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Sheth MM, Shybut TB. Operative Management for Displaced Distal Clavicle Fractures. Clin Sports Med 2023; 42:695-711. [PMID: 37716732 DOI: 10.1016/j.csm.2023.06.017] [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: 09/18/2023]
Abstract
This article reviews techniques and outcomes of surgical fixation for distal clavicle fractures. Near 100% union has been reported for several techniques. The most common are locked plating, coracoclavicular fixation and a combination of plating with CC fixation. Hook plates are useful for particular fracture patterns, but there can be complications specific to this implant. Low-profile constructs are favored due to the high rates of symptomatic hardware. Fixation of subacute and chronic injuries can provide reliable functional improvements, but is inferior to acute fixation. Surgery is generally the treatment of choice for displaced fractures in athletes.
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Affiliation(s)
- Mihir M Sheth
- Baylor College of Medicine, 7200 Cambridge Street, Suite 10A, Houston, TX 77030, USA
| | - Theodore B Shybut
- Southern California Orthopedic Institute, 6815 Noble Avenue, Van Nuys, CA 91405, USA.
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Furuhata R, Yokoyama Y, Tanji A, Fujita S. Plate fixation using parallelogram prism iliac bone grafts for clavicle oblique nonunion with shortening deformity: a case report. BMC Musculoskelet Disord 2023; 24:346. [PMID: 37143033 PMCID: PMC10157972 DOI: 10.1186/s12891-023-06468-w] [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: 12/15/2022] [Accepted: 04/27/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Plate fixation using a tricortical iliac bone graft can provide a high ratio of bone union and restore clavicle length in cases of atrophic nonunion. However, the surgical treatment of clavicle oblique nonunions with marked shortening deformity remains challenging and unresolved. Here, we describe a case of clavicle oblique nonunion with shortening that was treated using plate fixation with parallelogram prism iliac bone grafts. CASE PRESENTATION A 46-year-old man presented to our hospital with severe medial scapular pain. He had been diagnosed with a right clavicle mid-shaft fracture in a motorcycle accident 9 months earlier. He underwent conservative treatment, but radiographs and computed tomography showed clavicle oblique nonunion with marked shortening. Physical examination revealed no pain at the nonunion site; however, tenderness was noted on the medial side of the right scapula and protrusion of the inferior scapular angle was prominent. His symptoms interfered with daily life and required surgery. After release of the nonunion, we harvested the parallelogram prism bone grafts from the iliac crest. We inserted these bone grafts into the fracture ends and fixed them with lag screws, after which we performed plate fixation. Immediately after surgery, right medial scapular pain and scapula winging subsided. Bone union was achieved, and the length of the clavicle was restored at 9 months postoperatively. CONCLUSIONS This case report provides new information on the surgical treatment of clavicle oblique nonunion with shortening deformity. The presence of medial scapular pain and winging scapula can be clinically problematic in cases of clavicle nonunion with marked shortening. Our case revealed that reliable bone union and clavicle length recovery can be achieved with plate fixation and iliac bone grafts.
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Affiliation(s)
- Ryogo Furuhata
- Department of Orthopaedic Surgery, Ashikaga Red Cross Hospital, 284-1 Yobe-cho, Ashikaga, 326-0843, Tochigi, Japan.
