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Klein P, Goetsch T, Clavert P, Chakfé N, Amiri LE, Liverneaux P. Study of surgical performance during clavicle plate placements using 2 learning methods: naive practice versus deliberate practice. Orthop Traumatol Surg Res 2024:103951. [PMID: 39032863 DOI: 10.1016/j.otsr.2024.103951] [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: 01/31/2023] [Revised: 03/01/2024] [Accepted: 03/11/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Companionship and simple experience or naive practice (NP) rarely lead to expert level surgery, in contrast to deliberate practice (DP) where an expert analyzes the learner's errors and sets goals to improve performance. The main hypothesis was that using DP for learning would result in faster and/or greater progress than using NP. OBJECTIVES The objective of this work was to compare the evolution of the learning curve for clavicle locking plate placement on a sawbone model of a clavicle fracture, by surgical trainees learning via two different methods; NP and DP. PATIENTS AND METHODS Ten surgical residents, divided into 2 groups of 5, each placed 6 plates. The 6 trials were filmed. The NP group saw an expert video before each placement. The DP group saw this video once and then received personalized advice from the expert for improvement, by analyzing their own video after each subsequent trial. Objective performance (OP) was measured by a standardized evaluation grid (OSATS, with a score ranging from 10 to 50 points per trial), self-evaluation of performance by a numerical scale (from 0 to 10) and stress by an analgesia-nociception index (ANI, calculated by heart rate recording, from 0 to 100). RESULTS The mean OP at the last trial of clavicle plate placement was 41.8 (NP group) and 48.2 (DP group), with a mean progression from the first to last trials of 0.8 in the NP group, and 5.1 in the DP group. The mean progression in self-evaluation between the first and last trials was 3.4 (NP group) and 4.6 (DP group). The mean progression of the ANI between the first and last trials was -4.5 (NP group) and +5 (DP group). DISCUSSION The results of learning a clavicle plate osteosynthesis technique measured by OSATS were better with deliberate practice than with naive practice. The progression in self-evaluated performance was better with deliberate practice, but with a higher stress level. CONCLUSION Deliberate practice is a technique for learning the surgical procedure which complements companionship and experience. It shortens the learning curve and improves the level of performance of surgical trainees. LEVEL OF EVIDENCE IV; non-interventional research.
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Affiliation(s)
- Pierre Klein
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1 Avenue Molière, 67200 Strasbourg, France
| | - Thibaut Goetsch
- Department of Public Health, Strasbourg University Hospital, FMTS, GMRC, 1 Avenue de l'hôpital, 67091 Strasbourg, France
| | - Philippe Clavert
- Department of Shoulder and Elbow Surgery, Strasbourg University Hospitals, FMTS, 1 Avenue Molière, 67200 Strasbourg, France
| | - Nabil Chakfé
- ICube CNRS UMR7357, Strasbourg University, 2-4 rue Boussingault, 67000 Strasbourg, France
| | - Laela El Amiri
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1 Avenue Molière, 67200 Strasbourg, France
| | - Philippe Liverneaux
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1 Avenue Molière, 67200 Strasbourg, France; ICube CNRS UMR7357, Strasbourg University, 2-4 rue Boussingault, 67000 Strasbourg, France; Gepromed, Bâtiment d'Anesthésiologie, 4 rue Kirschleger 67085 Strasbourg Cedex, France.
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Ling K, VanHelmond T, Mehta N, Barry A, Wang E, Komatsu DE, Wang ED. Smoking Is Markedly Associated With 30-Day Readmission and Revision Surgery After Surgical Treatment of Clavicle Fracture. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202407000-00002. [PMID: 38996220 PMCID: PMC11239174 DOI: 10.5435/jaaosglobal-d-23-00278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/14/2024] [Accepted: 03/22/2024] [Indexed: 07/14/2024]
Abstract
BACKGROUND A recent database study found that 15.2% of clavicle fractures underwent surgical treatment. Recent evidence accentuates the role of smoking in predicting nonunion. The purpose of this study was to further elucidate the effect of smoking on the 30-day postoperative outcomes after surgical treatment of clavicle fractures. METHODS The authors queried the American College of Surgeons National Surgical Quality Improvement Program database for all patients who underwent open reduction and internal fixation of clavicle fracture between 2015 and 2020. Multivariate logistic regression, adjusted for notable patient demographics and comorbidities, was used to identify associations between current smoking status and postoperative complications. RESULTS In total, 6,132 patients were included in this study of whom 1,510 (24.6%) were current smokers and 4,622 (75.4%) were nonsmokers. Multivariate analysis found current smoking status to be significantly associated with higher rates of deep incisional surgical-site infection (OR, 7.87; 95% CI, 1.51 to 41.09; P = 0.014), revision surgery (OR, 2.74; 95% CI, 1.67 to 4.49; P < 0.001), and readmission (OR, 3.29; 95% CI, 1.84 to 5.89; P < 0.001). CONCLUSION Current smoking status is markedly associated with higher rates of deep incisional surgical-site infection, revision surgery, and readmission within 30 days after open reduction and internal fixation of clavicle fracture.
