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Hornung CM, Kramer R, Levine J, Hannink G, Hoogervorst P. Functional outcomes and complications of plate fixation for midshaft clavicle fractures by type and location: a systematic review and meta-analysis. JSES Int 2024; 8:407-422. [PMID: 38707570 PMCID: PMC11064701 DOI: 10.1016/j.jseint.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Abstract
Background Various plate types are used in the surgical treatment of displaced midshaft clavicle fractures. These plates can be positioned in different locations on the clavicle, although no studies to date have elucidated optimal plate type and location of fixation. This systematic review compares the functional outcomes and complications in the management of displaced midshaft clavicle fractures using plate fixation by stratifying by both plate type and location. Methods A systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted to identify all papers reporting functional outcomes, union rates, and/or complications using plates for the management of midshaft clavicle fractures. Multiple databases and trial registries were searched from inception until March 2022. A meta-analysis was conducted for functional outcomes and type of complication, stratified by plate type (locking, compression, or reconstruction) and location (superior or anteroinferior). Pooled estimates of functional outcome scores and incidence of complications were calculated using a random effects model. Risk of bias and quality were assessed using the risk of bias version 2 and ROBINS-I (Risk Of Bias In Non-randomised Studies - of Interventions) tools. The confidence in estimates were rated and described according to the recommendations of the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) working group. Results Forty-five studies were included in the systematic review and 43 were included in the meta-analysis. Depending on plate type and location, pooled Constant-Murley Scores ranged from 89.23 to 93.48 at 12 months. Nonunion rates were 3% (95% confidence interval [CI] 1-6) for superior locking plates (GRADE Low). Rates of any complication (nonunion, hardware failure, hardware irritation, wound dehiscence, keloid, superficial infection, deep infection, delayed union, malunion, and/or persistent pain) by plate type and location ranged from 3% to 17% (GRADE Very Low to Moderate). Superior compression plates had the highest incidence of any complications (17% [95% CI 5-44], GRADE Very Low), while anterior inferior compression plates had the lowest incidence of any complication (3% [95% CI 0-15], GRADE Very Low). Hardware irritation was the most reported individual complication for superior locking plates and superior compression plates, 11% (95% CI 7-17, GRADE Low) and 11% (95% CI 3-33, GRADE Very Low), respectively. Conclusion Although most studies were of low quality, studies reporting functional outcomes generally showed good functional results and similar incidence of any complication regardless of plate type and location. There is no evidence of a plate and location combination to optimize patient functional outcomes or complications. We were unable to reliably evaluate union rates or individual complications for most plate types stratified by location.
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Affiliation(s)
- Christopher M. Hornung
- Department of Orthopaedic Surgery, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Riley Kramer
- Department of Orthopaedic Surgery, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Joshua Levine
- Department of Orthopaedic Surgery, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Gerjon Hannink
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Paul Hoogervorst
- Department of Orthopaedic Surgery, University of Minnesota School of Medicine, Minneapolis, MN, USA
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Qvist AH, Jensen SL. Minimal early functional gains after operative treatment of midshaft clavicular fractures: a meta-analysis of 10 randomized controlled trials including 1333 patients. JSES Int 2024; 8:400-406. [PMID: 38707583 PMCID: PMC11064720 DOI: 10.1016/j.jseint.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Abstract
Background There is substantial evidence that operative treatment reduces the risk of nonunion but offers no long-term functional gains compared with nonoperative treatment. Despite some studies citing quicker recovery with surgery, the promise of accelerated functional recovery remains under-investigated. The aim of this meta-analysis of randomized controlled trials was to investigate the possible early functional gains (≤6 months) after operative treatment of displaced midshaft clavicular fractures compared with nonsurgical treatment. Methods A systematic search was performed to identify randomized controlled trials comparing plate osteosynthesis with nonoperative treatment. We evaluated shoulder function outcomes measured by Constant Score or Disability of the Arm, Shoulder, and Hand (DASH) questionnaire. Other outcomes of interest were sick leave and return to previous activity (work, leisure). Results Ten studies including 1333 patients were included. The mean difference in DASH score after 6 weeks was 9.4 points (95% confidence interval [CI] 13.7-5.1) in favor of operative treatment. At 3 months, the difference was 3.6 points (95% CI 6.9-0.4), and at 6 months, the difference was 3.2 points (95% CI 5.2-1.1), both in favor of operative treatment. Results for Constant Score were similar to that of DASH score. Conclusion This meta-analysis shows that there is an early functional gain at six weeks following plate fixation of midshaft clavicular fractures compared with nonoperative treatment. At three and six months, the functional gain is lesser and not clinically relevant.
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Affiliation(s)
- Andreas H. Qvist
- Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark
| | - Steen L. Jensen
- Department of Orthopedics and Orthopaedic Research Unit, Aalborg University Hospital, Aalborg, Denmark
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Sangiorgio A, Previtali D, Oldrini LM, Milev SR, Filardo G, Candrian C. Comparable results of superior vs antero-inferior plating for the treatment of displaced midshaft clavicle fractures. A comparative study. Injury 2024; 55:111449. [PMID: 38422762 DOI: 10.1016/j.injury.2024.111449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Clavicle fractures represent up to 10 % of all fractures, affecting mainly a young population. Open reduction and internal plate fixation provide good results, but evidence on the best plate positioning is still unclear. Aim of this retrospective study was to compare superior and antero-inferior plating positioning in the surgical treatment of displaced midshaft clavicle fractures. MATERIALS AND METHODS 104 patients aged > 18 years, treated surgically with plate fixation (51 superior, 53 antero-inferior) for a midshaft clavicle fracture from January 2010 to April 2021 were included. At the time of the visit, mean follow-up time was 6.6 ± 2.6 years. Shoulder function was evaluated with the use of Constant-Murley Score (CMS) and Disabilities of the Arm, Shoulder, and Hand (DASH) score. Return to sport, aesthetic satisfaction, operative time, radiological outcomes, rate of implant removal, and overall patient satisfaction were documented as well. RESULTS Mean CMS was 94.1 ± 10.0 points in the superior plating group and 93.4 ± 11.6 points in the antero-inferior plating group. DASH score: 4.6 ± 11.0 superior, 5.1 ± 10.5 antero-inferior. Return to sport: 8.2 ± 2.9 superior, 8.2 ± 3.0 antero-inferior. Aesthetic satisfaction: 8.9 ± 1.6 superior, 8.8 ± 2.1 antero-inferior. Overall satisfaction: 9.1 ± 1.5 superior, 8.9 ± 1.7 antero-inferior. The comparison between groups showed no statistically significant differences (p = n.s.) for all outcome measures. Operative time: 101.6 ± 27.3 min superior, 113.0 ± 31.6 min antero-inferior (p = 0.05). Radiological follow-up documented one non-union and one mal-union in the antero-inferior plating group. Overall, 63 patients underwent plate removal: 58.8 % in the superior plating group and 62.3 % in the antero-inferior plating group (p = n.s.). Main reason for plate removal was pain/discomfort. CONCLUSIONS Both superior and antero-inferior plating provided excellent clinical, functional, and radiological results for the treatment of displaced midshaft clavicle fractures, without significant differences between groups. The superior plating group showed a statistically shorter operative time. High rate of re-interventions with implant removal was documented in both groups. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Alessandro Sangiorgio
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland.
| | - Davide Previtali
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
| | | | - Stamen Roumenov Milev
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
| | - Giuseppe Filardo
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Christian Candrian
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
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Bents RT, Bents EJ. Intramedullary Screw Fixation for Midshaft Clavicle Fractures. Arthrosc Tech 2024; 13:102884. [PMID: 38584637 PMCID: PMC10995696 DOI: 10.1016/j.eats.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 11/02/2023] [Indexed: 04/09/2024] Open
Abstract
Operative fixation for acute displaced midshaft clavicle fractures provides improved functional outcomes and patient satisfaction over nonoperative treatment. Although open reduction and plate fixation is most commonly used, intramedullary fixation produces similar patient outcomes with fewer symptomatic hardware or scar complications. The purpose of this Technical Note is to detail a straightforward and cost-efficient method of intramedullary clavicle fracture fixation using a headless cannulated screw.
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Pastor T, Zderic I, Berk T, Souleiman F, Vögelin E, Beeres FJP, Gueorguiev B, Pastor T. New generation of superior single plating vs. low-profile dual minifragment plating in diaphyseal clavicle fractures: a biomechanical comparative study. J Shoulder Elbow Surg 2024; 33:409-416. [PMID: 37748530 DOI: 10.1016/j.jse.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/31/2023] [Accepted: 08/06/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Recently, a new generation of superior clavicle plates was developed featuring the variable-angle locking technology for enhanced screw positioning and a less prominent and optimized plate-to-bone fit design. On the other hand, minifragment plates in dual plating mode have demonstrated promising clinical results. The aim of the current study was to compare the biomechanical competence of single superior plating using the new-generation plate vs. dual plating using low-profile minifragment plates. METHODS Sixteen paired human cadaveric clavicles were pairwise assigned to 2 groups for instrumentation with either a superior 2.7-mm variable-angle locking compression plate (group 1), or with one 2.5-mm anterior combined with one 2.0-mm superior matrix mandible plate (group 2). An unstable clavicle shaft fracture (AO/OTA 15.2C) was simulated by means of a 5-mm osteotomy gap. Specimens were cyclically tested to failure under craniocaudal cantilever bending, superimposed with bidirectional torsion around the shaft axis, and monitored via motion tracking. RESULTS Initial construct stiffness was significantly higher in group 2 (9.28 ± 4.40 N/mm) compared to group 1 (3.68 ± 1.08 N/mm), P = .003. The amplitudes of interfragmentary motions in terms of axial and shear displacement, fracture gap opening and torsion, over the course of 12,500 cycles were significantly higher in group 1 compared to group 2, P ≤ .038. Cycles to 2 mm shear displacement were significantly lower in group 1 (22,792 ± 4346) compared to group 2 (27,437 ± 1877), P = .047. CONCLUSION From a biomechanical perspective, low-profile 2.5/2.0-mm dual plates could be considered as a useful alternative for diaphyseal clavicle fracture fixation, especially in less common unstable fracture configurations.
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Affiliation(s)
- Tatjana Pastor
- AO Research Institute Davos, Davos, Switzerland; Department for Plastic and Hand Surgery, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland
| | - Ivan Zderic
- AO Research Institute Davos, Davos, Switzerland
| | - Till Berk
- Department of Trauma, University Hospital Zurich, Zurich, Switzerland
| | - Firas Souleiman
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Esther Vögelin
- Department for Plastic and Hand Surgery, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland
| | - Frank J P Beeres
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | | | - Torsten Pastor
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland.
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Lin S, Huang J, Lamin BM, Zeng T, Tian Y, Liu L, Luo H. Effect of intramedullary fixation and plate fixation on postoperative wound complications in clavicle fractures: A meta-analysis. Int Wound J 2024; 21:e14361. [PMID: 37641210 PMCID: PMC10781614 DOI: 10.1111/iwj.14361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 08/06/2023] [Accepted: 08/08/2023] [Indexed: 08/31/2023] Open
Abstract
More and more meta-analyses have been conducted to compare the effects of intramedullary fixation (IF) and plate fixation (PF) on the outcome of midshaft clavicle fractures. It can affect the doctors' treatment decisions. A number of studies have been conducted in order to assist surgeons in selecting optimal operative procedures and to recommend operative treatment of clavicle fractures in accordance with the best available research. Our analysis of the IF and PF of clavicle fractures was done through a search for PubMed, Emabase, Web of Science, and Cochrane Library. Two different researchers analysed the research literature for quality of analysis and data extraction. The analysis of the data was done with RevMan 5.3. The 95% CI and OR models have been computed by means of either fixed-dose or randomize. In addition, RCT in 114 references have been reviewed and added for further analysis. It is concluded that the application of plate and intramedullary fixation in the middle clavicle operation has remarkable influence on the outcome of post-operation. There was a lower risk of postoperative wound infection in IF (OR, 5.92; 95% CI, 2.46, 14.27 p < 0.0001), smaller surgical incisions (MD, 6.57; 95% CI, 4.90, 8.25 p < 0.0001), and shorter operative time (MD, 17.09; 95% CI 10.42, 23.77 p < 0.0001), less blood loss (MD, 63.62; 95% CI, 55.84, 71.39 p < 0.0001) and shorter hospital stay (MD, 1.05; 95% CI, 0.84, 1.25 p < 0.0001). However, there is no statistical significance in the incidence of wound dehiscence. Thus, the effect of IF on the incidence of injury is better than that of the inner plate in the middle of the clavicle.