| | - Yuya Yokoyama
- Department of Orthopaedic Surgery, Ashikaga Red Cross Hospital, 284-1 Yobe-cho, Ashikaga, 326-0843, Tochigi, Japan
| | - Atsushi Tanji
- Department of Orthopaedic Surgery, Ashikaga Red Cross Hospital, 284-1 Yobe-cho, Ashikaga, 326-0843, Tochigi, Japan
| | - Shota Fujita
- Department of Orthopaedic Surgery, Ashikaga Red Cross Hospital, 284-1 Yobe-cho, Ashikaga, 326-0843, Tochigi, Japan
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White-Light Body Scanning Captures Three-Dimensional Shoulder Deformity After Displaced Diaphyseal Clavicle Fracture. J Orthop Trauma 2021; 35:e142-e147. [PMID: 32910627 DOI: 10.1097/bot.0000000000001957] [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] [Accepted: 08/28/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We sought to determine if white-light three-dimensional (3D) body scanning can identify clinically relevant shoulder girdle deformity after displaced diaphyseal clavicle fracture (DCF). METHODS Adult patients with DCF (OTA/AO 15A) were prospectively enrolled. Four subcutaneous osseous landmarks were used to measure shoulder girdle morphology of the injured and uninjured shoulder. Measurements were made both manually with a tape measure and digitally with a white-light 3D scanner. Bilateral radiographs were obtained, and clavicle length was recorded. Quick-Disabilities of the Arm, Shoulder, and Hand surveys were administered at injury and at 6 and 12 weeks. RESULTS Twenty-two patients were included in the study. At the initial visit, all patients had significant differences in deformity measurements between injured and uninjured shoulders as measured by 3D scanning. There was no difference between shoulders measured using manual measurements. At 6 and 12 weeks, shoulder asymmetry was significantly less in patients treated with surgery compared with nonoperative patients as measured by the 3D scanner alone. Clavicle shortening measured on 3D scanning had weak and moderate positive correlations to radiographs (R = 0.27) and manual measurements (R = 0.53), respectively. Patients treated with surgery had significant functional improvements by 6 weeks, and a similar improvement was not seen until 12 weeks in nonsurgical patients. CONCLUSION White-light 3D scanning was able to identify and monitor clinically relevant shoulder girdle deformity after DCF. This tool may become a useful adjunct to clinical examination and radiographic assessment, when determining clinically relevant deformity thresholds. In the future, quantifying and understanding shoulder deformity may inform clinical decision making in these patients. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Seror P, Lenglet T, Nguyen C, Ouaknine M, Lefevre-Colau MM. Unilateral winged scapula: Clinical and electrodiagnostic experience with 128 cases, with special attention to long thoracic nerve palsy. Muscle Nerve 2018; 57:913-920. [DOI: 10.1002/mus.26059] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Paul Seror
- Laboratoire d'électroneuromyographie; 146, Avenue Ledru Rollin Paris 75011 France
- Département de Neurophysiologie Clinique; Hôpital de la Pitié-Salpétrière; Paris France
| | - Timothee Lenglet
- Département de Neurophysiologie Clinique; Hôpital de la Pitié-Salpétrière; Paris France
| | - Christelle Nguyen
- Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, H^pital Cochin, APHP, Université Paris Descartes, PRES Sorbonne Paris Cité, ECaMO team, INSERM UMR-S 1153 et Institut Fédératif de Recherche sur le Handicap; Paris France
| | - MichaëL Ouaknine
- Service de chirurgie orthopédique et traumatologique Hôpital Cochin, APHP; Université Paris Descartes; Paris France
| | - Marie Martine Lefevre-Colau
- Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, H^pital Cochin, APHP, Université Paris Descartes, PRES Sorbonne Paris Cité, ECaMO team, INSERM UMR-S 1153 et Institut Fédératif de Recherche sur le Handicap; Paris France
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Haefeli M, Schenkel M, Schumacher R, Eid K. Corrective Osteotomy for Symptomatic Clavicle Malunion Using Patient-specific Osteotomy and Reduction Guides. Tech Hand Up Extrem Surg 2017; 21:91-100. [PMID: 28614274 DOI: 10.1097/bth.0000000000000161] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Midshaft clavicular fractures are often treated nonoperatively with good reported clinical outcome in a majority of patients. However, malunion with shortening of the affected clavicle is not uncommon. Shortening of the clavicle has been shown to affect shoulder strength and kinematics with alteration of scapular position. Whereas the exact clinical impact of these factors is unknown, the deformity may lead to cosmetic and functional impairment as for example pain with weight-bearing on the shoulder girdle. Other reported complications of clavicular malunion include thoracic outlet syndrome, subclavicular vein thrombosis, and axillary plexus compression. Corrective osteotomy has therefore been recommended for symptomatic clavicular malunions, generally using plain x-rays for planning the necessary elongation. Particularly in malunited multifragmentary fractures it may be difficult to exactly determine the plane of osteotomy intraoperatively to restore the precise anatomic shape of the clavicle. We present a technique for corrective osteotomy using preoperative computer planning and 3-dimensional printed patient-specific intraoperative osteotomy and reduction guides based on the healthy contralateral clavicle.