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Affiliation(s)
- Kenny Ling
- From the Department of Orthopaedics (Dr. Ling, Dr. VanHelmond, Dr. Mehta, Dr. Komatsu, and Dr. Edward D. Wang), and Renaissance School of Medicine at Stony Brook University (Mr. Barry and Mr. Eric Wang), Stony Brook, NY
| | - Taylor VanHelmond
- From the Department of Orthopaedics (Dr. Ling, Dr. VanHelmond, Dr. Mehta, Dr. Komatsu, and Dr. Edward D. Wang), and Renaissance School of Medicine at Stony Brook University (Mr. Barry and Mr. Eric Wang), Stony Brook, NY
| | - Nishank Mehta
- From the Department of Orthopaedics (Dr. Ling, Dr. VanHelmond, Dr. Mehta, Dr. Komatsu, and Dr. Edward D. Wang), and Renaissance School of Medicine at Stony Brook University (Mr. Barry and Mr. Eric Wang), Stony Brook, NY
| | - Alaydi Barry
- From the Department of Orthopaedics (Dr. Ling, Dr. VanHelmond, Dr. Mehta, Dr. Komatsu, and Dr. Edward D. Wang), and Renaissance School of Medicine at Stony Brook University (Mr. Barry and Mr. Eric Wang), Stony Brook, NY
| | - Eric Wang
- From the Department of Orthopaedics (Dr. Ling, Dr. VanHelmond, Dr. Mehta, Dr. Komatsu, and Dr. Edward D. Wang), and Renaissance School of Medicine at Stony Brook University (Mr. Barry and Mr. Eric Wang), Stony Brook, NY
| | - David E. Komatsu
- From the Department of Orthopaedics (Dr. Ling, Dr. VanHelmond, Dr. Mehta, Dr. Komatsu, and Dr. Edward D. Wang), and Renaissance School of Medicine at Stony Brook University (Mr. Barry and Mr. Eric Wang), Stony Brook, NY
| | - Edward D. Wang
- From the Department of Orthopaedics (Dr. Ling, Dr. VanHelmond, Dr. Mehta, Dr. Komatsu, and Dr. Edward D. Wang), and Renaissance School of Medicine at Stony Brook University (Mr. Barry and Mr. Eric Wang), Stony Brook, NY
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Trovarelli G, Rizzo A, Cerchiaro M, Pala E, Angelini A, Ruggieri P. The Evaluation and Management of Lung Metastases in Patients with Giant Cell Tumors of Bone in the Denosumab Era. Curr Oncol 2024; 31:2158-2171. [PMID: 38668063 PMCID: PMC11049429 DOI: 10.3390/curroncol31040160] [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: 03/01/2024] [Revised: 03/29/2024] [Accepted: 04/05/2024] [Indexed: 04/28/2024] Open
Abstract
Giant cell tumor of bone (GCTB) is characterized by uncertain biological behavior due to its local aggressiveness and metastasizing potential. In this study, we conducted a meta-analysis of the contemporary literature to evaluate all management strategies for GCTB metastases. A combination of the terms "lung metastases", "giant cell tumor", "bone", "treatment", and "oncologic outcomes" returned 133 patients meeting our inclusion criteria: 64 males and 69 females, with a median age of 28 years (7-63), at the onset of primary GCTB. Lung metastases typically occur at a mean interval of 26 months (range: 0-143 months) after treatment of the primary site, commonly presenting as multiple and bilateral lesions. Various treatment approaches, including surgery, chemotherapy, radiotherapy, and drug administration, were employed, while 35 patients underwent routine monitoring only. Upon a mean follow-up of about 7 years (range: 1-32 years), 90% of patients were found to be alive, while 10% had died. Death occurred in 25% of patients who had chemotherapy, whereas 96% of those not treated or treated with Denosumab alone were alive at a mean follow-up of 6 years (range: 1-19 years). Given the typically favorable prognosis of lung metastases in patients with GCTB, additional interventions beyond a histological diagnosis confirmation may not be needed. Denosumab, by reducing the progression of the disease, can play a pivotal role in averting or delaying lung failure.