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Affiliation(s)
- Shangce Lin
- Medical SchoolYangtze UniversityJingzhouChina
- Department of OrthopedicsThe First People's Hospital of JingzhouJingzhouChina
| | - Jin Huang
- Medical SchoolYangtze UniversityJingzhouChina
| | | | - Teng Zeng
- Department of OrthopedicsThe First People's Hospital of JingzhouJingzhouChina
| | - Yaqin Tian
- Department of OrthopedicsThe First People's Hospital of JingzhouJingzhouChina
| | - Lian Liu
- Medical SchoolYangtze UniversityJingzhouChina
| | - Huasong Luo
- Department of OrthopedicsThe First People's Hospital of JingzhouJingzhouChina
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Jirangkul P, Lorsuwannarat N, Wanichjaroen N. Precontoured dynamic compression plate using patient-specific 3D-printed models in minimally invasive surgical technique for midshaft clavicle fractures. Arch Orthop Trauma Surg 2024; 144:103-111. [PMID: 37658855 DOI: 10.1007/s00402-023-05042-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 08/17/2023] [Indexed: 09/05/2023]
Abstract
INTRODUCTION This study introduced a novel approach for the treatment of midshaft clavicle fractures, utilizing patient-specific 3D-printed models for accurate preoperative contouring of dynamic compression plates (DCPs) and an alternative minimally invasive plate osteosynthesis (MIPO) technique with precontoured DCPs through small vertical separated incisions. PATIENT AND METHODS Mirror image 3D clavicular models were reproduced from 40 patients with acute displaced midshaft clavicle fractures who underwent MIPO using precontoured DCPs inserted through small, vertical separated incisions. Exclusion criteria included patients with open fractures, pathological fractures, ipsilateral limb injury, skeletal immature patients, and those who had previous clavicle fractures or surgery. Postoperative evaluation was conducted using clinical and radiographic review. The Constant-Murley and American Shoulder and Elbow Surgeons Shoulder Scores were used for clinical evaluations, and the Patient and Observer Scar Assessment Scale was used to assess surgical scars. RESULTS The average time to union of all fractures was 12.88 weeks (range, 8-15) without loss of reduction. The patient-specific precontoured DCPs fitted well in all cases, with fracture consolidation and minimal three cortical sides connecting the fracture fragment. No hardware prominence and skin complications occurred, and clinical evaluation showed no existing difference compared with the contralateral sides. The average Constant-Murley and American Shoulder and Elbow Surgeons Shoulder Scores were 96.33 ± 3.66 and 93.26 ± 5.15, respectively. Two patients requested their implant removal, and scar qualities were satisfactory. CONCLUSIONS Our study demonstrated that the use of a patient-specific precontoured DCP, in combination with 3D printing technology, provides accurate preoperative planning, effective fracture reduction, and improved postoperative outcomes in displaced midshaft clavicle fractures. The MIPO with a patient-specific precontoured DCP through separated vertical incisions along the Langer's lines appears to be a promising option, regarding appearance, avoiding associated complications, and obviating the need for reoperation. These results suggest that this technique has merit and can be a viable option for the treatment of midshaft clavicle fractures.
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Affiliation(s)
- Puripun Jirangkul
- Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand.
| | | | - Nutthapong Wanichjaroen
- Department of Plastic Surgery, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
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Charles SJC, Kumar P, Reddy RP, Cong T, Chen S, Mittwede P, Moloney G, Siska P, Lin A. Dual Versus Single Plate Fixation of Displaced Midshaft Clavicle Fractures: A Cost-Effectiveness Analysis. J Bone Joint Surg Am 2023; 105:1886-1896. [PMID: 37967070 DOI: 10.2106/jbjs.23.00338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
BACKGROUND Prior studies have highlighted lower rates of reoperation if fixation of a displaced midshaft clavicle fracture is performed with dual plating (DP) compared with single plating (SP). Despite higher initial costs associated with the DP construct, the observed reduction in secondary surgeries compared with the SP construct may make it a more cost-effective treatment option. The objective of this study was to assess the cost-effectiveness of DP compared with SP in patients with operatively indicated displaced midshaft clavicle fractures. METHODS We developed a decision tree to model the occurrence of postoperative complications (acute hardware complications, wound healing issues, deep infection, nonunion, and symptomatic hardware) associated with secondary surgeries. Complication-specific risk estimates were pooled for both plating techniques using the available literature. The time horizon was 2 years, and the analysis was conducted from the health-care payer's perspective. The costs were estimated using direct medical costs, and the benefits were measured in quality-adjusted life-years (QALYs). We assumed that DP would be $300 more expensive than SP initially. We conducted probabilistic and 1-way sensitivity analyses. RESULTS The model predicted reoperation in 6% of patients in the DP arm compared with 14% of patients in the SP arm. In the base case analysis, DP increased QALYs by 0.005 and costs by $71 per patient, yielding an incremental cost-effectiveness ratio (ICER) of $13,242 per QALY gained. The sensitivity analysis demonstrated that the cost-effectiveness of DP was driven by the cost of the index surgery, risk of symptomatic hardware, and nonunion complications with SP and DP. At a willingness-to-pay threshold of $100,000 per QALY gained, 95% of simulations suggested that DP was cost-effective compared with SP. CONCLUSIONS When indicated, operative management of displaced midshaft clavicle fractures using DP was found to be cost-effective compared with SP. Despite its higher initial hardware costs, DP fixation appears to offset its added costs with greater health utility via lower rates of reoperation and improved patient quality of life. LEVEL OF EVIDENCE Economic and Decision Analysis Level II . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Shaquille J-C Charles
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Praveen Kumar
- Public Health Dynamics Laboratory, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Rajiv P Reddy
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Ting Cong
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Stephen Chen
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Peter Mittwede
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Gele Moloney
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Peter Siska
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Albert Lin
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Machado do Amaral F, Angeli Malavolta E, Brandao Andrade E Silva F, Garcia JC, da Silva Moura J, Assunção JH, Pecora JR. Comparative study of patients with midshaft clavicle fracture fixed with a locked plate via an open versus percutaneous approach. Injury 2023; 54 Suppl 6:110746. [PMID: 38143119 DOI: 10.1016/j.injury.2023.04.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/23/2023] [Accepted: 04/14/2023] [Indexed: 12/26/2023]
Abstract
OBJECTIVE To compare the results of surgical treatment of midshaft clavicle fractures, treated with the technique of minimally invasive plate osteosynthesis (MIPO) with locking compression plate versus open reduction and internal fixation (ORIF) with locked plate. METHODS Quasi-randomized comparative study, evaluating displaced midshaft clavicle fractures treated with MIPO versus ORIF, with procedures performed by a single surgeon. We evaluated patients at 12 months using the University of California at Los Angeles (UCLA) scale and radiographically at 8, 12, 26 and 52 weeks, in addition to describing complications. RESULTS We evaluated 44 patients; 22 submitted to MIPO and 22 to ORIF. The median UCLA scores at 12 months were 35 in the ORIF group and 35 in the MIPO group (p = 0.712). All patients had fracture healing at 3 months (p > 0.999). The mean surgery time was 87.5 min in the ORIF group and 47.5 in the MIPO (p < 0.001) group. As complications, 1 suture dehiscence (4.5%), 2 protruding plates (9.1%) and 1 change in sensitivity around the surgical wound (4.5%) were observed in the MIPO group, while in the ORIF group, 15 changes in sensitivity (68.2%) and 3 hypertrophic scars (13.6%) were observed. The only complication that showed a difference between the groups was the change in sensitivity (p < 0.001). No cases of pseudarthrosis or failure of osteosynthesis were identified in either technique. CONCLUSION This study demonstrated that the two treatments, ORIF and MIPO, are equally effective in the treatment of displaced middle third clavicle fractures. However, MIPO is superior to ORIF in regard to reduced surgical time and preservation of supraclavicular nerve sensitivity.
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Affiliation(s)
- Felipe Machado do Amaral
- Hospital Universitário HU, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
| | - Eduardo Angeli Malavolta
- Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil; HCor - Hospital do Coração, São Paulo, SP, Brazil
| | | | | | | | - Jorge Henrique Assunção
- Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Jose Ricardo Pecora
- Hospital Universitário HU, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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Jirangkul P, Kosiyatrakul A, Lorsuwannarat N. Minimally invasive plate osteosynthesis for displaced midshaft clavicle fractures: An indirect reduction using joystick technique. J Orthop Sci 2023; 28:1365-1372. [PMID: 36184268 DOI: 10.1016/j.jos.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 07/11/2022] [Accepted: 09/01/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND A minimally invasive plate osteosynthesis (MIPO) technique has become increasingly popular in long bone fracture fixation as it could eliminate postoperative complications. However, the most challenging aspect of employing the MIPO for midshaft clavicle fractures among general orthopedic surgeons is the technically demanding that indirect reduction is typically a closed maneuver. METHODS We present a consecutive series of patients with displaced midshaft clavicle fractures undergoing clavicular fixation using the MIPO technique between January 2017 and October 2019. The joystick technique was used to obtain anatomical reduction. Clinical outcomes were assessed using the Constant-Murley and the American shoulder and elbow surgeons shoulder scores. RESULTS Thirty patients with a mean age of 42.44 years were included. The functional shoulder scores showed no disabilities compared with those of a healthy population. No major complications requiring re-operation were noted, and all fractures were completely healed with an average time of 12.53 weeks. CONCLUSION This study demonstrated that facilitating the MIPO for midshaft clavicle fractures using simple operative devices and techniques was possible. The joystick technique with the use of an external fixator for temporary stabilization is a safe and effective method that can be added to achieve anatomical alignment with the fracture site unexposed. This technique could be performed either in a fresh fracture or a delayed case with failed conservative treatment.
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Affiliation(s)
- Puripun Jirangkul
- Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand.
| | - Arkaphat Kosiyatrakul
- Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
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11
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Lecoultre Y, van de Wall BJM, Diwersi N, Pfarr SW, Galliker B, Babst R, Link BC, Beeres FJP. A natural experiment study: Low-profile double plating versus single plating techniques in midshaft clavicle fractures-Study protocol. PLoS One 2023; 18:e0291238. [PMID: 37683048 PMCID: PMC10490911 DOI: 10.1371/journal.pone.0291238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 08/19/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Single plate osteosynthesis is commonly employed when performing surgical stabilization of midshaft clavicle fractures. In recent years, a smaller structural low-profile double plating technique has been described as a possible solution for the high removal rates associated with single plating. A previous meta-analysis has demonstrated that low-profile double plating attains the same healing rates as single plating without a higher chance of fracture-related infections. This meta-analysis, however, was based on relatively small studies. Therefore, a multicentre prospective natural experiment was designed using natural variation in treatment regimens and geographical location of the trauma as treatment allocation mechanism to compare both treatments on a larger scale. This manuscript describes its protocol. MATERIAL & METHODS Patients (≥16 years) with primary midshaft clavicle fractures that are eligible for operative treatment will be included. Treatment allocation will be determined by the geographical location of the accident and local hospital providing treatment. In two centres, single plating is the treatment of choice for these patients. In two others, low-profile double plating has become the standard treatment. For the low-profile double plating group, one superiorly positioned VariAx 2.0mm and one anterior VariAx 2.4mm or 2.7mm plate will be used. For the single plating group, the standard locally available implant will be used. A total of 336 patients will be included. The primary outcome of interest is re-intervention. Secondary outcomes include complications, operative time, length of incision, functional scores (DASH, EQ-5D-DL, VAS-Pain/Satisfaction) and cost-effectiveness. DISCUSSION This study will determine whether low-profile double plating has significant clinical and cost-effective benefits over single plating techniques in midshaft clavicle fractures. The study will also give insight in the performance of a natural experiment study design for orthopedic trauma research. TRIAL REGISTRATION This study has been registered on ClincialTrials.gov, identifier NCT05579873.
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Affiliation(s)
- Yannic Lecoultre
- Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Bryan J. M. van de Wall
- Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Department of Surgery, Obwalden Cantonal Hospital, Sarnen, Switzerland
| | - Nadine Diwersi
- Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
- Department of Surgery, Obwalden Cantonal Hospital, Sarnen, Switzerland
| | | | - Beat Galliker
- Department of Surgery, Sursee Hospital, Sursee, Switzerland
| | - Reto Babst
- Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Björn-Christian Link
- Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Frank J. P. Beeres
- Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
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12
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Hertzberg M, Maier L, Heil H, Hoegler J, Guthrie ST, Hakeos W. Postoperative Chest X-Rays After Open Reduction Internal Fixation of Clavicle Fractures May Not Be Cost-Effective or Necessary. J Orthop Trauma 2023; 37:e270-e273. [PMID: 36862985 DOI: 10.1097/bot.0000000000002590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/21/2023] [Indexed: 03/04/2023]
Abstract
OBJECTIVES To assess the use of chest x-rays after open-reduction internal fixation of clavicle fractures. Particularly in detection of acute postoperative pneumothorax and cost-effectiveness of obtaining routine chest x-rays postoperatively. DESIGN A retrospective cohort study. SETTING Level I trauma center. PATIENTS Two hundred thirty-six patients who underwent ORIF from 2013 to 2020 between the ages of 12 and 93. INTERVENTION Chest x-ray performed postoperatively. MAIN OUTCOME MEASUREMENT Presence of acute postoperative pneumothorax. RESULTS Of the 236 patients who underwent surgery, 189 (80%) patients received a CXR postoperatively and 7 (3%) patients experienced respiratory symptoms. All patients who had respiratory symptoms received a postoperative CXR. Those who did not receive a CXR postoperatively did not experience any respiratory complications. Two patients in the cohort had a postoperative pneumothorax, which was present preoperatively and unchanged in size postoperatively. Both of these patients were managed with general anesthesia and endotracheal intubation for surgery. The most common finding on CXR postoperatively was atelectasis. The cost of a portable CXR can be upward of $594 when including technology, personnel fees, and radiologic interpretation. CONCLUSION Postoperative chest x-rays after clavicle open reduction and internal fixation did not detect any acute postoperative pneumothorax in asymptomatic patients. It is not cost-effective to routinely get chest x-rays in patients after open-reduction internal fixation of clavicle fractures. In our study, of the 189 chest x-rays performed, only 7 patients experienced postoperative respiratory symptoms. Our health care system as a total could have saved upward of $108,108 in total for these patients because they may have been considered nonreimbursable by an insurance provider. LEVEL OF EVIDENCE Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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13
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Cogburn J, Gilens JF, Khodaee M. Pseudoaneurysm of the subclavian artery as a delayed complication of a clavicle fracture. BMJ Case Rep 2023; 16:e252430. [PMID: 37130639 PMCID: PMC10163432 DOI: 10.1136/bcr-2022-252430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
Vascular complications are relatively rare following surgical fixation of midshaft clavicle fractures. Here, we report a case of a woman in her 30s presenting 10 years after right clavicular open reduction and internal fixation with revision 6 years prior with sudden and rapidly progressive neck swelling. Physical examination revealed a soft pulsating mass in her right supraclavicular fossa. Ultrasound and CT angiography of the head and neck showed a pseudoaneurysm of her right subclavian artery with a surrounding haematoma. She was admitted to the vascular surgery team for endovascular repair with stenting. Postoperatively, she developed arterial thrombi requiring thrombectomy (twice) and is now on lifelong anticoagulation. It is crucial to be aware of complications that can develop in patients with a history of clavicular fracture managed non-operatively or operatively even years later and highlights the importance of risk and benefit discussions and counselling.
