[Locking, multidimensional plate osteosynthesis of midshaft clavicle fracture]

[Hematogenous osteomyelitis due to clavicular fracture : A rare complication after conservative treatment]

We present a case of a nondislocated clavicular fracture that was conservatively treated for 4 weeks with a sling. The patient was a smoker and suffered from type 2 diabetes mellitus. After 2 months a suppurative infection occurred due to an escalation based on a clavicular osteomyelitis. Through antibiotic treatment and an aggressive surgical approach the infection was cured but ended up with a painful malunion of the clavicle. The bone reconstruction was achieved with a long locking plate with an additional vascularized medial femoral condyle free flap. After 18 months the patient was subjectively very satisfied with the outcome, had no pain and excellent functional results in the Constant Murley and DASH (Disabilities of Arm, Shoulder and Hand) scores. The X‑ray assessment showed full bone union.

A study on the outcome of displaced midshaft non-comminuted clavicle fractures treated with anatomical locking plate versus titanium elastic nail

Purpose:

Fixation of displaced midshaft clavicle is well known to decrease nonunion, malunion and shoulder disability as compared to nonoperative treatment. This study was done to compare the clinical and functional outcome of group 1 clavicle fractures treated with anatomic locking plates (ALP) versus Titanium elastic nail (TEN).

Methods:

We studied patients presenting with displaced midshaft clavicle fractures treated with ALP or TEN. The study period was from Jan 2013 to Dec 2016. Patients were reviewed and at each visit clinical and radiological progress of union was noted, complications if any were noted, functional assessment was done using the quick Dash score and Constant Murley score.

Results:

A total of 116 patients met our inclusion criteria. 62 patients were treated with TEN and 54 with ALP. Bony union was achieved at an average of 11.8 weeks in the TENS group and 12.8 weeks in the ALP group post operatively and this was found to be significant. The mean postoperative Constant Murley score in the ALP and the TEN groups were 92.8 (range 80–97), and 93.7 (82–97) respectively. The mean postoperative quick dash score in the ALP and TEN groups were 2.48(range from 0 to 6.8) and 2.1 (range 0–9.1) respectively.

Conclusion:

Both Anatomical locking plate and TEN are good options for the treatment of non-comminuted mid clavicular fractures as they have a similar functional outcome. TEN nail insertion has the advantage of being minimally invasive, having a faster union time and may be recommended in midshaft clavicle fractures without comminution.

Does candidate for plate fixation selection improve the functional outcome after midshaft clavicle fracture? A systematic review of 1348 patients

INTRODUCTION

The hypothesis of this study was that patient selection for midshaft clavicle fracture (open reduction internal fixation with plate versus conservative) would give better functional outcome than random treatment allocation.

METHODS

We performed a systematic literature search for primary studies providing functional score and non-union rate after conservative or surgical management of midshaft clavicle fractures. Six randomized controlled trial and 19 non-randomized controlled trial studies encompassing a total of 1348 patients were included.

RESULTS

Patients treated with surgical management were found to have statistically superior Constant scores in non-randomized controlled trials than in randomized controlled trials (94.76 ± 6.4 versus 92.49 ± 6.2; p < 0.0001). For conservative treatment, randomized controlled trials were found to have significantly better functional outcome. The prevalence of non-union (6.1%) did not show significant statistical difference between non-randomized controlled trial and randomized controlled trial studies. The functional outcome after surgical management was significantly higher than after conservative management in both randomized controlled trial and non-randomized controlled trial groups. The non-union rate after surgery (1.1% for both non-randomized controlled trial and randomized controlled trial) was significantly lower than following conservative treatment (9.9% non-randomized controlled trial versus 15.1% randomized controlled trial).

DISCUSSION

This review shows that patient selection for surgery may influence functional outcome after midshaft clavicle fracture. Our results also confirm that plate fixation provides better functional outcome and lower non-union rate.