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Affiliation(s)
- Giulia Trovarelli
- Department of Orthopedics and Orthopedic Oncology, University of Padua, 35128 Padua, Italy; (G.T.); (A.R.); (M.C.); (E.P.); (A.A.)
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, 35128 Padua, Italy
| | - Arianna Rizzo
- Department of Orthopedics and Orthopedic Oncology, University of Padua, 35128 Padua, Italy; (G.T.); (A.R.); (M.C.); (E.P.); (A.A.)
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, 35128 Padua, Italy
| | - Mariachiara Cerchiaro
- Department of Orthopedics and Orthopedic Oncology, University of Padua, 35128 Padua, Italy; (G.T.); (A.R.); (M.C.); (E.P.); (A.A.)
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, 35128 Padua, Italy
| | - Elisa Pala
- Department of Orthopedics and Orthopedic Oncology, University of Padua, 35128 Padua, Italy; (G.T.); (A.R.); (M.C.); (E.P.); (A.A.)
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, 35128 Padua, Italy
| | - Andrea Angelini
- Department of Orthopedics and Orthopedic Oncology, University of Padua, 35128 Padua, Italy; (G.T.); (A.R.); (M.C.); (E.P.); (A.A.)
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, 35128 Padua, Italy
| | - Pietro Ruggieri
- Department of Orthopedics and Orthopedic Oncology, University of Padua, 35128 Padua, Italy; (G.T.); (A.R.); (M.C.); (E.P.); (A.A.)
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, 35128 Padua, Italy
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Kang Y, Zhang Q, Ma Y, Zhou M, Jia X, Lin F, Wu Y, Rui Y. Clinical effect of nice knot-assisted minimally invasive titanium elastic nail fixation to treat Robinson 2B midshaft clavicular fracture. BMC Musculoskelet Disord 2024; 25:59. [PMID: 38216916 PMCID: PMC10787378 DOI: 10.1186/s12891-024-07197-4] [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: 04/04/2023] [Accepted: 01/11/2024] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND The treatment of completely displaced midshaft clavicle fractures is still controversial, especially Robinson 2B fractures. Titanium elastic nail (TEN) fixation is a good option for simple fractures, but no reports exist on its use in complex fractures. This study aimed to present a surgical method using the Nice knot-assisted TEN fixation to treat Robinson 2B midshaft clavicular fractures. METHODS A retrospective analysis of 29 patients who underwent fixation with TEN and had a 1-year postoperative follow-up between 2016 and 2020 was performed. The fractures were classified as Robinson type 2B1 in 17 cases and type 2B2 in 12 cases. Length of the incision, postoperative shoulder function Disability of Arm Shoulder and Hand (DASH) score and Constant score, complications rate, and second surgical incision length were recorded. RESULTS The length of the incision was 2-6 cm (average 3.7 cm). All incisions healed by first intention, and no infection or nerve injury occurred. The Constant score was 92-100 (average 96) and the DASH score was 0-6.2 (mean, 2.64). TEN bending and hypertrophic nonunion occurred in one case (3.4%) and implant irritation occurred in four cases (13.8%) Fixation implants were removed at 12-26 months (mean, 14.6 months) after surgery, and the length of the second incision was 1-2.5 cm (average 1.3 cm). CONCLUSIONS Intramedullary fixation by TEN is approved as a suitable surgical technique in clavicular fracture treatment. Nice knot-assisted fixation provides multifragmentary fracture stabilization, contributing to good fracture healing. Surgeons should consider this technique in treating Robinson 2B midshaft clavicular fractures. TRIAL REGISTRATION Retrospectively registered. This study was approved by the Ethics Committee of Wuxi Ninth People's Hospital (LW20220021).
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Affiliation(s)
- Yongqiang Kang
- Medical College, Soochow University, Suzhou, Jiangsu, China
| | - Qingqing Zhang
- Department of Traumatic Orthopedics, Wuxi Ninth People's Hospital, Soochow University, Liangxi Road, No.999, Binhu District, Wuxi, Jiangsu, China
| | - Yunhong Ma
- Department of Traumatic Orthopedics, Wuxi Ninth People's Hospital, Soochow University, Liangxi Road, No.999, Binhu District, Wuxi, Jiangsu, China
| | - Ming Zhou
- Department of Traumatic Orthopedics, Wuxi Ninth People's Hospital, Soochow University, Liangxi Road, No.999, Binhu District, Wuxi, Jiangsu, China
| | - Xueyuan Jia
- Department of Traumatic Orthopedics, Wuxi Ninth People's Hospital, Soochow University, Liangxi Road, No.999, Binhu District, Wuxi, Jiangsu, China
| | - Fang Lin
- Department of Traumatic Orthopedics, Wuxi Ninth People's Hospital, Soochow University, Liangxi Road, No.999, Binhu District, Wuxi, Jiangsu, China
| | - Yongwei Wu
- Department of Traumatic Orthopedics, Wuxi Ninth People's Hospital, Soochow University, Liangxi Road, No.999, Binhu District, Wuxi, Jiangsu, China.
