Plate Fixation Versus Nonoperative Treatment for Displaced Midshaft Clavicular Fractures

Woltz, Sarah; Krijnen, Pieta; Schipper, Inger B.

doi:10.2106/jbjs.16.01068

Cited by 99 publications

(91 citation statements)

References 26 publications

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“…And over 80% of clavicle fractures involve the midshaft, and over half of these fractures are displaced in the reason of the relatively narrow cross-section of the bone experiencing excessive torsional or bending stress [1,2]. Due to high-quality randomized controlled studies reporting, the treatment have changed a lot in the past few decades, significantly decreased rates of nonunion and symptomatic malunion in surgery compared with nonoperative treatment [1,[3][4][5][6][7][8]. For athletes, high return rate, faster return to play, and excellent patient-reported outcomes have been reported after fixation.…”

Section: Introductionmentioning

confidence: 99%

“…Although various fixation methods of midshaft clavicle fractures have been reported by multifarious techniques, plate fixation remains the most established method. Fixations including anterior plate, superior plate, or spiral plate, and, more recently, dual small plate fixation have been reported as can minimize hardware-related complications [2,7,[9][10][11][12]. Plate hardware irritation and prominence are commonly reported as reasons for revision surgeries [3,6,13].…”

Section: Introductionmentioning

confidence: 99%

“…On the contrary, higher patient cosmetic acceptability has been reported with small single plate fixation compared with larger, more prominent plates (95% vs 50%, respectively). Recently, excellent clinical outcomes, 100% union rate, and 0% reoperation rate have been reported with dual small plate fixation [7,10,11,[13][14][15][16]. This has caused clinical interest in dual small plating, to minimize hardware irritation and reoperation rates.…”

Section: Introductionmentioning

confidence: 99%

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Finite element analysis of dual small plate fixation and single plate fixation for treatment of midshaft clavicle fractures

Zhang

Chen

et al. 2020

J Orthop Surg Res

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Background: Midshaft clavicle fractures are one of the most familiar fractures. And, dual small plate fixation has been reported as can minimize hardware-related complications. However, the biomechanical properties of the dual small plate fixation have not yet been thoroughly evaluated. Here, we report the results of a finite element analysis of the biomechanical properties of midshaft clavicle fractures treated with dual small plating and superior and anteroinferior single plate fixation. Methods: A three-dimensional (3D) finite element model of the midshaft clavicle fractures was created, whose 4mm transverse fracture gap, having an angle < 30 degree and devoid of overlapping triangles, was simulated between the fractured segments of the middle-shaft of the clavicle. The equivalent von Mises stress and displacement of the model was used as the output measures for analysis. Results: No significant differences were found between dual plating, superior or anteroinferior single plating in cantilever bending, axial compression, and axial torsion. Dual plating with a smaller plate-screw construct is biomechanically eligible to compare with superior and anteroinferior single plate fixation using larger plate-screw constructs.Conclusions: This study demonstrated that larger plate-screw constructs for the treatment of simple are placed clavicular fractures; however, weight-bearing and exorbitant shoulder activity should be avoided after the operation. Therefore, dual plating may provide a viable option for fixing midshaft clavicle fractures and, thus, may be preferred for patients who need early activity.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Finite element analysis of dual small plate fixation and single plate fixation for treatment of midshaft clavicle fractures

Zhang

Chen

et al. 2020

J Orthop Surg Res

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“…Many primary studies and systematic reviews have been conducted comparing operative to nonoperative interventions for midshaft clavicle fractures. However, this is the first study to analyze the differences in nonunion rates, functional outcomes, and residual pain among nonoperative rehabilitation protocols depending upon effect of immobilization and/or functional rehabilitation.…”

Section: Discussionmentioning

confidence: 99%

Healing, Pain and Function after Midshaft Clavicular Fractures: A Systematic Review of Treatment with Immobilization and Rehabilitation

Catapano

Hoppe

Henry

et al. 2019

PM&R

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Objective To systematically evaluate the scientific literature examining the efficacy of nonoperative management for midshaft clavicular fractures, specifically looking at the effect of immobilization and/or functional rehabilitation. Type Systematic review. Literature Survey MEDLINE (PubMed), EMBASE, CINAHL databases were searched. Methodology Inclusion criteria included adult patients enrolled in a controlled study evaluating bony healing, pain and/or function‐related improvements after a strict nonoperative treatment plan for management of midshaft clavicle fractures. Synthesis A total of 10 articles were included in the study. Only four studies contained level I evidence; four studies were prospective case series without a control, and one was a retrospective case series without a control. Half of studies used a strict immobilization period, and most utilized a period of functional rehabilitation. There were no direct comparisons between rehabilitation protocols. Studies without a strict immobilization period had a nonunion rate of 5% to 24% and residual pain in 35% to 83% of patients compared to studies with a strict immobilization period with a nonunion rate of 3% to 29% and residual pain in 14% to 49% of patients. Studies including functional rehabilitation protocol reported functional as measured by the Constant Shoulder Score of 87.8 to 96, out of a maximum of 100 representing no functional limitations, and nonunion rates of 12% to 25% compared to 81 to 85 and 3% to 29% in those without a rehabilitation protocol. Conclusions No studies directly examine the effect of immobilization and functional rehabilitation on clinical outcomes for midshaft clavicular fractures. Future studies are needed to better elucidate the most effective treatment. Level of Evidence I

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“…Clavicular fractures are common and typically occur in young patients, leading to a burden for this active population [1,2]. Clavicle fractures are categorized as proximal, midshaft, or distal fractures.…”

Section: Introductionmentioning

confidence: 99%

Clavicle hook plate versus distal clavicle locking plate for Neer type II distal clavicle fractures

Jiang

et al. 2019

J Orthop Surg Res

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Background: The purpose of this meta-analysis was to compare clavicle hook plates versus distal clavicle locking plates for the treatment of Neer type II distal clavicle fractures. were systematically searched without language restrictions for literature retrieval. The Constant-Murley shoulder joint function score at 3 and 6 months after the operation and the postoperative complications after the operation (shoulder joint pain, abduction restriction, fracture delay healing, subacromial impingement) were the outcomes. Stata 12.0 was used for the meta-analysis. Results: A total of 9 clinical trials involving 446 patients were finally included in this meta-analysis. The results showed that the improvement in the Constant-Murley shoulder joint function score in the distal locking plate group was better than that in the clavicle hook plate group at 3 and 6 months after the operation (P < 0.05). There were fewer cases of shoulder joint pain and restricted shoulder abduction range of motion in the distal locking plate group, and the difference was statistically significant (P < 0.05). There were no statistically significant differences in fracture delay healing and subacromial impingement between the two groups (P > 0.05). Conclusion: Compared with the clavicular hook plate, the distal clavicle locking plate for the treatment of Neer type II distal clavicle fractures is associated with better shoulder function recovery and fewer complications related to pain and abduction restriction.

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Plate Fixation Versus Nonoperative Treatment for Displaced Midshaft Clavicular Fractures

Abstract: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Cited by 99 publications

References 26 publications

Finite element analysis of dual small plate fixation and single plate fixation for treatment of midshaft clavicle fractures

Finite element analysis of dual small plate fixation and single plate fixation for treatment of midshaft clavicle fractures

Healing, Pain and Function after Midshaft Clavicular Fractures: A Systematic Review of Treatment with Immobilization and Rehabilitation

Clavicle hook plate versus distal clavicle locking plate for Neer type II distal clavicle fractures

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