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Affiliation(s)
- Jennifer Cogburn
- Family Medicine, University of Colorado Denver School of Medicine, Denver, Colorado, USA
| | - Joshua F Gilens
- Family Medicine, University of Colorado Denver School of Medicine, Denver, Colorado, USA
| | - Morteza Khodaee
- Family Medicine and Orthopedics, University of Colorado Denver School of Medicine, Denver, Colorado, USA
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14
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Tandron M, Cohen L, Cohen J, Allegra P, Munoz J, Kaplan L, Baraga M. The fifty most-cited articles regarding midshaft clavicle fractures. J Orthop 2023; 39:50-58. [PMID: 37125014 PMCID: PMC10130696 DOI: 10.1016/j.jor.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 02/17/2023] [Accepted: 03/30/2023] [Indexed: 05/02/2023] Open
Abstract
Introduction The clavicle is the most frequently fractured bone in the human body, and up to 80% of clavicle fractures occur in the middle third diaphyseal region of the clavicle (midshaft). We conducted a bibliometric analysis to identify and evaluate the 50 most-cited publications pertaining to midshaft clavicle fractures (MCF). Materials and methods Two independent reviewers conducted separate queries on Web of Science in December 2021 for "midshaft clavicle fractures". The publications yielded were organized from highest to lowest number of citations. We included articles, review articles, and editorial materials and excluded other document types. Both reviewers independently reviewed all abstracts until 50 studies pertaining to MCF were included. Theory We hypothesized that most articles would be published between 2000 and 2019, pertain to outcomes, and those with a greater (lower numeric) level of evidence would correlate with number of citations. Results The most prolific decade was from 2010 to 2019, with 50% (25/50) of articles published. Average citation density was 6.3 ± 5.5 (range, 1.3-33.1), defined as the average number of citations per year since publication. The median level of evidence (LOE) was 3.5 (IQR: 3). One-way ANOVA tests were used to compare the effects of LOE on total citations and citation density. There were statistically significant differences in total citations (F value = 12.07, p = 0.001) and citation density (F value = 21.14, p < 0.001) between LOE groups. The median number of total citations, grouped by LOE of 1 through 5, were as follows: 110, 66, 66, 51, 52. Conclusions This review provides an overview of the 50 most cited papers regarding MCF. This should be used as a reference for physicians and other providers who treat patients with MCF for treatment guidance and for those in teaching roles as a student and resident/fellow educational resource.
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Affiliation(s)
- Marissa Tandron
- University of Miami, Department of Orthopaedic Surgery, Miami, FL, 33136, USA
| | - Lara Cohen
- Harvard Combined Orthopaedic Residency Program, Boston, MA, 02114, USA
| | - Jacob Cohen
- University of Miami, Department of Orthopaedic Surgery, Miami, FL, 33136, USA
| | - Paul Allegra
- Lenox Hill Hospital, Department of Orthopaedic Surgery, New York, NY, 10075, USA
| | - Julianne Munoz
- University of Miami, Department of Orthopaedic Surgery, Miami, FL, 33136, USA
| | - Lee Kaplan
- University of Miami, Department of Orthopaedic Surgery, Miami, FL, 33136, USA
| | - Michael Baraga
- University of Miami, Department of Orthopaedic Surgery, Miami, FL, 33136, USA
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15
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Rawal A, Mannambeth R, Murray S, Moaveni A. Clavicular osteotomy to assess subclavian vein injury during internal fixation of midshaft clavicle fractures. Shoulder Elbow 2022; 14:642-647. [PMID: 36479011 PMCID: PMC9720870 DOI: 10.1177/17585732211047206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 08/21/2021] [Accepted: 08/21/2021] [Indexed: 11/17/2022]
Abstract
Midshaft clavicle fractures are commonly fixed with locking plates. The subclavian vein risks injury during this procedure and the consequences can be fatal. The purpose of this present study is to describe a clavicular osteotomy technique in order to equip orthopaedic surgeons with a means of rapidly accessing a subclavian vein injury. The osteotomy should only be performed following an urgent intraoperative vascular surgery assessment. There must be shared consensus from both orthopaedic and vascular surgery that direct repair of the subclavian vein is necessary, and further exposure is required. The results of the technique performed on thirteen embalmed cadaveric specimens are also included. The osteotomy was able to expose 3.16 cm (SD = 0.60) of the subclavian vein and both the fracture and osteotomy site of all clavicles (100%) were able to be reduced and fixed using a single pre-contoured fifteen-hole lateral plate intended for use on the contralateral shoulder. This surgical technique study confirms that in the rare circumstance that the osteotomy is utilized, adequate exposure of the subclavian vein is achieved.
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Affiliation(s)
- Aziz Rawal
- The Department of Orthopaedic Surgery, The Alfred Hospital, Melbourne, Victoria, Australia
- The Department of Anatomy and Neuroscience, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rejith Mannambeth
- The Department of Orthopaedic Surgery, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Simon Murray
- The Department of Anatomy and Neuroscience, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ash Moaveni
- The Department of Orthopaedic Surgery, The Alfred Hospital, Melbourne, Victoria, Australia
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16
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Labandeyra H, Furno JL, Campos JL, Roqués Escolar V, Valdés Vilches LF. Ultrasound-guided clavipectoral fascia plane block for middle third clavicular fracture: A case series. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2022; 69:683-688. [PMID: 36344406 DOI: 10.1016/j.redare.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 12/28/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVE Clavipectoral fascia plane block has been described as an anaesthetic and analgesic strategy for osteosynthesis of midclavicular fractures. However, to date, only isolated cases have been published. The aim of this study was to evaluate the anaesthetic and analgesic efficacy of this new approach in midclavicular fracture surgery in a large case series. MATERIAL AND METHODS Descriptive, observational study of 50 patients undergoing osteosynthesis of middle third clavicular fracture who received CPB block associated with supraclavicular nerve block. The primary objective was to assess pain on a VAS scale in the immediate postoperative period, and at 6, 12 and 24h. Secondary objectives were to determine the degree of intraoperative sedation, perioperative morphine consumption, need for rescue analgesia, unplanned general anaesthesia, presence of motor and sensory blockade, and diagnosis of diaphragmatic paralysis. RESULTS Postoperative pain was 1.04 (SD=1.26) in the immediate postoperative period; 1.24 (SD=1.42) at 6h; 1.34 (SD=1.92) at 12h; and 0.96 (SD=1.29) at 24h. Mean total intraoperative fentanyl dose was 0.88μg/kg. Postoperatively, nine patients (18%) requested rescue analgesia. There were no conversions to general anaesthesia, no motor or sensory blockade of upper extremities, and no hemidiaphragmatic paralysis. CONCLUSIONS Our series supports the anaesthetic and analgesic efficacy of CPB block for osteosynthesis of midclavicular fractures.
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Affiliation(s)
- H Labandeyra
- Fellowship Sanatorio Mapaci, Rosario, Santa Fe, Argentina.
| | - J L Furno
- Sanatorio Mapaci, Rosario, Santa Fe, Argentina
| | - J L Campos
- Fellowship Sanatorio Mapaci, Rosario, Santa Fe, Argentina
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17
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Kumar AV, Ramachandra Kamath K, Salian PRV, Krishnamurthy SL, Annappa R, Keerthi I. Operative stabilisation versus non-operative management of mid-shaft clavicle fractures. SICOT J 2022; 8:45. [PMID: 36426961 PMCID: PMC9879146 DOI: 10.1051/sicotj/2022046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/06/2022] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Fractures of the mid-shaft clavicle are commonly encountered in clinical practice. These can be managed either by conservative method or operative by internal fixation. This study aims to compare the outcomes of conservative and operative management. METHODS Forty patients with displaced and comminuted mid-shaft clavicle fractures were included in the study, among which twenty-five patients were treated conservatively and 15 patients underwent surgery and were followed up for a period of 1 year. Time taken for union, functional outcome, complications, and patient satisfaction were compared. RESULTS In the non-operative group, 28% of the fractures took less than twelve weeks to unite, whereas in the operative group 60% of them took less than 12 weeks to unite. At the end of 1 year, there was no statistical difference in mean UCLA (University of California and Los Angeles) score and the mean DASH score of the non-operative group and operative group. There were more complications in the operative group. Re-operative rate in the operative group was 40%. Patient satisfaction was 80% in the non-operative group, whereas 48% of patients were satisfied in the operative group. CONCLUSION Displaced and comminuted mid-shaft clavicle fractures treated conservatively have more advantages when compared to surgically treated fractures.
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Affiliation(s)
- Alla Vasanth Kumar
- Department of Orthopaedics, Asram Medical College Eluru Andhra Pradesh India
| | - K. Ramachandra Kamath
- Department of Orthopaedics, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education Manipal Karnataka 576104 India
| | - Preetham Raj V. Salian
- Department of Orthopaedics, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education Manipal Karnataka 576104 India
| | - Sunil Lakshmipura Krishnamurthy
- Clinical Fellow in Sports Injury and Arthroscopy, Department of Orthopaedics, Division of Sports Injury and Arthroscopy, St John’s Medical College Bangalore Karnataka 560034 India
| | - Rajendra Annappa
- Department of Orthopaedics, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education Manipal Karnataka 576104 India
,Corresponding author:
| | - Ishwara Keerthi
- Department of Orthopaedics, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education Manipal Karnataka 576104 India
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18
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Sheth U, Fernandez CE, Morgan AM, Henry P, Nam D. Are two plates better than one? A systematic review of dual plating for acute midshaft clavicle fractures. Shoulder Elbow 2022; 14:500-509. [PMID: 36199514 PMCID: PMC9527487 DOI: 10.1177/17585732211002495] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 01/11/2021] [Accepted: 02/23/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND The rate of operative fixation of acute midshaft clavicle fractures has exponentially increased in recent years; however, the rate of reoperation for symptomatic hardware removal remains high and the optimal fixation strategy unknown. This systematic review aimed to summarize available evidence for dual plating of acute displaced midshaft clavicle fractures. METHODS EMBASE, MEDLINE, and PubMed searches identified clinical studies evaluating dual plate fixation of acute midshaft clavicle fractures. Pooled analysis was performed using a random-effects model in RevMan 5.3. RESULTS Eleven studies including 672 patients were included. Hardware removal occurred in 4.4% and 12.3% of patients undergoing dual and single plate fixation, respectively. Compared to single plating, dual plating had significantly lower odds of hardware removal (P = 0.001) with no difference in union rates. There were no significant differences in reoperation (excluding hardware removal), complications, and patient-reported outcomes between the two groups (P > 0.05). CONCLUSIONS This study suggests that dual plating of acute displaced midshaft clavicle fractures may lead to lower rates of reoperation for symptomatic hardware removal without compromising fracture healing. Ultimately, well-designed randomized trials are needed to further investigate the findings from this systematic review.
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Affiliation(s)
- Ujash Sheth
- Sunnybrook Orthopaedic Upper Limb (SOUL), Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada,Ujash Sheth, 2075 Bayview Avenue, MG301 Toronto, ON, Canada M4N 3M5.
| | - Claire E Fernandez
- Department of Orthopaedic Surgery, Northwestern University, Chicago, USA
| | - Allison M Morgan
- Department of Orthopaedic Surgery, Northwestern University, Chicago, USA
| | - Patrick Henry
- Sunnybrook Orthopaedic Upper Limb (SOUL), Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Diane Nam
- Sunnybrook Orthopaedic Upper Limb (SOUL), Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
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19
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Zielinski E, Doe K, Perdue P. Dual Plate Minifragment Fixation of Clavicle Fractures- Technique and Approach. J Orthop Trauma 2022; 36:S1-S2. [PMID: 35838561 DOI: 10.1097/bot.0000000000002389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/10/2022] [Indexed: 02/02/2023]
Abstract
SUMMARY The treatment of midshaft clavicle fractures continues to evolve, with a variety of fixation techniques and constructs used. Symptomatic hardware is a common complication related to plate fixation of the clavicle, and often results in secondary surgery for implant removal. The minifragment dual plate fixation technique for clavicle fractures provides a construct that may result in fewer implant related complications with comparable fixation stability to precontoured locking plates. Our case presentation demonstrates our approach to midshaft clavicle fractures, the benefits of this surgical technique, and reported outcomes from this fixation method.