| | - Yongjun Rui
- Department of Traumatic Orthopedics, Wuxi Ninth People's Hospital, Soochow University, Liangxi Road, No.999, Binhu District, Wuxi, Jiangsu, China.
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Tedeschi R. "Case report: Integrating aerobic activity in post-surgical management of plurifragmentary distal clavicle fractures - A holistic approach to pain modulation and recovery". Int J Surg Case Rep 2023; 113:109024. [PMID: 37956497 PMCID: PMC10681916 DOI: 10.1016/j.ijscr.2023.109024] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/04/2023] [Accepted: 11/04/2023] [Indexed: 11/15/2023] Open
Abstract
INTRODUCTION Clavicle fractures, particularly at the distal end, are common orthopedic injuries. While surgical interventions are often prioritized, the role of aerobic activity in post-operative pain modulation remains underexplored. CASE PRESENTATION A 34-year-old male presented with a plurifragmentary distal clavicle fracture following a direct trauma during a soccer match. Initial pain was severe (NPRS 6/7), with restricted shoulder mobility. Radiographic examinations confirmed the fracture. Following orthopedic consultation, the patient underwent surgical fixation using plate and screws. Post-operatively, pain management was uniquely addressed using low-impact aerobic activities, progressing from walking to running. At the 7-year follow-up, the patient reported optimal functional outcomes with a Disabilities of the Arm, Shoulder, and Hand (DASH) score of 0, highlighting the success of the combined approach. CLINICAL DISCUSSION The surgical intervention ensured anatomical alignment and stability, crucial for the healing of plurifragmentary fractures. The innovative approach of using aerobic activity for pain modulation post-surgery showcased significant pain reduction without consistent reliance on medications. CONCLUSIONS This case emphasizes the potential benefits of a comprehensive approach to clavicle fracture management. By integrating surgical intervention with aerobic activity for pain modulation, patients can achieve optimal long-term recovery and improved quality of life.
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Affiliation(s)
- Roberto Tedeschi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
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Labandeyra H, Heredia-Carques C, Campoy JC, Váldes-Vilches LF, Prats-Galino A, Sala-Blanch X. Clavipectoral fascia plane block spread: an anatomical study. Reg Anesth Pain Med 2023:rapm-2023-104785. [PMID: 37699731 DOI: 10.1136/rapm-2023-104785] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/25/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND The clavipectoral fascia plane block (CPB) is a novel anesthetic management strategy proposed by Valdes-Vilches for clavicle fractures. This study aimed to investigate the distribution of the injected solution around the clavicle and the surrounding tissues. METHODS Twelve clavicle samples were acquired from six cadavers. CPB was conducted using a 20 mL solution comprising methylene blue and iodinated contrast agent to improve visibility of the injected substance's dispersion. Methylene blue spread was assessed through anatomical dissection across distinct planes (subcutaneous, superficial muscular, deep muscular, and periosteal layers of the clavicle) in five cadavers. For the purpose of comparing methylene blue distribution, CT scans were performed on three cadavers. RESULTS Methylene blue was detected in the medial, intermediate, and lateral supraclavicular nerves, as well as superficial muscles including the deltoid, trapezius, sternocleidomastoid, and pectoralis major. However, no staining was observed in the deep muscle plane, including the subclavius, pectoralis minor, and clavipectoral fascia (CPF). Anterosuperior periosteum exhibited staining in 54% of surface, while only 4% of the posteroinferior surface. CT images displayed contrast staining in anterosuperior periclavicular region, consistent with observations from sagittal sections and anatomical dissections. CONCLUSION The CPB effectively distributes the administered solution in the anterosuperior region of the clavicular periosteum, superficial muscular plane, and supraclavicular nerves. However, it does not affect the posteroinferior region of the clavicular periosteum or the deep muscular plane, including the CPF.