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Affiliation(s)
- Mathias Haefeli
- *Center for Orthopaedic Surgery, State Hospitals Aarau and Baden, Baden †School of Life Sciences, Institute for Medical and Analytical Technologies, University of Applied Sciences Northwestern Switzerland, Muttenz, Switzerland
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Coppa V, Dei Giudici L, Cecconi S, Marinelli M, Gigante A. Midshaft clavicle fractures treatment: threaded Kirschner wire versus conservative approach. Strategies Trauma Limb Reconstr 2017; 12:141-150. [PMID: 28825169 PMCID: PMC5653602 DOI: 10.1007/s11751-017-0293-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 08/16/2017] [Indexed: 11/28/2022] Open
Abstract
Clavicle fractures are common, accounting for 2.6 to 10% of all fractures. Treatment of these fractures is usually non-surgical. Recent evidence, however, reveals that the final result of non-surgically midshaft clavicular fractures, particularly those with quite large displacements or shortening, is not like that which was previously thought. This study evaluated retrospectively all patients presented with a clavicle fracture at Emergency Department of our Institution, between January 2006 and December 2011. Fractures were classified according to Allman’s radiographic classification system, modified by Nordqvist and Petersson. Patients were distinguished into two groups: one that underwent conservative treatment with a “figure-of-8” orthosis and one that underwent surgery with reduction in fracture and fixation with intramedullary threaded Kirschner wire. Pin removal was performed after 4 weeks of rest in Gilchrist bandage, after clinical and radiographic evaluation demonstrating the bone healing. The QuickDASH score and the Constant Murley Shoulder Score were used to evaluate the clinical outcomes. The radiographic outcome was evaluated at 1 and 6 months of follow-up. Database review provided a final cohort of 58 patients, with similar demographic features. There was no significant difference in qDASH and CS between the two groups. The results of qDASH and CS evaluated in function of the radiographic outcome show a statistically significant correlation between the worst qDASH and CS results and the grade of malunion in both groups. In particular, we have found unsatisfactory results when final shortening of the clavicle was 20 mm or more. On radiographic evaluation, surgical treatment demonstrated a greater efficacy in reducing initial shortening of the fractured bone; this is in opposition to conservative treatment that results very often in malunion, shortening, anatomic alterations and loss of functionality. The use of intramedullary threaded Kirschner wire for fixation of midshaft clavicle fractures is a safe procedure and is recommended in case of shortening greater than 2 cm in high-function-demand patients.
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Affiliation(s)
- Valentino Coppa
- Clinical Orthopaedics, Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Via Tronto, 10/A, 60126, Ancona, Italy.