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Affiliation(s)
- Elizabeth Zielinski
- Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, Richmond, VA; and
| | - Keli Doe
- Department of Orthopaedic Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - Paul Perdue
- Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, Richmond, VA; and
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20
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Fox B, Clement ND, MacDonald DJ, Robinson M, Nicholson JA. Plate fixation of midshaft clavicle fractures for delayed union and non-union is a cost-effective intervention but functional deficits persist at long-term follow-up. Shoulder Elbow 2022; 14:360-367. [PMID: 35846398 PMCID: PMC9284296 DOI: 10.1177/1758573221990367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/27/2020] [Accepted: 12/31/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND The primary aim of this study was to compare the long-term functional outcome of midshaft clavicle fracture fixation for delayed (≥3 month) and non-union (≥6 month) compared to a matched cohort of patients that achieved union with non-operative management. The secondary aim was to assess cost-effectiveness of fixation. METHODS A consecutive series of patients over 10-years were retrospectively reviewed using the QuickDASH, Oxford Shoulder Score and EuroQol five-dimension summary index (EQ-5D). These patients were compared to a matched cohort that achieved union after non-operative management using propensity score matching. RESULTS Sixty patients (follow-up 79%, n = 60/76) at 4.1 years post-operative (1.1-10.0 years) had a QuickDASH of 16.5 (95% CI 11.6-21.5), Oxford Shoulder Score 41.5 (39.0-44.1) and EQ-5D 0.7621 (0.6822-0.8421). One in five patients were dissatisfied with their final outcome (n = 13/60). Functional outcome was inferior following fixation when compared to patients that united with non-operative management (QuickDASH 16.5 vs. 5.5, p < 0.001 and EQ-5D 0.7621 vs. 0.9073, p = 0.001). However, significant improvements were found when compared to pre-operative scores (QuickDASH p < 0.001 and EQ-5D p < 0.001). The cost per QALY for fixation was £5624.62 for the study cohort. CONCLUSIONS Clavicle fixation for delayed and non-union is a cost-effective intervention but outcomes are worse compared to patients that unite with non-operative management.
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Affiliation(s)
- Ben Fox
- Jamie A Nicholson, Department of Trauma and
Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.
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21
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Zenker M, Theodorou E, Andermatt D, Winkler R, Hoyen HA, Jaeger M, Jiang C, Lambert S, Nijs S, Fontana AD. Quantifying osteosynthesis plate prominence - mathematical definitions and case study on a clavicle plate. Comput Methods Biomech Biomed Engin 2022; 26:917-926. [PMID: 35833691 DOI: 10.1080/10255842.2022.2098676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Hardware prominence remains a clinical challenge in focus for implant design in subcutaneous plate applications. Existing evaluation of hardware prominence relies on plate-to-bone distance at a single point or on average. A reproducible measure for plate prominence remains undefined. This study mathematically defines the plate prominence linked to the cross-sectional area change due to the plate presence on the bone. Two anatomical plate designs were fitted to 100 clavicles, and afterwards plate prominence parameters were evaluated and compared. This methodology enables the quantification of hardware prominence for different plate designs to inform the development of implants targeting low prominence.
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Affiliation(s)
| | | | | | - Ralf Winkler
- Innomedic GmbH, DePuy Synthes, Philippsburg-Rheinsheim, Germany
| | - Harry A Hoyen
- Department of Orthopaedic Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Martin Jaeger
- Department of Orthopedics and Trauma Surgery, Medical Center-Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Chunyan Jiang
- Shoulder Service, School of Medicine, Beijing Jishuitan Hospital, Peking University, Peking, China
| | - Simon Lambert
- Department of Trauma and Orthopedic Surgery, University College London Hospital NHS Foundation Trust, London, UK
| | - Stefaan Nijs
- Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium
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22
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Degeorge B, Ravoyard S, Lazerges C, Toffoli A, Chammas M, Coulet B. Clinical Impact of Malunion After All-Arthroscopic Coracoclavicular Stabilization for Displaced and Unstable Lateral Clavicle Fractures. J Orthop Trauma 2022; 36:e271-e277. [PMID: 34941602 DOI: 10.1097/bot.0000000000002330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the clinical outcome of lateral clavicle malunion treated with all-arthroscopic coracoclavicular (CC) stabilization. DESIGN Retrospective, case series. SETTING Department of hand and upper extremity surgery, university hospital center. PATIENTS Forty-five patients with unstable and displaced lateral clavicle fracture treated between January 2015 and August 2019 were included in the study. INTERVENTION Closed reduction and arthroscopic CC stabilization using cortical buttons. MAIN OUTCOME MEASUREMENTS Shoulder pain and active motion. Patient-reported outcome measures included the Constant score, the Subjective Shoulder Value, the AcromioClavicular Joint Instability score, and the Specific AcromioClavicular Score. Radiographic evaluation assessed bony union and malunion. RESULTS Mean duration of follow-up was 25 months (12-60 months). Five patients (11%) had lateral clavicle nonunion and 7 (16%) had lateral clavicle malunion (5 in the coronal plane and 2 in the axial plane). Lateral clavicle malunion did not significantly affect clinical or functional outcomes (P > 0.05). Mean active shoulder motion was forward flexion 163 degrees (SD 28), abduction 162 degrees (SD 26), and external rotation 63 degrees (SD 21). On average, the patients scored 88.3 (SD 17.7) in the Constant score, 90% (SD 12) in the Subjective Shoulder Value, 88.8 (SD 9.4) in the AcromioClavicular Joint Instability score, and 11.4 (SD 8.5) for SACS. The overall complication rate was 38% (including 7 malunions, 5 nonunions, 2 adhesive capsulitis, and 3 button malpositions). CONCLUSIONS Closed reduction and internal fixation of lateral clavicle fracture with all-arthroscopic CC stabilization using cortical button potentiates bony union but may generate lateral clavicle malunion, which does not affect the clinical or functional outcome. This result can be attributed to CC ligament healing and acromioclavicular joint congruence. All-arthroscopic CC stabilization is a minimally invasive but demanding surgical alternative for managing unstable and displaced lateral clavicle fracture. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Benjamin Degeorge
- Service de Chirurgie Orthopédique et Traumatologique du Membre Supérieur, Chirurgie de la Main et des Nerfs Périphériques, CHU Lapeyronie, Montpellier, France ; and
- Clinique Saint-Jean Sud de France, Groupe OrthoSud, Saint Jean de Védas, France
| | - Salomé Ravoyard
- Service de Chirurgie Orthopédique et Traumatologique du Membre Supérieur, Chirurgie de la Main et des Nerfs Périphériques, CHU Lapeyronie, Montpellier, France ; and
| | - Cyril Lazerges
- Service de Chirurgie Orthopédique et Traumatologique du Membre Supérieur, Chirurgie de la Main et des Nerfs Périphériques, CHU Lapeyronie, Montpellier, France ; and
| | - Adriano Toffoli
- Service de Chirurgie Orthopédique et Traumatologique du Membre Supérieur, Chirurgie de la Main et des Nerfs Périphériques, CHU Lapeyronie, Montpellier, France ; and
- Clinique Saint-Jean Sud de France, Groupe OrthoSud, Saint Jean de Védas, France
| | - Michel Chammas
- Service de Chirurgie Orthopédique et Traumatologique du Membre Supérieur, Chirurgie de la Main et des Nerfs Périphériques, CHU Lapeyronie, Montpellier, France ; and
| | - Bertrand Coulet
- Service de Chirurgie Orthopédique et Traumatologique du Membre Supérieur, Chirurgie de la Main et des Nerfs Périphériques, CHU Lapeyronie, Montpellier, France ; and
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23
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Vancleef S, Wesseling M, Duflou JR, Nijs S, Jonkers I, Vander Sloten J. Thin patient-specific clavicle fracture fixation plates can mechanically outperform commercial plates: An in silico approach. J Orthop Res 2022; 40:1695-1706. [PMID: 34668224 DOI: 10.1002/jor.25178] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 08/26/2021] [Accepted: 09/07/2021] [Indexed: 02/04/2023]
Abstract
Current fixation plates used to operatively stabilize clavicular fractures are suboptimal, leading to reoperation rates up to 53%. Plate irritation, which can be caused by a poor geometric fit and plate thickness, has been found to be an important factor for reoperation. Moreover, muscle attachment sites (MAS) have to be detached occasionally. To improve current surgical clavicle fracture treatment with plate osteosynthesis, a change in plate design is required. The goal of this study was to design a patient-specific clavicle fracture fixation plate that includes geometrical optimization and stiffness determination. Its biomechanical performance has been compared with a commercial plate by examining the geometric fit, anatomical outline, stresses and interfragmentary motion using a finite element analysis with physiological loading and boundary conditions. Evaluation showed a better geometrical fit of the patient-specific plate as well as an improved fracture reduction. Displacements between fracture fragments were lower in case of the patient-specific plate, both when a fracture gap and no fracture gap were present. Results indicate a superior mechanical performance in terms of all investigated outcomes of the patient-specific plate compared to the commercial plate, while better aligning with the patient-specific geometry and without the need for MAS release. Due to the patient-specific geometry and reduced thickness, these fixation plates are expected to decrease the operation time, as intraoperative contouring will become irrelevant, and to decrease reoperation rates as implant irritation will be minimized.
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Affiliation(s)
- Sanne Vancleef
- Biomechanics Section, Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
| | - Mariska Wesseling
- Human Movement Biomechanics Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Joost R Duflou
- Manufacturing Processes and Systems (MaPS), Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
| | - Stefaan Nijs
- Department of Development and Regeneration, Locomotor and Neurological Disorders, KU Leuven, Leuven, Belgium.,Department of Traumatology, Universitaire Ziekenhuizen (UZ), Leuven, Belgium
| | - Ilse Jonkers
- Human Movement Biomechanics Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Jos Vander Sloten
- Biomechanics Section, Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
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Ankers T, Sawalha S, Nixon M, Kenyon P, Webb M. Does a skin incision along Langer's lines reduce complications following fixation of displaced middle-third clavicle fractures? Arch Orthop Trauma Surg 2022; 142:1003-1007. [PMID: 33555400 DOI: 10.1007/s00402-021-03766-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/01/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Internal fixation of displaced middle-third clavicle fractures is a widely used treatment but is frequently associated with post-operative complications. The aim of this study is to investigate whether or not using a skin incision along Langer's lines, as opposed to a traditional transverse incision, reduces complications. METHODS We retrospectively reviewed data on 108 patients who underwent open reduction and internal fixation of mid-shaft clavicle fractures between 2014 and 2018. Either an oblique incision along Langer's lines or a transverse incision was used according to surgeon's preference. A pre-contoured diaphyseal locking plate was used in all cases. We collected data on fracture classification, minor complications (irritation from plate, chest wall numbness, superficial wound infection) and major complications (irritation from plate necessitating metalwork removal, periprosthetic fracture, deep infection, neurovascular injury and non-union). Statistical analysis was performed using multivariant regression analysis and Fisher's exact tests. RESULTS Fifty-seven patients underwent fixation using the oblique incision and 51 via the transverse incision. Age, gender and fracture pattern in the two groups were comparable. There were 14 minor and 6 major complications in the oblique group. In the transverse group, there were 16 minor and 5 major complications. The major complication rate was 10.5% in the oblique group and 9.8% in the transverse group. The overall major complication rate was 10.2%. No statistically significant difference in the rate of complications between the two groups was identified. CONCLUSION Based on our data, an incision following Langer's lines does not reduce the rate of complications following fixation of displaced middle-third clavicle fractures.
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Affiliation(s)
- Thomas Ankers
- Countess of Chester Hospital, Chester, UK. .,Countess of Chester Hospital, Liverpool Road, Chester, CH2 1UL, UK.
| | - Seif Sawalha
- Countess of Chester Hospital, Liverpool Road, Chester, CH2 1UL, UK
| | - Matthew Nixon
- Countess of Chester Hospital, Liverpool Road, Chester, CH2 1UL, UK
| | - Peter Kenyon
- Countess of Chester Hospital, Liverpool Road, Chester, CH2 1UL, UK
| | - Mark Webb
- Countess of Chester Hospital, Liverpool Road, Chester, CH2 1UL, UK
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Peters J, Singh G, Hakobyan H. Surgical Treatment of Clavicular Fractures, Refractures, Delayed and Non-Unions Using a Resorbable, Gentamicin-Eluting Calcium Sulphate/Hydroxyapatite Biocomposite. Ther Clin Risk Manag 2022; 18:551-560. [PMID: 35586156 PMCID: PMC9109884 DOI: 10.2147/tcrm.s361006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/26/2022] [Indexed: 11/23/2022] Open
Abstract
Objective This study describes clinical and radiological outcomes following treatment of displaced primary fractures, refractures, delayed unions and non-unions of the clavicle with open reduction and internal fixation (ORIF) with a plate plus filling of the residual bone defect and/or implant augmentation with a gentamicin-loaded bone graft substitute (CERAMENT G, BONESUPPORT). Patients and Methods Patients who underwent surgical treatment either for displaced clavicle fractures, refractures, delayed unions or non-unions between June 2018 and May 2021 were enrolled in this retrospective study. Bony consolidation, complication rate, and functional outcomes, including overall health, were assessed. Results A total of 26 clavicles in 25 patients with a mean age of 50.7 (16–85) years, 16 male and 9 female, were enrolled in the study. The mean follow-up was 14.9 (6–31) months. There were 18 cases of displaced clavicle fractures, four refractures, two delayed unions and two non-unions. The majority of the clavicle lesions were located at the middle third (17/26, 65.4%), seven at the lateral third (26.9%) and two at the medial third (7.7%) of the clavicle. A mean Goldberg score of 7 indicated complete bony union and remodeling of the bone graft substitute in all cases. No complications occurred. The mean University of California at Los Angeles Shoulder Score and the mean Quick Disability of the Arm, Shoulder and Hand Score were 34.6±0.8 (32–35) points and 0.6±1.6 (0–5.4) points, respectively, and revealed excellent functional results. The mean 12-item Short-Form Survey physical component questionnaire was 57.7±1.7 (54.1–58.9) points, and no patient experienced any pain at the last follow-up. Conclusion Our initial experience suggests that ORIF using a plate plus bone defect filling and/or implant augmentation with a gentamicin-eluting bone graft substitute may be useful not only for complication management after clavicle fractures but also in the initial treatment of challenging clavicular fractures.
