponent of early fixation of fresh clavicle fracture is to prevent complication, like non-union, malunion, shoulder ABSTRACT Background: Clavicle fracture is one of common bony injury; which is more common in young active individual. It has been traditionally treated with non-operative method. This present study was undertaken to study the role of the surgical management in the fresh middle third clavicle fracture. Methods: 30 adult patients (21 male and 9 female) of average age of 32 years presented with fresh middle third clavicle fracture and treated surgically with open reduction and internal fixation with plate and screws and followed. Study conducted between November 2011 to November 2012. Results: In 27 patients fracture were united at end of 12 weeks, in 2 patients fracture were united at end of 24 weeks and 1 patient went for non-union. One patient had superficial infection. None had deep infection. One patient had plate loosening at 4week but fracture was united at the end of 24 weeks. 2 patients had persistent pain which is controlled with occasional analgesic but not effecting ordinary work. One patient had gross restriction of shoulder movement. Functional outcome assessed according to near shoulder scoring system. 24 patients had excellent result, 4 patients had satisfactory result, 1 patient had unsatisfactory result and 1patients had failure. Conclusions: The study showed rigid fixation with plate and screw for fresh middle third clavicle fracture especially displaced and comminuted give immediate pain relief and prevent the development of shoulder stiffness &non-union and give good functional outcome.

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Plate fixation of fresh displaced midshaft clavicle fractures

Cited by 159 publications

References 13 publications

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

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

Observational study to compare the outcome of non-operative and operative management of displaced fracture clavicle: A retrospective study

Functional outcome of open reduction and internal fixation of clavicle fracture

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