| | - Luca Dei Giudici
- Clinical Orthopaedics, Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Via Tronto, 10/A, 60126, Ancona, Italy
| | - Stefano Cecconi
- Clinic of Adult and Paediatric Orthopaedic, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Mario Marinelli
- Clinic of Adult and Paediatric Orthopaedic, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Antonio Gigante
- Clinical Orthopaedics, Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Via Tronto, 10/A, 60126, Ancona, Italy
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Lee BK, Itamura JM. Midshaft Clavicle Fractures: The Saga Continues: Commentary on articles by Marcel Jun Sugawara Tamaoki, MD, PhD, et al.: "Treatment of Displaced Midshaft Clavicle Fractures: Figure-of-Eight Harness Versus Anterior Plate Osteosynthesis. A Randomized Controlled Trial" and E.B. Goudie, MRCSEd, et al.: "The Influence of Shortening on Clinical Outcome in Healed Displaced Midshaft Clavicular Fractures After Nonoperative Treatment". J Bone Joint Surg Am 2017; 99:e79. [PMID: 28719566 DOI: 10.2106/jbjs.17.00502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Brian K Lee
- Kerlan-Jobe Orthopaedic Clinic, Los Angeles, California Kerlan-Jobe Orthopaedic Clinic/White Memorial Medical Center, Los Angeles, California
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Goudie EB, Clement ND, Murray IR, Lawrence CR, Wilson M, Brooksbank AJ, Robinson CM. The Influence of Shortening on Clinical Outcome in Healed Displaced Midshaft Clavicular Fractures After Nonoperative Treatment. J Bone Joint Surg Am 2017; 99:1166-1172. [PMID: 28719555 DOI: 10.2106/jbjs.16.01010] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND We aimed to evaluate the effect of clavicular shortening, measured with 3-dimensional computed tomography (3DCT), on functional outcomes and satisfaction in patients with healed displaced midshaft clavicular fractures up to 1 year following injury. METHODS The data used in this study were collected as part of a multicenter, prospective randomized controlled trial of open reduction and plate fixation compared with nonoperative treatment for acute, displaced midshaft clavicular factures. Patients who were randomized to nonoperative treatment and had healed by 1 year were included in the present study. Clavicular shortening relative to the uninjured, contralateral clavicle was measured on 3DCT. Outcome analysis was conducted at 6 weeks, 3 months, 6 months, and 1 year following injury and included the Disabilities of the Arm, Shoulder and Hand (DASH), Constant, and Short Form-12 (SF-12) scores and patient satisfaction. RESULTS In the original trial, 105 patients were randomized to nonoperative treatment. Thirteen patients were lost to follow-up, leaving 92 patients, and an additional 16 (17%) developed nonunion and were excluded from the present study. Of the remaining 76 patients, 48 who had a 3DCT scan that included the whole length of both clavicles were included in the present study. The shortening of the injured clavicles, relative to the contralateral side, was a mean (and standard deviation) of 11.3 ± 7.6 mm, with a mean proportional shortening of 8%. Proportional shortening did not significantly correlate with the DASH (p ≥ 0.42), Constant (p ≥ 0.32), or SF-12 (p ≥ 0.08) scores at any point during follow-up. There was no significant difference in the mean DASH or Constant scores at any follow-up time point when the cutoff for shortening was defined as 1 cm (p ≥ 0.11) or as 2 cm (p ≥ 0.35). There was no significant difference in clavicular shortening between satisfied and unsatisfied patients (p ≥ 0.49). CONCLUSIONS The present study demonstrated no association between shortening and functional outcome or satisfaction in patients with healed displaced midshaft clavicular fractures up to 1 year following injury. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- E B Goudie
- 1The Edinburgh Shoulder Clinic, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom 2Department of Trauma and Orthopaedics, The Glasgow Royal Infirmary, Glasgow, United Kingdom
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Archer LA, Hunt S, Squire D, Moores C, Stone C, O'Dea F, Furey A. Plain film measurement error in acute displaced midshaft clavicle fractures. Can J Surg 2016; 59:311-6. [PMID: 27438054 DOI: 10.1503/cjs.003016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Clavicle fractures are common and optimal treatment remains controversial. Recent literature suggests operative fixation of acute displaced mid-shaft clavicle fractures (DMCFs) shortened more than 2 cm improves outcomes. We aimed to identify correlation between plain film and computed tomography (CT) measurement of displacement and the inter- and intraobserver reliability of repeated radiographic measurements. METHODS We obtained radiographs and CT scans of patients with acute DMCFs. Three orthopedic staff and 3 residents measured radiographic displacement at time zero and 2 weeks later. The CT measurements identified absolute shortening in 3 dimensions (by subtracting the length of the fractured from the intact clavicle). We then compared shortening measured on radiographs and shortening measured in 3 dimensions on CT. Interobserver and intraobserver reliability were calculated. RESULTS We reviewed the fractures of 22 patients. Bland-Altman repeatability coefficient calculations indicated that radiograph and CT measurements of shortening could not be correlated owing to an unacceptable amount of measurement error (6 cm). Interobserver reliability for plain radiograph measurements was excellent (Cronbach α = 0.90). Likewise, intraobserver reliabilities for plain radiograph measurements as calculated with paired t tests indicated excellent correlation (p > 0.05 in all but 1 observer [p = 0.04]). CONCLUSION To establish shortening as an indication for DMCF fixation, reliable measurement tools are required. The low correlation between plain film and CT measurements we observed suggests further research is necessary to establish what imaging modality reliably predicts shortening. Our results indicate weak correlation between radiograph and CT measurement of acute DMCF shortening.