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Affiliation(s)
- Jens Peters
- Department of Trauma Surgery and Orthopaedics, Clinic Sulingen, Sulingen, Lower Saxony, 27232, Germany
- Correspondence: Jens Peters, Department of Trauma Surgery and Orthopaedics, Clinic Sulingen, Schmelingstrasse 47, Sulingen, Lower Saxony, 27232, Germany, Tel +49 4271 82 33210, Fax +49 4271 82 33212, Email
| | - Gurdeep Singh
- Department of Trauma Surgery and Orthopaedics, Clinic Sulingen, Sulingen, Lower Saxony, 27232, Germany
| | - Hrayr Hakobyan
- Department of Trauma Surgery and Orthopaedics, Clinic Sulingen, Sulingen, Lower Saxony, 27232, Germany
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Pastor T, Knobe M, van de Wall BJM, Rompen IF, Zderic I, Visscher L, Link BC, Babst R, Gueorguiev B, Beeres FJP. Low-profile dual mini-fragment plating of diaphyseal clavicle fractures. A biomechanical comparative testing. Clin Biomech (Bristol, Avon) 2022; 94:105634. [PMID: 35367818 DOI: 10.1016/j.clinbiomech.2022.105634] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 03/11/2022] [Accepted: 03/25/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Implant removal rates after clavicle plating are high. Recently, low-profile dual mini-fragment plate constructs have revealed lower implant removal rates following fixation of diaphyseal clavicle fractures. However, they have not been subject to a biomechanical investigation. AIMS To: (1) investigate thebiomechanical competence of different dual plate designs and (2) compare them against single superoanterior plating. METHODS Twelve artificial clavicles with a simulated AO/OTA 15.2C unstable diaphyseal clavicle fracture were assigned to 2 groups and instrumented with dual titanium mandible plates as follows: Group 1 - 2.5 mm anterior plus 2.0 mm superior (2.5/2.0); Group 2 - 2.0 mm anterior plus 2.0 mm superior (2.0/2.0). Specimens were cyclically tested to failure under craniocaudal cantilever bending superimposed with torsion around the shaft axis and compared to previous published data acquired using 6 locking superoanterior plates tested under the same conditions (Group 3). FINDINGS Initial stiffness was highest in Group 1 followed by Group 2 and Group 3, being significantly different between Group 1 and Group 3 (p = 0.020). Displacement after 5000 cycles was biggest in Group 3, followed by Group 2 and Group 1, with significant differences between Group 3 and both Group 1 and Group 2 (p ≤ 0.027). Cycles to failure were highest in Group 3 followed by Group 1 and Group 2, being significantly different between Group 2 and Group 3 (p = 0.004). INTERPRETATION Low-profile 2.0/2.0 dual plates demonstrated similar initial stiffness compared with single 3.5 mm locking plates, however, they revealed significantly lower resistance to failure. Moreover, low-profile 2.5/2.0 dual plates demonstrated significantly higher initial stiffness and similar resistance to failure compared with single 3.5 mm locking plates and can therefore be considered as their useful alternative for diaphyseal clavicle fracture fixation.
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Affiliation(s)
- Torsten Pastor
- AO Research Institute Davos, Davos, Switzerland; Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland.
| | - Matthias Knobe
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Bryan J M van de Wall
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Ingmar F Rompen
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Ivan Zderic
- AO Research Institute Davos, Davos, Switzerland
| | | | - Björn-Christian Link
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Reto Babst
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland; Department of Health Science and Medicine, University of Lucerne, Lucerne, Switzerland
| | | | - Frank J P Beeres
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
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Wolf S, Chitnis AS, Manoranjith A, Vanderkarr M, Plaza JQ, Gador LV, Holy CE, Sparks C, Lambert SM. Surgical treatment, complications, reoperations, and healthcare costs among patients with clavicle fracture in England. BMC Musculoskelet Disord 2022; 23:135. [PMID: 35139854 PMCID: PMC8830003 DOI: 10.1186/s12891-022-05075-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/20/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The clinical and economic burden of clavicle fractures in England is not well documented. This study evaluated rates of surgical treatment, post-surgical complications, reoperations and costs in patients with clavicle fractures using the Clinical Practice Research Datalink (CPRD) database. METHODS CPRD data were linked to National Health Service Hospital Episode Statistics data. Patients with a diagnosis of clavicle fracture between 2010-2018 were selected in CPRD (date of fracture = index date). Of those, patients with surgical intervention within 180 days from index fracture were identified. Rates of post-surgical complications (i.e., infection, non-union, and mal-union), reoperations (for device removal or for postoperative complications), post-operative costs and median time to reoperations were evaluated up to 2 years after surgery. RESULTS 21,340 patients with clavicle fractures were identified (mean age 35.0 years(standard deviation (SD): 26.5), 66.7% male). Surgery was performed on 672 patients (3.2% of total cohort) at an average 17.1 (SD: 25.2) days post-fracture. Complications (i.e., infection, non-union, or malunion) affected 8.1% of surgically treated clavicle fracture patients; the rate of infection was 3.5% (95% CI, 1.7%- 5.2%), non-union 4.4% (95% CI, 2.4%-6.5%), and mal-union 0.3% (95% CI, 0%-0.7%). Adjusting for age, gender, comorbidities and time to surgery, the all-cause reoperation rate was 20.2% (13.2%-30.0%) and the adjusted rate of reoperation for implant removal was 17.0% (10.7%-25.9%)-84% of all-cause reoperations were thus performed for implant removal. Median time to implant removal was 254 days. The mean cost of reoperations for all causes was £5,000. The most expensive reoperations were for cases that involved infection (mean £6,156). CONCLUSIONS Complication rates following surgical clavicle fracture care averaged 8.1%. However, reoperation rates exceed 20%, the vast majority of reoperations being performed for device removal. Technologies to alleviate secondary device removal surgeries would address a significant clinical unmet need.
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Affiliation(s)
| | | | | | | | | | | | - Chantal E Holy
- Medical Devices Epidemiology, Johnson & Johnson, New Brunswick, NJ, USA.
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Salazar LM, Koso RE, Momtaz DA, Dutta AK. Results of pre-contoured titanium anterior plating of midshaft clavicle fractures. J Shoulder Elbow Surg 2022; 31:107-112. [PMID: 34174450 DOI: 10.1016/j.jse.2021.05.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 05/07/2021] [Accepted: 05/16/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Plating midshaft clavicle fractures anteriorly is gaining popularity because of low complication rates. Improvements in plate fixation constructs for midshaft clavicle fractures have unclear clinical significance. The purpose of this study was to present the early clinical and radiographic outcomes of pre-contoured titanium anterior plates for the treatment of midshaft clavicle fractures. METHODS Skeletally mature patients who underwent plate fixation of a midshaft clavicular fracture from 2008 to 2015 using pre-contoured titanium anterior plates were included in this retrospective investigation. The primary outcome measures were union rate and hardware removal rate. The secondary outcome measures included reoperation for all causes and mechanical implant failure. RESULTS A total of 26 patients were included. Complete healing occurred in 96% of patients without further surgical intervention, and all patients achieved union. Medical complications occurred in 2 patients (7.7%), consisting of cellulitis (n = 1) and chronic pain (n = 1). In 1 patient (3.8%), delayed union occurred and the use of a bone stimulator was required postoperatively to achieve union. Finally, 2 patients (7.7%) had symptomatic implants that required removal. CONCLUSIONS In the acute fracture setting, the anterior plating system used in this study led to a high rate of union with decreased rates of implant irritation. Only 7.7% of patients required hardware removal for symptomatic hardware, as opposed to the estimated 20%-60% reported in the literature in patients with symptomatic superior clavicle plates.
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Affiliation(s)
- Luis M Salazar
- Department of Orthopaedics, UT Health San Antonio, San Antonio, TX, USA.
| | - Riikka E Koso
- Department of Orthopaedics, UT Health San Antonio, San Antonio, TX, USA
| | - David A Momtaz
- Department of Orthopaedics, UT Health San Antonio, San Antonio, TX, USA
| | - Anil K Dutta
- Department of Orthopaedics, UT Health San Antonio, San Antonio, TX, USA
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Meselhy MA, Shosha AM, Essawy OM, Eltrigy SAE. Management of Clavicular Fracture in Adults by Plating: a Systematic Review. SN COMPREHENSIVE CLINICAL MEDICINE 2021; 3:2603-2617. [DOI: 10.1007/s42399-021-01070-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/21/2021] [Indexed: 09/02/2023]
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Uchiyama Y, Handa A, Omi H, Hashimoto H, Shimpuku E, Imai T, Takatori N, Watanabe M. Locking versus nonlocking superior plate fixations for displaced midshaft clavicle fractures: A prospective randomized trial comparing clinical and radiografic results. J Orthop Sci 2021; 26:1094-1099. [PMID: 33176960 DOI: 10.1016/j.jos.2020.09.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/11/2020] [Accepted: 09/23/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND It is unknown whether locking or nonlocking superior plate fixation is better for managing displaced midshaft clavicle fractures. Therefore, we aimed to compare the clinical and radiographic outcomes of locking and nonlocking superior plate fixation of displaced midshaft clavicle fractures. METHODS A total of 102 consecutive patients with displaced midshaft clavicle fractures (2B1 and 2B2 in Robinson classification) participated in this randomized controlled trial; 12 patients were excluded. Surgeries were performed using a 3.5-mm Locking Compression Plate (LCP) between 2007 and 2015. Patients were treated either with a locking plate (group L, n = 45) or a nonlocking plate (group N, n = 45). In both groups, the plates were fixed to the proximal and distal clavicle with two and/or three screws, respectively. The main outcome measures were complication rates, time to bone union, and Constant score. RESULTS Forty-two patients in group L (mean age, 45.9 years) and 41 in group N (mean age, 43.6 years) were followed. The overall complication rates in groups L and N were 7.2% (three peri-implant fractures) and 7.3% (non-union, deformed plate, and peri-implant fracture), respectively (p = .98). The average time to union significantly differed between groups (L vs. N: 13.0 ± 4.1 vs. 17.5 ± 6.3 weeks; p < .01). However, the Constant score at the final follow-up was not significantly different between groups (L vs. N: 87.0 ± 12.3 vs. 89.8 ± 9.1). CONCLUSIONS Similar complication rates and clinical results were found for locking and nonlocking superior plate fixation for displaced midshaft clavicle fractures. However, the time to bone union was shorter with the locking plate. This study suggests that both plating systems are effective for treating displaced midshaft clavicle fractures. LEVEL OF EVIDENCE Therapeutic, level I.
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Affiliation(s)
- Yoshiyasu Uchiyama
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.
| | - Akiyoshi Handa
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Hiroko Omi
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Hiroyuki Hashimoto
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Eiji Shimpuku
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Takeshi Imai
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Naoki Takatori
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Masahiko Watanabe
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
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Ruzbarsky JJ, Nolte PC, Miles JW, Tanghe KK, Tross AK, Hackett TR. Does dual plating clavicle fractures increase the risk of refracture after hardware removal? A biomechanical investigation. J Shoulder Elbow Surg 2021; 30:e594-e601. [PMID: 33571652 DOI: 10.1016/j.jse.2020.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/12/2020] [Accepted: 12/27/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Dual orthogonal plating of midshaft clavicle fractures is increasingly used for osteosynthesis. The risk of refracture after hardware removal remains unknown. The purpose of this study was to compare the torsional and 3-point bending loads to failure of the clavicle following removal of single-plane, superior 3.5-mm plate fixation vs. dual orthogonal plating 2.7-mm constructs. METHODS This study used 12 pairs of clavicles (N = 24) harvested from cadaveric specimens with a mean age at death of 56.5 years (range, 46-65 years). One clavicle from each pair was randomly assigned to either superior plating (SP, n = 12) or double plating (DP, n = 12). For SP, a superior 3.5-mm plate was used as a template to drill 3 bicortical 2.8-mm holes medial and lateral to the center of the clavicle. For DP, two 2.7-mm plates were used as a template to drill 4 bicortical 2.0-mm holes medial and lateral to the center of the clavicle. Clavicle pairs were randomly and evenly distributed to undergo either 3-point bending (n = 12) or posterior torsional loading (n = 12). Cyclic loading was performed, followed by load-to-failure testing. Stiffness, displacement at failure, load to failure, and failure mode were assessed and compared between SP and DP constructs. RESULTS No significant differences between the SP and DP groups were observed for stiffness (768.2 ± 281.3 N/mm vs. 785.5 ± 315.0 N/mm, P = .872), displacement at failure (8.1 ± 2.8 mm vs. 5.4 ± 1.2 mm, P = .150), and ultimate load at failure (1831.0 ± 229.6 N vs. 1842.0 ± 662.4 N, P = .964) under the condition of 3-point bending. Similarly, no significant differences between the SP and DP groups were observed for torsional stiffness (1.3 ± 0.8 N · m/° vs. 1.1 ± 0.4 N · m/°, P = .844), rotation at failure (17.3° ± 4.4° vs. 14.4° ± 1.2°, P = .205), and ultimate torque at failure (14.8 ± 6.5 N · m vs. 14.7 ± 6.9 N · m, P = .103) under the condition of posterior torsional loading. The most common mode of failure for 3-point bending testing was an oblique fracture (7 of 12 clavicles, 58.3%), with no significant difference between groups (3 of 6 in SP group [50%] vs. 4 of 6 in DP group [66.7%], P > .999). The most common mode of failure with posterior torsional loading was a spiral fracture (10 of 12 clavicles, 83.3%), with no significant difference between groups (4 of 6 in SP group [66.7%] vs. 6 of 6 in DP group [100%], P = .455). CONCLUSION Following clavicle plate removal of either DP or SP, there is no statistically significant difference in the amount of force, under the condition of 3-point bending or torsional loading, required to fracture the diaphyseal clavicle in vitro.
