What is the hardware removal rate after anteroinferior plating of the clavicle? A retrospective cohort study

Baltes, Thomas P. A.; Donders, Johanna C. E.; Kloen, Peter

doi:10.1016/j.jse.2017.03.011

Cited by 21 publications

(17 citation statements)

References 45 publications

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“…26 Several authors have suggested to positioning the clavicle plate anteroinferior in order to reduce implant related complications. 7,12,17,27 Although the scientific evidence suggests that an anteroinferior position could be associated with a decreasing incidence of symptomatic hardware, it is associated with a more extensive muscle dissection and most available plates are designed for a superior position. 17 The renewed interest in midshaft clavicular fracture fixation has led to several anatomical studies that have focused on how current plates fit the clavicle.…”

Section: Introductionmentioning

confidence: 99%

Why off-the-shelf clavicle plates rarely fit: anatomic analysis of the clavicle through statistical shape modeling

Vancleef

Herteleer

Carette

et al. 2019

Journal of Shoulder and Elbow Surgery

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Background The clavicle presents a large variability in its characterizing sigmoid shape. Prominent and nonproperly fitting fixation plates (FP) cause soft tissue irritation and lead to hardware removal. It is therefore key in FP design to account for shape variations. Statistical shape models (SSMs) have been built to analyze a cluster of complex shapes. The goal of this study was to describe the anatomical variation of the clavicle using SSMs. Methods Two different SSMs of the clavicle were created and their modes of variation were described. One model contained 120 left male and female clavicles. The other model consisted of 76 left and corresponding right clavicles, 41 originating from men and 35 from women. Results The model of 120 left clavicles showed that 10 modes of variation are necessary to explain 95% of the variation. The most important modes of variation are the clavicle length, inferior-superior bow, and medial and lateral curvature. Statistically significant differences between male and female clavicles were seen in length, sigmoid shape, and medial curvature. Comparison in men between left and right revealed significant differences in length and medial curvature. For women, a statistically significant difference between left and right was only seen in the length. Conclusion Although the operative treatment of displaced midshaft clavicular fractures has clear benefits, the variable anatomy of the clavicle often makes it challenging for the surgeon to make the plate fit adequately. Based on the identified variability in the clavicle's anatomy, it seems unlikely that a clavicle plating system can fit the entire population.

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Section: Introductionmentioning

confidence: 99%

Why off-the-shelf clavicle plates rarely fit: anatomic analysis of the clavicle through statistical shape modeling

Vancleef

Herteleer

Carette

et al. 2019

Journal of Shoulder and Elbow Surgery

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“…Baltes et al . looked in detail at the influence of plate positioning on hardware removal rate but could not conclude that it leads to reduced implant removal rates 27 . From an anatomical point of view our results support a superior plating position as this would lead to a less extensive muscle dissection.…”

Section: Discussionmentioning

confidence: 99%

Variation of the clavicle’s muscle insertion footprints – a cadaveric study

Herteleer

Vancleef²,

Herijgers³

et al. 2019

Sci Rep

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The muscle footprint anatomy of the clavicle is described in various anatomical textbooks but research on the footprint variation is rare. Our goal was to assess the variation and to create a probabilistic atlas of the muscle footprint anatomy. 14 right and left clavicles of anatomical specimens were dissected until only muscle fibers remained. 3D models with muscle footprints were made through CT scanning, laser scanning and photogrammetry. Then, for each side, the mean clavicle was calculated and non-rigidly registered to all other cadaveric bones. Muscle footprints were indicated on the mean left and right clavicle through the 1-to-1 mesh correspondence which is achieved by non-rigid registration. Lastly, 2 probabilistic atlases from the clavicle muscle footprints were generated. There was no statistical significant difference between the surface area (absolute and relative), of the originally dissected muscle footprints, of male and female, and left and right anatomical specimens. Visualization of all muscle footprints on the mean clavicle resulted in 72% (right) and 82% (left) coverage of the surface. The Muscle Insertion Footprint of each specimen covered on average 36.9% of the average right and 37.0% of the average left clavicle. The difference between surface coverage by all MIF and the mean surface coverage, shows that the MIF location varies strongly. From the probabilistic atlas we can conclude that no universal clavicle exists. Therefore, patient-specific clavicle fracture fixation plates should be considered to minimally interfere with the MIF. Therefore, patient-specific clavicle fracture fixation plates which minimally interfere with the footprints should be considered.

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“…Superior plating is the most commonly used technique, but anterior-inferior plating, anterior plating or double plating with mini-fragment plates are described as well. 62 - 64 A biomechanical study comparing anterior and superior plate placement showed that, for all fracture patterns, more construct stiffness was achieved in axial compression and with a superior plate, whereas more construct stiffness was achieved in cantilever bending with an anterior plate. 65 Antero-inferior plating of midshaft clavicle fractures results in lower hardware removal due to plate prominence.…”

Section: Orif Using Plates and Screwsmentioning

confidence: 99%

“…65 Antero-inferior plating of midshaft clavicle fractures results in lower hardware removal due to plate prominence. 62 , 66 It was found that anterior-inferior plating reduces the time to union, but the location of the plate does not seem to influence functional outcomes or infection rates. 63 …”

Section: Orif Using Plates and Screwsmentioning

confidence: 99%

Midshaft clavicle fractures

2018

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Clavicle fractures are common fractures and the optimal treatment strategy remains debatable. The present paper reviews the available literature and current concepts in the management of displaced and/or shortened midshaft clavicle fractures.Operative treatment leads to improved short-term functional outcomes, increased patient satisfaction, an earlier return to sports and lower rates of non-union compared with conservative treatment. In terms of cost-effectiveness, operative treatment also seems to be advantageous.However, operative treatment is associated with an increased risk of complications and re-operations, while long-term shoulder functional outcomes are similar.The optimal treatment strategy should be one tailor-made to the patient and his/her specific needs and expectations by utilizing a shared decision-making model.Cite this article: EFORT Open Rev 2018;3:374-380. DOI: 10.1302/2058-5241.3.170033

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What is the hardware removal rate after anteroinferior plating of the clavicle? A retrospective cohort study

Cited by 21 publications

References 45 publications

Why off-the-shelf clavicle plates rarely fit: anatomic analysis of the clavicle through statistical shape modeling

Why off-the-shelf clavicle plates rarely fit: anatomic analysis of the clavicle through statistical shape modeling

Variation of the clavicle’s muscle insertion footprints – a cadaveric study

Midshaft clavicle fractures

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