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Affiliation(s)
- Lori Anne Archer
- From the Department of Orthopedics, Memorial University of Newfoundland, St. John's, NL (Archer, Squire, Moores, Stone, O'Dea, Furey); and the Department of Orthopedics, University of Calgary, Calgary, Alta. (Hunt)
| | - Stephen Hunt
- From the Department of Orthopedics, Memorial University of Newfoundland, St. John's, NL (Archer, Squire, Moores, Stone, O'Dea, Furey); and the Department of Orthopedics, University of Calgary, Calgary, Alta. (Hunt)
| | - Daniel Squire
- From the Department of Orthopedics, Memorial University of Newfoundland, St. John's, NL (Archer, Squire, Moores, Stone, O'Dea, Furey); and the Department of Orthopedics, University of Calgary, Calgary, Alta. (Hunt)
| | - Carl Moores
- From the Department of Orthopedics, Memorial University of Newfoundland, St. John's, NL (Archer, Squire, Moores, Stone, O'Dea, Furey); and the Department of Orthopedics, University of Calgary, Calgary, Alta. (Hunt)
| | - Craig Stone
- From the Department of Orthopedics, Memorial University of Newfoundland, St. John's, NL (Archer, Squire, Moores, Stone, O'Dea, Furey); and the Department of Orthopedics, University of Calgary, Calgary, Alta. (Hunt)
| | - Frank O'Dea
- From the Department of Orthopedics, Memorial University of Newfoundland, St. John's, NL (Archer, Squire, Moores, Stone, O'Dea, Furey); and the Department of Orthopedics, University of Calgary, Calgary, Alta. (Hunt)
| | - Andrew Furey
- From the Department of Orthopedics, Memorial University of Newfoundland, St. John's, NL (Archer, Squire, Moores, Stone, O'Dea, Furey); and the Department of Orthopedics, University of Calgary, Calgary, Alta. (Hunt)
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Stegeman SA, de Witte PB, Boonstra S, de Groot JH, Nagels J, Krijnen P, Schipper IB. Posttraumatic midshaft clavicular shortening does not result in relevant functional outcome changes. Acta Orthop 2015; 86:545-52. [PMID: 25872962 PMCID: PMC4564775 DOI: 10.3109/17453674.2015.1040982] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Shoulder function may be changed after healing of a nonoperatively treated clavicular fracture, especially in cases of clavicular shortening or mal-union. We investigated scapular orientations and functional outcome in healed clavicular fractures with and without clavicular shortening. PATIENTS AND METHODS 32 participants with a healed nonoperatively treated midshaft clavicular fracture were investigated. Motions of the thorax, arm, and shoulder were recorded by standardized electromagnetic 3D motion tracking. The DASH score and Constant-Murley score were used to evaluate functional outcome. Orientation of the scapula and humerus at rest and during standardized tasks, and strength and function of the affected shoulders were compared with corresponding values for the uninjured contralateral shoulders. RESULTS Mean clavicular shortening was 25 mm (SD 16). Scapula protraction had increased by mean 4.4° in rest position in the affected shoulders. During abduction, slightly more protraction, slightly more lateral rotation, and slightly less backward tilt was found for the affected shoulders. For anteflexion, the scapular orientations of the affected shoulders also showed slightly increased protraction, slightly increased lateral rotation, and slightly reduced backward tilt. Scapulohumeral kinematics, maximum humerus angles, and strength were not associated with the degree of clavicular shortening. All participants had excellent performance on the Constant-Murley score and DASH score. INTERPRETATION Scapulohumeral kinematics in shoulders with a healed clavicular fracture differ from those in uninjured shoulders, but these changes are small, do not result in clinically relevant changes in outcome, and do not relate to the amount of clavicular shortening. These findings do not support routine operative reduction and fixation of shortened midshaft clavicular fractures based on the argument of functional outcome.