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Affiliation(s)
- Joseph J Ruzbarsky
- Department of Orthopaedic Surgery, Steadman Philippon Research Institute, Vail, CO, USA; Department of Orthopaedic Surgery, The Steadman Clinic, Vail, CO, USA.
| | - Philip-C Nolte
- Department of Orthopaedic Surgery, Steadman Philippon Research Institute, Vail, CO, USA; Clinic for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Jon W Miles
- Department of Orthopaedic Surgery, Steadman Philippon Research Institute, Vail, CO, USA
| | - Kira K Tanghe
- Department of Orthopaedic Surgery, Steadman Philippon Research Institute, Vail, CO, USA
| | - Anna-K Tross
- Department of Orthopaedic Surgery, Steadman Philippon Research Institute, Vail, CO, USA; Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Thomas R Hackett
- Department of Orthopaedic Surgery, Steadman Philippon Research Institute, Vail, CO, USA; Department of Orthopaedic Surgery, The Steadman Clinic, Vail, CO, USA
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Examining the novel use of continuous compression implants in clavicle reconstruction: A biomechanical study. Clin Biomech (Bristol, Avon) 2021; 88:105437. [PMID: 34311318 DOI: 10.1016/j.clinbiomech.2021.105437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 06/15/2021] [Accepted: 07/15/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Current implants for clavicle fractures are known to cause poor cosmesis and irritation, which may require implant removal. Low-profile shape-memory staples provide an attractive alternative, but their biomechanical utility in clavicle reconstruction is unknown. We hypothesized that shape-memory reconstructions would be more compliant compared to traditional constructs but would also outperform conventional plates during cyclic loading to failure. METHODS This study was performed with 36 synthetic clavicles and 12 matched pairs of cadaveric specimens. The synthetic study tested four reconstructions: a single superiorly placed staple (n = 6), a single anteroinferiorly-placed staple (n = 6), a 3.5 mm reconstruction plate (n = 12), and two orthogonally placed staples (n = 12). The cadaveric study tested three constructs: reconstruction plate (n = 8), two orthogonal staples (n = 8), and a 2.7 mm reconstruction plate combined with a superior staple (n = 8). Non-destructive 4-point bending, compression, and torsion assays were performed prior to destructive cantilever bending and cyclic torsion tests. FINDINGS The single staple and double staple groups demonstrated significantly decreased resistance to bending (p < 0.001) and torsion (p ≤ 0.027) when compared to reconstruction plate groups. The double staple group sustained significantly fewer cycles to failure than the reconstruction plate group in cyclic torsional tests (p = 0.012). The synthetic models produced higher stiffness and failure mechanisms that were completely different from cadaveric specimens. INTERPRETATION Shape memory alloy implants provided inadequate stiffness for clavicle fixation but may have utility in other orthopaedic applications when used as a supplementary compression device in conjunction with traditional plated constructs. Synthetic bones have limited capacity for modeling fragility fractures.
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Advantage of Multi-Directional Stability of Spiral Clavicle Plate in Treatment of Middle One-Third Clavicle Fracture: A Finite Element Study. J Med Biol Eng 2021. [DOI: 10.1007/s40846-021-00635-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Park HY, Kim SJ, Sur YJ, Jung JW, Kong CG. Refracture after locking compression plate removal in displaced midshaft clavicle fractures after bony union: a retrospective study. Clin Shoulder Elb 2021; 24:72-79. [PMID: 34078014 PMCID: PMC8181845 DOI: 10.5397/cise.2021.00059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 03/27/2021] [Indexed: 11/25/2022] Open
Abstract
Background A midshaft clavicle fracture is a common fracture that typically responds well to open reduction and internal fixation (ORIF). However, refracture can occur after implant removal (IR). This study aimed to analyze the rate of refracture and related factors after removal of the locking compression plate (LCP) for displaced midshaft clavicle fractures. Methods We retrospectively reviewed the medical records of 201 patients who had undergone ORIF with LCP for midshaft clavicle fractures after IR after bony union from January 2011 to May 2018 at our institute. We evaluated basic demographic characteristics and radiographic parameters. All patients were treated with an LCP for primary fracture. The patients were divided into two groups: a refracture group that experienced a second fracture within 1 year after IR and a no-fracture group. Results There were four cases (1.99%) of refracture; three were treated conservatively, while one was treated surgically. All patients achieved bony union. The average interval between refracture and IR was 64 days (range, 6–210 days). There was a significant difference in classification of fractures (AO Foundation/Orthopaedic Trauma Association [AO/OTA] classification) between the two groups. However, other patient demographics and radiographic measurements between refracture and IR, such as bone diameter, showed no significant difference between the two groups. Conclusions This study showed that one in 50 patients suffered from refracture after removal of the LCP. Thus, if patients desire IR, the surgeon should explain that there is a relatively higher possibility of refracture for cases with simple or segmental fractures than for other types of fracture.
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Affiliation(s)
- Ho-Youn Park
- Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Seok-Jung Kim
- Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Yoo-Joon Sur
- Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Jae-Woong Jung
- Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Chae-Gwan Kong
- Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
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Surgical fixation of displaced midshaft clavicular fractures with precontoured plates in adolescents. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021. [DOI: 10.1016/j.recote.2020.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Kongmalai P, Chiaprasert P, Rungsinaporn V. Reliability of the radiographic views in supine position for evaluation of displaced midshaft clavicle fracture length. J Orthop Surg (Hong Kong) 2021; 28:2309499020952295. [PMID: 32909906 DOI: 10.1177/2309499020952295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To analyze the agreement of the displaced midshaft clavicle fracture length measurement between each of the supine radiographic position (chest anteroposterior (AP), both clavicle AP, and 20° cephalic tilt clavicle AP view) and computed tomography (CT) scan of the clavicle. Furthermore, the inter- and intraobserver reliability of each radiographic position was analyzed. METHODS Prospective cross-sectional study was performed with patients diagnosed with displaced midshaft clavicle fracture treated conservatively. Three views of radiographs and CT scan of clavicle were obtained in supine position after informed consent. The measurement of fractured clavicle length was done by three observers at the time and after 4 weeks interval. RESULTS Thirty-three patients (25 males and 8 females), with a mean age of 45, were recruited. The agreement between each of the radiographic measurement and CT scan was good. The interobserver reliability was moderate to good for radiographic measurement. The highest intraclass correlation coefficient (ICC) of 0.80-0.81 was shown between the 20° cephalic tilt and the CT scan, followed by the both clavicle AP (0.75-0.77) and the chest AP (0.69-0.75), respectively. There was an excellent intraobserver reliability for all of the radiographic measurement with the ICC 0.92-0.99. CONCLUSION The supine radiographs could be a useful option to measure the displaced midshaft clavicle fracture length. The recommended view was the 20° cephalic tilt clavicle AP view in supine position to best evaluate the fractured clavicle length.
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Affiliation(s)
- Pinkawas Kongmalai
- Department of Orthopaedics, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand
| | - Peeraput Chiaprasert
- Department of Orthopaedics, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand
| | - Visit Rungsinaporn
- Department of Orthopaedics, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand
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Yang TH, Ko HJ, Wang AD, Tseng WJ, Chia WT, Chen MK, Su YH. Complications of clavicle fracture surgery in patients with concomitant chest wall injury: a retrospective study. BMC Musculoskelet Disord 2021; 22:294. [PMID: 33743671 PMCID: PMC7981946 DOI: 10.1186/s12891-021-04148-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 03/04/2021] [Indexed: 11/22/2022] Open
Abstract
Background The impact of associated chest wall injuries (CWI) on the complications of clavicle fracture repair is unclear to date. This study aimed to investigate the complications after surgical clavicle fracture fixation in patients with and without different degrees of associated CWI. Methods A retrospective review over a four-year period of patients who underwent clavicle fracture repair was conducted. A CWI and no-CWI group were distinguished, and the CWI group was subdivided into the minor-CWI (three or fewer rib fractures without flail chest) and complex-CWI (flail chest, four or more rib fractures) subgroup. Demographic data, classification of the clavicle fracture, number of rib fractures, and associated injuries were recorded. Overall complications included surgery-related complications and unplanned hospital readmissions. Univariate analysis and stepwise backward multivariate logistic regression were used to identify potential risk factors for complications. Results A total of 314 patients undergoing 316 clavicle fracture operations were studied; 28.7% of patients (90/314) occurred with associated CWI. Patients with associated CWI showed a significantly higher age, body mass index, and number of rib fractures. The overall and surgical-related complication rate were similar between groups. Unplanned 30-day hospital readmission rates were significantly higher in the complex-CWI group (p = 0.02). Complex CWI and number of rib fractures were both independent factor for 30-day unplanned hospital readmission (OR 1.59, 95% CI: 1.00–2.54 and OR 1.33, 95% CI: 1.06–1.68, respectively). Conclusion CWI did not affect surgery-related complications after clavicle fracture repair. However, complex-CWI may increase 30-day unplanned hospital readmission rates. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04148-1.
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Affiliation(s)
- Tsung-Han Yang
- Department of Orthopedics, National Taiwan University Hospital Hsin-Chu Branch, 25, Lane 442, Sec 1, Jingguo Rd, Hsinchu City, 30059, Taiwan.,Department of Orthopedics, National Taiwan University Hospital, Taipei City, 10002, Taiwan
| | - Huan-Jang Ko
- Department of Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City, 30059, Taiwan
| | - Alban Don Wang
- Department of Emergency, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City, 30059, Taiwan
| | - Wo-Jan Tseng
- Department of Orthopedics, National Taiwan University Hospital Hsin-Chu Branch, 25, Lane 442, Sec 1, Jingguo Rd, Hsinchu City, 30059, Taiwan.,Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan
| | - Wei-Tso Chia
- Department of Orthopedics, National Taiwan University Hospital Hsin-Chu Branch, 25, Lane 442, Sec 1, Jingguo Rd, Hsinchu City, 30059, Taiwan
| | - Men-Kan Chen
- Department of Family Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City, 30059, Taiwan.
| | - Ying-Hao Su
- Department of Orthopedics, National Taiwan University Hospital Hsin-Chu Branch, 25, Lane 442, Sec 1, Jingguo Rd, Hsinchu City, 30059, Taiwan. .,Department of Orthopedics, National Taiwan University Hospital Hsin-Chu Biomedical Park Branch, Hsinchu, County, 30261, Taiwan. .,Department of Orthopedics, National Taiwan University College of Medicine, Taipei City, 10002, Taiwan.
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Matsuda Y, Karino M, Okui T, Kanno T. Complications of Poly-l-Lactic Acid and Polyglycolic Acid (PLLA/PGA) Osteosynthesis Systems for Maxillofacial Surgery: A Retrospective Clinical Investigation. Polymers (Basel) 2021; 13:polym13060889. [PMID: 33799342 PMCID: PMC8001587 DOI: 10.3390/polym13060889] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/06/2021] [Accepted: 03/10/2021] [Indexed: 12/02/2022] Open
Abstract
Two second-generation PLLA/PGA bioresorbable osteosynthetic plate systems for oral and maxillofacial surgery are available in Japan. The two systems have different PLLA-PGA component ratios (RapidSorb®, 85:15; Lactosorb®, 82:18) and plate and screw shapes. We conducted a retrospective study to compare our clinical evaluation and examine the incidence of postoperative complications between the two plate systems. A retrospective survey was conducted in 148 patients (midfacial fracture/trauma (68.2%) and dentofacial deformity patients (31.8%); males (54.7%); median age, 37.5 years) treated using maxillofacial osteosynthetic plate systems. The complications included plate exposure (7.4%), infection, (2.7%), and plate breakage (0.7%). Multivariate logistic regression analysis showed a significant correlation between sex (female), plate system (Lactosorb®), number of plates, and pyriform aperture and periorbital sites of plate placement (p < 0.05). Additionally, the propensity score-adjusted model showed a significant correlation between Lactosorb® and postoperative complications (odds ratio 1.007 (95% confidence interval, 1.001–1.055), p < 0.01). However, the two plate systems showed a low incidence rate of complications, and the plate integration and survivability were similar using 2.0-mm or 1.5-mm resorbable plate regardless of the plate system. Our findings suggest that female sex and a greater number of plates are risk factors for postoperative complications, whereas pyriform aperture and periorbital plate placements reduce the risk.
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Davis BP, Shybut TB, Coleman MM, Shah AA. Risk factors for hardware removal following operative treatment of middle- and distal-third clavicular fractures. J Shoulder Elbow Surg 2021; 30:e103-e113. [PMID: 32663568 DOI: 10.1016/j.jse.2020.06.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/20/2020] [Accepted: 06/28/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The incidence of hardware removal (HWR) after operative fixation of clavicular fractures varies widely. Risk factors related to HWR remain incompletely understood. The aim of this study was to evaluate the incidence of and risk factors for HWR after plate fixation of middle- and distal-third clavicular fractures. We hypothesized that (1) the total HWR incidence would be <20%, (2) the HWR incidence of operatively treated distal- and middle-third clavicular fractures would not be statistically different, and (3) symptomatic implants would be the most common HWR indication. METHODS We performed a multi-hospital retrospective study of skeletally mature patients who underwent plate fixation of middle- and distal-third clavicular fractures from November 2008 to November 2018. Data included patient demographic characteristics, mechanism of injury, operative records, hardware-related symptoms, subsequent HWR, and complications. RESULTS A total of 103 patients (aged 16-75 years, 76.7% male patients) were included. Of the patients, 87 (84.5%) underwent plate fixation for midshaft clavicular fractures and 16 (15.5%) underwent plate fixation for distal-third clavicular fractures. HWR was performed in 13 patients (12.6%). A significantly higher percentage of HWR procedures were performed for distal clavicular fractures (50%) than for middle-third clavicular fractures (4.9%, P < .0001). An initial high-energy mechanism of injury was associated with HWR (P = .0025). The most common indication for HWR was symptomatic hardware (69.2%). The overall complication rate was 14.5%. CONCLUSION The overall incidence of clavicular HWR was 12.6%. A distal fracture location was associated with a significantly higher incidence of HWR. An initial high-energy mechanism of injury was a significant risk factor for HWR. The primary indication for HWR was symptomatic hardware.
