Abstract:Patients suffering from extremely medial clavicle fractures combined with distinct displacement generally need surgical intervention. Double-plate fixation is a widely applied technique in the treatment of distal radius fracture, which has been reported to fix lateral clavicle fracture as well. This study reveals the effect of double-plate fixation as an innovative procedure in the treatment of extremely medial clavicle fractures for the first time.
Nine patients complaint of extremely medial clavic… Show more
“…The Disabilities of the Arm, Shoulder and Hand (DASH) score was the most commonly reported functional outcome measure. 3 , 5 , 15 , 16 , 19 , 27 , 37 Shoulder range of motion, 3 , 5 , 14 , 15 , 16 , 19 , 27 , 30 , 34 return to work, 14 , 15 , 24 , 27 , 30 , 34 and complications 3 , 5 , 7 , 14 , 15 , 16 , 19 , 23 , 24 , 27 , 34 , 35 were also frequently reported.…”
Section: Resultsmentioning
confidence: 99%
“…Outcomes following nonoperative treatment were reported for 39 patients 3 , 22 , 23 , 24 , 35 and after operative treatment for 96 patients. 3 , 5 , 7 , 14 , 15 , 16 , 19 , 27 , 30 , 34 , 37 Figure 1 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram. …”
Section: Resultsmentioning
confidence: 99%
“… 3 , 5 , 7 , 15 , 16 , 19 , 28 , 30 , 34 About 75% of patients had a computed tomography scan in conjunction with a plain radiograph. 3 , 7 , 14 , 15 , 27 , 34 , 35 All studies, except one, 30 defined the medial end of the clavicle to be either the medial 1/5 or 1/3 of the clavicle. Twelve studies 3 , 5 , 7 , 14 , 15 , 19 , 22 , 23 , 24 , 27 , 35 , 37 defined fracture displacement using either the Robinson (>100% translation of major fracture fragments), 22 Throckmorton (>10 mm displacement), 33 or AB (no contact between fracture ends) 35 classification systems ( Table I ) with 3 studies having no definition.…”
Section: Resultsmentioning
confidence: 99%
“… 3 , 7 , 14 , 15 , 27 , 34 , 35 All studies, except one, 30 defined the medial end of the clavicle to be either the medial 1/5 or 1/3 of the clavicle. Twelve studies 3 , 5 , 7 , 14 , 15 , 19 , 22 , 23 , 24 , 27 , 35 , 37 defined fracture displacement using either the Robinson (>100% translation of major fracture fragments), 22 Throckmorton (>10 mm displacement), 33 or AB (no contact between fracture ends) 35 classification systems ( Table I ) with 3 studies having no definition. 16 , 30 , 34 The operative group, which included the treatment of 5 nonunions 7 , 16 , 27 and 8 physeal fractures, 27 , 34 had an overall mean follow-up of 23 months (range, 3-124 months).…”
Section: Resultsmentioning
confidence: 99%
“… 7 , 15 , 27 , 30 , 34 , 37 Some authors used a variety of plates including distal radius, 27 distal humerus, 7 and pilon locking plates. 19 Hook plate fixation 5 and double-plating 14 were also reported. When plating, most authors placed the medial screws in a unicortical fashion 15 , 27 , 30 , 34 , 37 due to the close proximity of underlying mediastinal structures.…”
“…The Disabilities of the Arm, Shoulder and Hand (DASH) score was the most commonly reported functional outcome measure. 3 , 5 , 15 , 16 , 19 , 27 , 37 Shoulder range of motion, 3 , 5 , 14 , 15 , 16 , 19 , 27 , 30 , 34 return to work, 14 , 15 , 24 , 27 , 30 , 34 and complications 3 , 5 , 7 , 14 , 15 , 16 , 19 , 23 , 24 , 27 , 34 , 35 were also frequently reported.…”
Section: Resultsmentioning
confidence: 99%
“…Outcomes following nonoperative treatment were reported for 39 patients 3 , 22 , 23 , 24 , 35 and after operative treatment for 96 patients. 3 , 5 , 7 , 14 , 15 , 16 , 19 , 27 , 30 , 34 , 37 Figure 1 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram. …”
Section: Resultsmentioning
confidence: 99%
“… 3 , 5 , 7 , 15 , 16 , 19 , 28 , 30 , 34 About 75% of patients had a computed tomography scan in conjunction with a plain radiograph. 3 , 7 , 14 , 15 , 27 , 34 , 35 All studies, except one, 30 defined the medial end of the clavicle to be either the medial 1/5 or 1/3 of the clavicle. Twelve studies 3 , 5 , 7 , 14 , 15 , 19 , 22 , 23 , 24 , 27 , 35 , 37 defined fracture displacement using either the Robinson (>100% translation of major fracture fragments), 22 Throckmorton (>10 mm displacement), 33 or AB (no contact between fracture ends) 35 classification systems ( Table I ) with 3 studies having no definition.…”
Section: Resultsmentioning
confidence: 99%
“… 3 , 7 , 14 , 15 , 27 , 34 , 35 All studies, except one, 30 defined the medial end of the clavicle to be either the medial 1/5 or 1/3 of the clavicle. Twelve studies 3 , 5 , 7 , 14 , 15 , 19 , 22 , 23 , 24 , 27 , 35 , 37 defined fracture displacement using either the Robinson (>100% translation of major fracture fragments), 22 Throckmorton (>10 mm displacement), 33 or AB (no contact between fracture ends) 35 classification systems ( Table I ) with 3 studies having no definition. 16 , 30 , 34 The operative group, which included the treatment of 5 nonunions 7 , 16 , 27 and 8 physeal fractures, 27 , 34 had an overall mean follow-up of 23 months (range, 3-124 months).…”