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Affiliation(s)
| | - Pieter Bas de Witte
- Department of Orthopaedics,the Laboratory for Kinematics and Neuromechanics, Leiden University Medical Center, Leiden, the Netherlands.
| | | | - Jurriaan H de Groot
- Department of Rehabilitation Medicine,the Laboratory for Kinematics and Neuromechanics, Leiden University Medical Center, Leiden, the Netherlands.
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Cochrane in CORR®: Surgical versus conservative interventions for treating fractures of the middle third of the clavicle. Clin Orthop Relat Res 2014; 472:2579-85. [PMID: 24807347 PMCID: PMC4117872 DOI: 10.1007/s11999-014-3643-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 04/10/2014] [Indexed: 01/31/2023]
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Mohammed E, Mahadane H, Mechchat A, Shimi M, Elibrahimi A, Elmrini A. Functional outcome of midclavicular fracture fixation utilising a reconstruction plate. Malays Orthop J 2013; 7:6-9. [PMID: 25674299 PMCID: PMC4322134 DOI: 10.5704/moj.1311.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Clavicular fractures are common injuries. The
aim of this study is to present results of surgical treatment of
midclavicular fracture managed with open reduction and
internal fixation (ORIF) with superior reconstruction plating.
This study involved 34 patients, with mean age of 31 years,
with completely displaced midclavicular fractures, 28 on the
right and 6 on the left, stabilized by contoured plate. One
patient developed an early wound infection, which was
successfully managed by surgical debridement. The average
time of union was 14 weeks, with one case of nonunion. The
average constant score was 95.33 with SD 3.4 in one year
follow up. Plate fixation of completely displaced midshaft
clavicular fracture provides stable fixation and improves the
functional outcome.
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Affiliation(s)
- Elidrissi Mohammed
- Department of Orthopeadic Surgery B4, Hassan II University Hospital, Fez, Morocco
| | - H Mahadane
- Department of Orthopeadic Surgery B4, Hassan II University Hospital, Fez, Morocco
| | - A Mechchat
- Department of Orthopeadic Surgery B4, Hassan II University Hospital, Fez, Morocco
| | - M Shimi
- Department of Orthopeadic Surgery B4, Hassan II University Hospital, Fez, Morocco
| | - A Elibrahimi
- Department of Orthopeadic Surgery B4, Hassan II University Hospital, Fez, Morocco
| | - A Elmrini
- Department of Orthopeadic Surgery B4, Hassan II University Hospital, Fez, Morocco
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Abstract
Over the past decade, there has been an increased interest in understanding the operative indications and techniques in treating scapular fractures and tracking their outcomes. Multiple studies have documented poor functional outcomes following nonoperative management of displaced scapular fractures. There is a groundswell of recognition that severe deformity from scapular malunion is associated with functional consequences for patients. This has led to a growing recognition that scapular fractures should be held to the same standards as other bodily fractures with regard to fracture fixation principles, including anatomic articular reduction, proper alignment, and stable internal fixation. Through research, there has been an improved understanding of scapular fracture patterns and the relevant surgical approaches and exposures used for fracture fixation. As with many bones, however, there still remains the absence of a compelling study that defines thresholds for surgical indication based on degrees of deformity and amounts of displacement.
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Affiliation(s)
- Peter A. Cole
- />Chief of Orthopaedic Surgery, Regions Hospital, University of Minnesota, 640 Jackson Street, St Paul, MN 55101 USA
| | - Gil Freeman
- />Department of Orthopaedic Surgery, Regions Hospital-University of Minnesota, 640 Jackson Street, St Paul, MN 55101 USA
| | - Jonathan R. Dubin
- />Department of Orthopaedic Surgery, Regions Hospital-University of Minnesota, 640 Jackson Street, St Paul, MN 55101 USA
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