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Rossi LA, Magno G, Tanoira I, Puigdevall MH, Bosio S, Ranalletta M. Surgical fixation of displaced midshaft clavicular fractures with precontoured plates in adolescents. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021; 65:223-228. [PMID: 33419672 DOI: 10.1016/j.recot.2020.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/02/2020] [Accepted: 08/18/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The use of plate fixation to treat displaced midshaft clavicular fractures in adults reduces complications and residual shoulder disability. New features of the precontoured locking plates have been shown to reduce the need for hardware removal in adults. There is a lack of studies evaluating surgical fixation of displaced clavicular fractures with precontoured plates in adolescents. We evaluate outcomes and complications of adolescents with displaced midshaft clavicular fractures treated with precontoured locking plates. MATERIALS AND METHODS 40 adolescents with displaced midshaft clavicular fractures were surgically treated from January 2010 to May 2017. Outcomes were evaluated using the Constant score, the 11- item version of the Disabilities of Arm, Shoulder and Hand (QuickDASH) questionnaires, and radiographs, and a visual analog scale. Return-to-sport rate, level achieved, and complications were recorded. RESULTS Mean follow-up was 50 months (18 - 108 months). Constant, Quick-DASH, and visual analog scale scores were 95.6, 2.8 and 0.5 points, respectively. 100% of adolescents returned to sports at the same level they had before injury. Mean time to return was 69 days and 95% of patients were able to return before 12 weeks. Complication rate was 12.5%, 3 patients (7.5%) required hardware removal. CONCLUSIONS Adolescents with displaced midshaft clavicular fractures treated with precontoured locking plates exhibited satisfactory outcomes and low complication rate. Compared to other reports, this study had lower rates, anatomic plates might reduce hardware-related complications.
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Affiliation(s)
- L A Rossi
- Departamento de Ortopedia y Traumatología, Prof. Dr. Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - G Magno
- Departamento de Ortopedia y Traumatología, Prof. Dr. Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - I Tanoira
- Departamento de Ortopedia y Traumatología, Prof. Dr. Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - M H Puigdevall
- Departamento de Ortopedia y Traumatología, Prof. Dr. Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - S Bosio
- Departamento de Ortopedia y Traumatología, Prof. Dr. Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - M Ranalletta
- Departamento de Ortopedia y Traumatología, Prof. Dr. Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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STORTI THIAGOMEDEIROS, CAMILO MAURÍCIOSIQUEIRA, SILVA RAFAELFRANCISCOALVES, FARIA RAFAELSALOMONSILVA, SIMIONATTO CAROLINALIMA, PANIAGO ALEXANDREFIRMINO. CLINICAL EVALUATION OF THE TREATMENT OF CLAVICLE FRACTURES: INTRAMEDULLARY NAIL × PLATE. ACTA ORTOPEDICA BRASILEIRA 2021; 29:34-38. [PMID: 33795967 PMCID: PMC7976870 DOI: 10.1590/1413-785220212901231439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective: Studies confirm the benefit of surgical treatment for fixation of displaced midshaft clavicle fractures. Plate fixation and intramedullary nail are the two most used techniques. Our study seeks to compare these two surgical techniques. Methods: This is a retrospective study, conducted by the evaluation of patients treated for displaced midshaft clavicle fracture with intramedullary nail, and plate and screws. Socioeconomic variables were collected, a visual pain scale questionnaire was applied, the shoulder function was measured using CONSTANT and UCLA scores, and radiography was performed to verify the consolidation and evaluation of the final clavicle shortening. Results: Sixty-five patients were evaluated, 36 (55.4%) of which were subjected to clavicle fixation with plate and screws and 29 (44.6%) with intramedullary nail. The median shortening was 0.1mm for plate and 5.8mm for nail (p = 0.001). The UCLA score shows an average of 35 in the plate group and 35 in the intramedullary group. The median CONSTANT scores were 96.5 for plate and 95 for nail, without significance. In all groups, 13 (20%) complications were registered, 9 fixed with plate and 4 fixed with intramedullary nail. The most common complication was skin erosion with exposure of the synthetic material. Conclusion: The two techniques present satisfactory results for the treatment of displaced midshaft clavicle fractures. Level of Evidence III, Therapeutic Studies Investigating the Results of Treatment.
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Affiliation(s)
- THIAGO MEDEIROS STORTI
- Instituto do Ombro de Brasília, Brazil; Hospital Ortopédico e Medicina Especializada, Brazil
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van Doremalen RFM, van der Linde RA, Kootstra JJ, van Helden SH, Hekman EEG. Can 3D-printing avoid discomfort-related implant removal in midshaft clavicle fractures? A four-year follow-up. Arch Orthop Trauma Surg 2021; 141:1899-1907. [PMID: 33128609 PMCID: PMC8497298 DOI: 10.1007/s00402-020-03654-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 10/15/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Due to the variation in shape and curvature of the clavicle, plates often have to be adjusted during surgery to acquire a good fit. Poorly fitted plates can cause discomfort, eventually requiring implant removal. 3D-printed replicas of the fractured clavicle can assist in planning of the surgical approach, plate selection and, if necessary, adjustment of the plate prior to surgery. We hypothesized this method of preoperative preparation would reduce implant-related discomfort resulting in a reduced reoperation rate MATERIALS AND METHODS: In a prospective cohort study, perioperative plate handling and clavicle fixation were timed and follow-up data were collected from participants undergoing operative treatment for a midshaft clavicle fracture. The control group (n = 7) received conventional surgery with standard precontoured plates. For the intervention group (n = 7), 3D-printed replicas of the fractured clavicle and a mirrored version of the healthy contralateral clavicle were available prior to surgery for planning of the surgical approach, and for plate selection and contouring. Primary outcome was reoperation rate due to implant-related discomfort. Secondary outcomes were complications and time differences in the different surgical phases (reduction, fixation and overall operation time) RESULTS: More participants in the control group had the plate removed due to discomfort compared to the intervention group (5/7 vs. 0/6; P = 0.012). One participant was excluded from the intervention group due to a postoperative complication; an infection occurred at the implant site. No relevant time difference in surgical plate handling was found between both groups. CONCLUSIONS Preoperative preparation using 3D-printed replicas of the clavicle fracture may reduce implant removal caused by plated-related discomfort. No relevant effect on surgery time was found. TRIAL REGISTRATION Registered with 'toetsingonline.nl', trial number NL51269.075/14, 17-02-2015.
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Affiliation(s)
- Rob F. M. van Doremalen
- Department of Surgery, Isala Hospital, 8000 GK Zwolle, The Netherlands ,Department of Robotics and Mechatronics, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands ,Deventer Hospital, 7400 GC Deventer, The Netherlands
| | - Rens A. van der Linde
- Department of Surgery, Isala Hospital, 8000 GK Zwolle, The Netherlands ,Department of Surgery, Medisch Spectrum Twente, 7500 KA Enschede, The Netherlands
| | - Jan J. Kootstra
- Department of Surgery, Isala Hospital, 8000 GK Zwolle, The Netherlands ,Department of Surgery, Hospital Group Twente, 7600 SZ Almelo, The Netherlands
| | | | - Edsko E. G. Hekman
- Department of Biomechanical Engineering, University of Twente, 7500 AE Enschede, The Netherlands
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Hsiao YC, Lin TY, Wang YC, Chang CW, Tang HC, Chen CH, Su CY. Prognostic factors and outcomes of secondary surgery after plate fixation for midshaft clavicle fracture: Comparison of traditional DCP and pre-contoured locking plate. Injury 2020; 51:2241-2244. [PMID: 32616334 DOI: 10.1016/j.injury.2020.06.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/18/2020] [Accepted: 06/13/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES This study aimed to evaluate the prognostic factors of reoperation after plate fixation for midshaft clavicle fracture and compare outcomes of dynamic compression plates (DCP) and pre-contoured locking plates. DESIGN Retrospective comparative study. SETTING Level I trauma center. PATIENTS/PARTICIPANTS We recruited 274 consecutive patients who underwent plate fixation for midshaft clavicle fracture from 2007 to 2017 and completed at least 1 year of follow-up. INTERVENTION 235 patients underwent surgery with DCP, while 39 patients were treated with locking plate. MAIN OUTCOME MEASUREMENTS We reviewed the possible variables of secondary surgeries, and documented complications from the medical records. Patients with a DCP or locking plate were further divided for outcome comparisons. RESULTS 150 (54.7%) patients underwent reoperation after the initial surgery, and plate removal represented the major etiology. On multivariate analysis, superficial wound infection and prominent implant were identified as significant risk factors for reoperation, while aging, locking plate usage, and higher body mass index (BMI) were protective factors (all P < 0.05). The locking plate featured a significantly decreased implant removal rate (7.7% vs. 60.9%, P < 0.05). CONCLUSIONS Patients with risk factors for superficial wound infection or a prominent implant tended to require a secondary operation after surgery for midshaft clavicle fracture, while aging, pre-contoured locking plate usage, and higher BMI decreased the risk. Compared with DCP, patients with locking plates tended to have better prognosis and significantly lower implant removal rates. LEVEL OF EVIDENCE Prognostic III.
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Affiliation(s)
- Yung-Chuan Hsiao
- Department of Orthopaedic Surgery, Chang Gune Memorial Hospital, Keelung branch, Bone and Joint Research Center, and Chang Gung University, Taiwan, F7, No 222 Mai-King Road, Keelung, Taiwan.
| | - Tung-Yi Lin
- Department of Orthopaedic Surgery, Chang Gune Memorial Hospital, Keelung branch, Bone and Joint Research Center, and Chang Gung University, Taiwan, F7, No 222 Mai-King Road, Keelung, Taiwan.
| | - Ying-Chih Wang
- Department of Orthopaedic Surgery, Chang Gune Memorial Hospital, Keelung branch, Bone and Joint Research Center, and Chang Gung University, Taiwan, F7, No 222 Mai-King Road, Keelung, Taiwan.
| | - Chia-Wei Chang
- Department of Orthopaedic Surgery, Chang Gune Memorial Hospital, Keelung branch, Bone and Joint Research Center, and Chang Gung University, Taiwan, F7, No 222 Mai-King Road, Keelung, Taiwan.
| | - Hao-Che Tang
- Department of Orthopaedic Surgery, Chang Gune Memorial Hospital, Keelung branch, Bone and Joint Research Center, and Chang Gung University, Taiwan, F7, No 222 Mai-King Road, Keelung, Taiwan.
| | - Chien-Hao Chen
- Department of Orthopaedic Surgery, Chang Gune Memorial Hospital, Keelung branch, Bone and Joint Research Center, and Chang Gung University, Taiwan, F7, No 222 Mai-King Road, Keelung, Taiwan.
| | - Chun-Yi Su
- Department of Orthopaedic Surgery, Chang Gune Memorial Hospital, Keelung branch, Bone and Joint Research Center, and Chang Gung University, Taiwan, F7, No 222 Mai-King Road, Keelung, Taiwan.
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Kim HY, Yang DS, Bae JH, Cha YH, Lee KW, Choy WS. Clinical and Radiological Outcomes after Various Treatments of Midshaft Clavicle Fractures in Adolescents. Clin Orthop Surg 2020; 12:396-403. [PMID: 32904052 PMCID: PMC7449852 DOI: 10.4055/cios20026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 03/02/2020] [Indexed: 11/21/2022] Open
Abstract
Backgroud Controversy exists about the optimal treatment of midshaft clavicle fractures in the presence of significant displacement, comminution, or shortening of the fracture in adolescents. The purpose of this study was to compare the clinical and radiological outcomes of 4 different treatments for midshaft clavicle fractures in adolescents: conservative treatment with a figure-of-8 (FO8) brace, open reduction and internal fixation with a plate (OPL), minimally invasive plate osteosynthesis (MIPO), and intramedullary nail fixation with a threaded Steinmann pin (TSP). Methods A total of 94 teenagers with midshaft clavicle fractures were divided into the FO8, OPL, MIPO, and TSP groups (n = 24, 33, 16, and 21, respectively). We analyzed clinical and radiological outcomes and complications in each group and compared the results among the groups. Results All groups showed satisfactory clinical and radiological outcomes, but each group showed different results for the assessment items. The Constant-Murley scores were higher in the operated groups than in the FO8 group. Recovery of joint motion was faster in the operated groups. The TSP group had the highest cosmetic satisfaction with respect to the satisfaction score and measured scar length. Fracture union was achieved in all patients. At the final follow-up, the bone length was closer to normal in the OPL and TSP groups than in the FO8 and MIPO groups, and angulation was less in the OPL and TSP groups than in the MIPO and FO8 groups. The TSP and MIPO groups obtained faster bone healing than the OPL and FO8 groups. In the operated groups, 9 patients had metal-induced irritating symptoms; 1, supraclavicular nerve injury symptoms; and 4, refractures after plate removal. Conclusions The nonoperatively treated group had no iatrogenic complications. The operated groups complained of various disadvantages induced by surgery; however, these groups achieved faster functional recovery and slightly better radiological and functional results than the nonoperative group.