Section: Resultsmentioning
confidence: 99%
“… 7 , 15 , 27 , 30 , 34 , 37 Some authors used a variety of plates including distal radius, 27 distal humerus, 7 and pilon locking plates. 19 Hook plate fixation 5 and double-plating 14 were also reported. When plating, most authors placed the medial screws in a unicortical fashion 15 , 27 , 30 , 34 , 37 due to the close proximity of underlying mediastinal structures.…”
Background
Medial clavicle fractures are uncommon, occurring in older and multiply injured patients. The management of these fractures and the factors that predispose toward poor outcomes are controversial. Furthermore, the functional outcomes of treatment are not well characterized or correlated with fracture patterns.
Questions/purposes
(1) To determine minimum 1-year functional outcomes using QuickDASH scores and pain scores after medial clavicle fractures and (2) to identify factors associated with these outcome variables.
Methods
In an institutional review board–approved, retrospective study, we identified adult patients with medial clavicle fractures at two tertiary care referral centers in a single metropolitan area in the United States from January 2010 to March 2019. Our initial query identified 1950 patients with clavicle fractures, from which 74 adult patients with medial clavicle fractures and at least 1 year of follow-up were identified. We attempted to contact these eligible patients by telephone for functional outcomes and pain scores. Twenty-six patients were deceased according to the most recent Social Security Death Index data and public obituaries, three declined participation, and 14 could not be reached, leaving 42% of the total (31 of 74) and 65% (31 of 48) of living patients included in the analysis. Demographic characteristics, fracture characteristics, and clinical and radiographic union as assessed by plain radiography and CT were collected through record review. Twenty-nine patients were treated nonoperatively and two patients underwent open reduction internal fixation. Sixty-eight percent (21 of 31) of the included patients also had radiographic follow-up at least 6 weeks postoperatively; two patients had persistent nonunion at a mean of 5 ± 3 years after injury. Our primary response variable was the QuickDASH score at a minimum of 1 year (median [range] 5 years [2 to 10]). Our secondary response variable was the pain score on a 10-point Likert scale. A bivariate analysis was performed to identify factors associated with these response variables. The following explanatory variables were studied: age, gender, race, dominant hand injury, employment status, manual labor occupation, primary health insurance, social deprivation, BMI, diabetes mellitus, smoking status, American Society of Anesthesiologists physical status classification, Charlson Comorbidity Index, nonisolated injury, high-energy mechanism of injury, nondisplaced fracture, fracture comminution, superior-inferior fracture displacement, medial-lateral fracture shortening, and surgical treatment of the medial clavicle fracture.
Results
The mean QuickDASH score was 12 ± 15, and the mean pain score was 1 ± 1 at a mean of 5 ± 3 years after injury. The mortality rate of the cohort was 15% (11 of 74) at 1 year, 22% (16 of 74) at 3 years, and 34% (25 of 74) at 5 years after injury. With the numbers available, no factors were associated with the QuickDASH score or pain score, but it is likely we were underpowered to detect potentially important differences.
Conclusion
Medial clavicle fractures have favorable functional outcomes and pain relief at minimum 1-year follow-up among those patients who survive the trauma, but a high proportion will die within 3 years of the injury. This likely reflects both the frailty of a predominantly older patient population and the fact that these often are high-energy injuries. The outcome measures in our cohort were not associated with fracture displacement, shortening, or comminution; however, our sample size was underpowered on these points, and so these findings should be considered preliminary. Further studies are needed to determine the subset of patients with this injury who would benefit from surgical intervention.
Level of Evidence
Level IV, therapeutic study.
Case:
A 67-year-old patient sustained a medial clavicle fracture (MCF) treated with open reduction and fixation with cerclage sutures. A year later, he presented with symptomatic nonunion and skin prominence, which was revised with an intramedullary tendon allograft fixation including the sternoclavicular joint. At 31 months after the procedure, the patient showed no pain or clinical instability.
Conclusion:
MCF is an uncommon injury. Symptomatic nonunion after the failure of fixation is rarely described. Although the best way to treat this complication is debatable, revision fixation using an intramedullary tendon allograft can be a viable option in elderly patients.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