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Affiliation(s)
- Ha Yong Kim
- Department of Orthopedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Dae Suk Yang
- Department of Orthopedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Jin Hyun Bae
- Department of Orthopedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Yong Han Cha
- Department of Orthopedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Kwang Won Lee
- Department of Orthopedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Won Sik Choy
- Department of Orthopedic Surgery, Eulji University Hospital, Daejeon, Korea
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Gombera MM, Morris BJ, Elkousy HA, Laughlin MS, Vidal EA, Brinker MR. Trauma fellowship impact on trends and complications of operatively treated clavicle fractures in recently trained orthopedic surgeons. J Clin Orthop Trauma 2020; 13:24-29. [PMID: 33680804 PMCID: PMC7919946 DOI: 10.1016/j.jcot.2020.08.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/21/2020] [Accepted: 08/30/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The purpose of this study was to evaluate whether fellowship training affected trends and complications of operative clavicle fracture treatment in newly trained orthopedic surgeons. METHODS The American Board of Orthopedic Surgery (ABOS) database was utilized to identify cases of open treatment of clavicle fractures submitted by ABOS Part-II Board Certification candidates. From 2005 to 2017, 3148 candidates performed at least one open clavicle fracture treatment. Overall, 6919 cases were included; 3516 of these had over 6 weeks of follow-up. Candidates were divided by fellowship type into 5 groups: Trauma, Sports Medicine, Hand and Upper Extremity or Shoulder, multiple, and other or no fellowship(s). Group differences were analyzed with ANOVA and Bonferroni post hoc analysis. Complications, reoperations, nonunion rates, and readmissions between groups were evaluated with Chi-squared test and logistic regression analyses. RESULTS Case volume during the study period was significantly higher after 2007. Trauma candidates performed significantly more operations for clavicle fracture per candidate while candidates with other or no fellowship(s) performed significantly fewer operations per candidate. Patients treated by Trauma candidates were significantly older, had significantly fewer early surgical complications and significantly more early medical complications. Nonunion rates were not significantly different between groups. CONCLUSION Candidates treated clavicle fractures surgically more often in 2007 and beyond. Trauma candidates treated older patients, had fewer early surgical complications, and had more medical complications. Reoperation, readmission and nonunion rates were not significantly different between groups.
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Affiliation(s)
- Mufaddal M. Gombera
- Fondren Orthopedic Group L.L.P., Texas Orthopedic Hospital, 7401 Main Street, Houston, TX, 77030, USA,Fondren Orthopedic Research Institute (FORI), 7401 Main Street, Houston, TX, 77030, USA,Texas Education and Research Foundation for Shoulder and Elbow Surgery, Inc. (TERFSES), 7401 Main Street, Houston, TX, 77030, USA
| | - Brent J. Morris
- Fondren Orthopedic Group L.L.P., Texas Orthopedic Hospital, 7401 Main Street, Houston, TX, 77030, USA,Fondren Orthopedic Research Institute (FORI), 7401 Main Street, Houston, TX, 77030, USA,Texas Education and Research Foundation for Shoulder and Elbow Surgery, Inc. (TERFSES), 7401 Main Street, Houston, TX, 77030, USA
| | - Hussein A. Elkousy
- Fondren Orthopedic Group L.L.P., Texas Orthopedic Hospital, 7401 Main Street, Houston, TX, 77030, USA,Fondren Orthopedic Research Institute (FORI), 7401 Main Street, Houston, TX, 77030, USA,Texas Education and Research Foundation for Shoulder and Elbow Surgery, Inc. (TERFSES), 7401 Main Street, Houston, TX, 77030, USA
| | - Mitzi S. Laughlin
- Fondren Orthopedic Research Institute (FORI), 7401 Main Street, Houston, TX, 77030, USA,Texas Education and Research Foundation for Shoulder and Elbow Surgery, Inc. (TERFSES), 7401 Main Street, Houston, TX, 77030, USA,Corresponding author. Fondren Orthopedic Research Institute (FORI), 7401 Main Street, Houston, TX, 77030, USA.
| | - Emily A. Vidal
- Fondren Orthopedic Research Institute (FORI), 7401 Main Street, Houston, TX, 77030, USA,Texas Education and Research Foundation for Shoulder and Elbow Surgery, Inc. (TERFSES), 7401 Main Street, Houston, TX, 77030, USA
| | - Mark R. Brinker
- Fondren Orthopedic Group L.L.P., Texas Orthopedic Hospital, 7401 Main Street, Houston, TX, 77030, USA,Fondren Orthopedic Research Institute (FORI), 7401 Main Street, Houston, TX, 77030, USA,Center for Problem Fractures and Limb Restoration, 7401 Main Street, Houston, TX, 77030, USA
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46
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Gan JT, Chandrasekaran SK, Tuan Jusoh TB. Clinical outcome and operative cost comparison: Locked compression plate versus reconstruction plate in midshaft clavicle fractures. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2020; 54:483-487. [PMID: 33155556 DOI: 10.5152/j.aott.2020.19219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to compare the clinical outcomes and operative cost of a locked compression plate (LCP) and a nonlocked reconstruction plate in the treatment of displaced midshaft clavicle fracture. METHODS From January 2013 till March 2018, a total of 55 patients with acute unilateral closed midshaft clavicle fracture were treated with either a 3.5-mm pre-contoured LCP [32 patients; 25 men and 7 women; mean age: 35 years (range: 19-63 years)] or a 3.5-mm nonlocked reconstruction plate [23 patients; 20 men and 3 women; mean age: 31.4 years (range: 17-61 years)]. The clinical outcomes in terms of fracture union, Quick Disability of Arm, Shoulder and Hand (DASH) score, implant irritation, failure rate, and reoperation rate were evaluated retrospectively. The patient billing records were reviewed to obtain primary operation, reoperation, and total operative cost for midshaft clavicle fracture. These values were analyzed and converted from Malaysia Ringgit (RM) to United States Dollar (USD) at the exchange rate of RM 1 to USD 0.24. All patients were followed up for at least one-year duration. RESULTS The mean time to fracture union, implant irritation, implant failure, and reoperation rate showed no significant difference between the two groups of patients. The mean Quick DASH score was significantly better in the reconstruction plate group with 13 points compared with 28 points in the LCP group (p=0.003). In terms of total operative cost, the LCP group recorded a cost of USD 391 higher than the reconstruction plate group (p<0.001). CONCLUSION The 3.5-mm reconstruction plate achieved not only satisfactory clinical outcomes but was also more cost-effective than the LCP in the treatment of displaced midshaft clavicle fractures. LEVEL OF EVIDENCE Level III, Therapeutic study.
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Affiliation(s)
- Jin Tatt Gan
- Department of Orthopaedic Surgery, University Malaya, School of Medicine, Lembah Pantai, Kuala Lumpur, Malaysia
| | | | - Tuan Basyirudin Tuan Jusoh
- Department of Orthopaedic Surgery, University Malaya, School of Medicine, Lembah Pantai, Kuala Lumpur, Malaysia
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Ju W, Mohamed SO, Qi B. Comparison of plate fixation vs. intramedullary fixation for the management of mid-shaft clavicle fractures: A systematic review and meta-analysis of randomised controlled trials. Exp Ther Med 2020; 20:2783-2793. [PMID: 32765773 PMCID: PMC7401851 DOI: 10.3892/etm.2020.9002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 05/22/2020] [Indexed: 11/06/2022] Open
Abstract
A number of meta-analyses have compared clinical outcomes following plate vs. intramedullary fixation for midshaft clavicle fractures (MSCF), but with conflicting results. There is a requirement for updated level-1 evidence to guide clinicians managing MSCF. The aim of the present systematic review and meta-analysis was to compare clinical outcomes following plate vs. intramedullary fixation of MSCF. The PubMed, Scopus, BioMed Central, Cochrane Central Register of Controlled Trials and Google Scholar databases were searched for records added until 1st July 2019. A total of 10 randomised controlled trials (RCTs) were included. Shoulder function was assessed using the Constant-Murley Shoulder Outcome questionnaire and the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH). There was no statistically significant difference in Constant-Murley scores between plate and intramedullary fixation [Mean difference (MD)=0.75; 95% CI: -2.49 to 3.99; P=0.65; I2=85%]. Similarly, there was no statistically significant difference in DASH scores between the two groups (MD=1.55; 95% CI: -1.12 to 4.23; P=0.26; I2=89%). There was no statistically significant difference in complications requiring non-routine surgery between plate and intramedullary fixation [risk ratio (RR)=1.80, 95%CI: 0.80-4.05, P=0.15; I2=0%]. There was an increased risk of complications that did not require non-routine surgery with plate fixation as compared to intramedullary fixation (RR=2.38, 95%CI: 1.22-4.62, P=0.01; I2=70%). Plate fixation was also associated with an increased risk of infection and complications of cosmetic dissatisfaction. The present results indicated no difference in long-term functional outcomes between plate and intramedullary fixation of MSCF. Plate fixation was associated with an increased risk of complications not requiring non-routine surgery. Further high-quality RCTs shall strengthen the evidence on this subject.
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Affiliation(s)
- Weina Ju
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Sayid Omar Mohamed
- Department of Orthopedics, Jazeera University Hospital, Mogadishu BN SO 935, Somalia
| | - Baochang Qi
- Department of Orthopedic Traumatology, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
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KAMACI S, ÖZDEMİR E, GÜLCÜ A, COLOSİMO A. Klavikula cisim kırıklarının anatomik kilitli plaklar ile cerrahi tedavisinin sonuçları. ACTA MEDICA ALANYA 2020. [DOI: 10.30565/medalanya.709140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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49
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Boyce GN, Philpott AJ, Ackland DC, Ek ET. Single versus dual orthogonal plating for comminuted midshaft clavicle fractures: a biomechanics study. J Orthop Surg Res 2020; 15:248. [PMID: 32646450 PMCID: PMC7346347 DOI: 10.1186/s13018-020-01771-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 06/30/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Dual orthogonal plating of clavicle fractures may provide greater stiffness and strength than unilateral plate constructs and allow the use of lower-profile plates. We aim to biomechanically compare three clavicle plating constructs in a comminuted clavicle fracture model. METHOD Fifteen clavicle sawbones were osteotomised, simulating a comminuted midshaft fracture and allocated to either: group 1, single superior plate (3.5 mm superior plate); group 2, combination plating (3.5 mm superior plate, 2.8 mm anterior plate) and group 3, dual mini-plates (two 2.8-mm orthogonal mini-plates). Specimens were biomechanically tested under torsion and cantilever bending. Construct stiffness (Nm/degree) and load to failure (Nm) were measured. RESULTS Group 2 had higher torsional (0.70 vs. 0.60 Nm/deg, p = 0.017) and cantilever bending stiffness (0.61 vs. 0.51 Nm/deg, p = 0.025) than group 1. Group 3 had lower cantilever bending stiffness (0.39 vs. 0.51 Nm/deg, p < 0.004) and load to failure (40.87 vs. 54.84 Nm, p < 0.01) than group 1. All dual plate constructs that catastrophically failed did so from fracture at the lateral ends of the plates. Single plate constructs failed due to plate bending. CONCLUSION Dual orthogonal fixation with mini-plates demonstrated lower stiffness and strength than traditional superior plating. The addition of an anterior mini-plate to a traditional superior plating improved construct stiffness and may have a role in patients seeking early return to activity. LEVEL OF EVIDENCE Basic science biomechanical study.
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Affiliation(s)
- Glenn N Boyce
- Melbourne Orthopaedic Group, 33 The Avenue, Windsor, Melbourne, VIC, 3181, Australia
- Department of Orthopaedic Surgery, Bendigo Health, Bendigo, VIC, Australia
| | - Andrew J Philpott
- Melbourne Orthopaedic Group, 33 The Avenue, Windsor, Melbourne, VIC, 3181, Australia
| | - David C Ackland
- Department of Biomedical Engineering, University of Melbourne, Melbourne, VIC, Australia
| | - Eugene T Ek
- Melbourne Orthopaedic Group, 33 The Avenue, Windsor, Melbourne, VIC, 3181, Australia.
- Department of Surgery, Monash Medical Centre, Monash University, Melbourne, VIC, Australia.
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50
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Firoozabadi R, Wilkerson J, Hemingway J, Tran N. Axillary Artery Pseudoaneurysm After Revision Plate Osteosynthesis of a Midshaft Clavicle Fracture Nonunion: A Case Report. JBJS Case Connect 2020; 10:e19.00591. [PMID: 37475452 DOI: 10.2106/jbjs.cc.19.00591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
CASE A patient with history of nonunion repair of traumatic midshaft clavicle fracture was referred to our orthopaedic trauma clinic for new-onset shoulder pain and paresthesias involving the ipsilateral arm. Computed tomography angiography revealed an axillary artery pseudoaneurysm adjacent to the instrumentation and recurrent nonunion of the fracture site. The patient underwent coil embolization of the pseudoaneurysm and nonunion repair. CONCLUSION This case demonstrates that iatrogenic neurovascular injury during clavicle fracture nonunion repairs can present in a delayed fashion requiring more thorough clinical and imaging evaluation to achieve successful treatment.
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Affiliation(s)
- Reza Firoozabadi
- Department of Orthopaedics & Sports Medicine, University of Washington, Seattle, Washington
| | - Jacob Wilkerson
- Department of Orthopaedics & Sports Medicine, University of Washington, Seattle, Washington
| | - Jake Hemingway
- Department of Vascular Surgery, University of Washington, Seattle, Washington
| | - Nam Tran
- Department of Vascular Surgery, University of Washington, Seattle, Washington
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