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Affiliation(s)
- Hipolito Labandeyra
- Human Anatomy and Embryology Unit, Universitat de Barcelona Facultat de Medicina i Ciències de la Salut, Barcelona, Catalunya, Spain
| | | | - José Cros Campoy
- Anesthesia, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | | | - Alberto Prats-Galino
- Laboratory of Surgical Nauroanatomy (LSNA); Human Anatomy and Embryology, Universitat de Barcelona Facultat de Medicina i Ciències de la Salut, Barcelona, Catalunya, Spain
| | - Xavier Sala-Blanch
- Human Anatomy and Embryology Unit, Universitat de Barcelona Facultat de Medicina i Ciències de la Salut, Barcelona, Catalunya, Spain
- Anesthesiology, Hospital Clinic de Barcelona, Barcelona, Spain
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Pradel S, Brunaud M, Coulomb R, Kouyoumdjian P, Marès O. Less than 1.5cm shortening in clavicle midshaft fracture has long-term functional impact. Orthop Traumatol Surg Res 2023; 109:103590. [PMID: 36905957 DOI: 10.1016/j.otsr.2023.103590] [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: 03/11/2022] [Revised: 12/11/2022] [Accepted: 01/23/2023] [Indexed: 03/11/2023]
Abstract
INTRODUCTION Mediolateral shortening is a risk in treatment of clavicle shaft fracture, and can lead to scapular dyskinesis and shoulder dysfunction. Many studies advocated surgical treatment if shortening exceeds 15mm. HYPOTHESIS Clavicle shaft shortening of less than 15mm has negative impact on shoulder function at more than 1 year's follow-up. MATERIALS AND METHODS A retrospective case-control comparative study was performed, with assessment by an independent observer. Clavicle length was measured on frontal radiographs showing both clavicles, and the ratio between the healthy and affected sides was calculated. Functional impact was assessed on Quick-DASH. Scapular dyskinesis was analyzed by global antepulsion on Kibler's classification. In total, 217 files were retrieved for a 6-year period. Clinical assessment was performed for 20 patients managed non-operatively and 20 patients managed by locking plate fixation, at a mean 37.5months' follow-up (range: 12-69months). RESULTS Mean Quick-DASH score was significantly higher in the non-operated group: 11.363 [0-50] versus 2.045 [0-11.36] (p=0.0092). Pearson ρ correlation between percentage shortening and Quick-DASH score was -0.3956 [95% CI: -0.6295; -0.0959] (p=0.012). Clavicle length ratio differed significantly between groups: operated group, +2.2% [-5.1%; +17%] for 0.34cm; non-operated group, -8.28% [-17.3%; -0.7%] for 1.38cm (p<0.0001). Shoulder dyskinesis was significantly more frequent non-operated patients: 10 versus 3 (p=0.018). A threshold of 1.3cm shortening was found for functional impact. CONCLUSION Restoring scapuloclavicular triangle length is an important aim in management of clavicular fracture. Surgery by locking plate fixation is therefore to be recommended in case of>8% radiological shortening (1.3cm) to avoid medium- and long-term complications in shoulder function. LEVEL OF EVIDENCE III; case-control study.
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Affiliation(s)
- Sarah Pradel
- Service de Chirurgie Orthopédique et Traumatologique, Centre Hospitalo-Universitaire de Nîmes, Nîmes, France.
| | - Maxime Brunaud
- Service de Chirurgie Orthopédique et Traumatologique, Centre Hospitalo-Universitaire de Nîmes, Nîmes, France
| | - Rémy Coulomb
- Service de Chirurgie Orthopédique et Traumatologique, Centre Hospitalo-Universitaire de Nîmes, Nîmes, France
| | - Pascal Kouyoumdjian
- Service de Chirurgie Orthopédique et Traumatologique, Centre Hospitalo-Universitaire de Nîmes, Nîmes, France
| | - Olivier Marès
- Service de Chirurgie Orthopédique et Traumatologique, Centre Hospitalo-Universitaire de Nîmes, Nîmes, France
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Lin J, Sun W, Chen J, Dong J, Bao D, Yan L, Ni W, Xiang M, Ding J, Cai M, Song J, Mao M, Wu X. Comparison of Interobserver Agreement of Four Classification Systems for Lateral Clavicle Fractures between Two Groups of Surgeons: A Multicenter Study. Orthop Surg 2023; 15:2138-2143. [PMID: 36718055 PMCID: PMC10432448 DOI: 10.1111/os.13659] [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: 09/07/2022] [Revised: 12/11/2022] [Accepted: 12/22/2022] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE Distal clavicle fracture classification directly affects the treatment decisions. It is unclear whether the classification systems implemented differ depending on surgeons' backgrounds. This study aimed to compare the interobserver agreement of four classification systems used for lateral clavicle fractures by shoulder specialists and general trauma surgeons. METHODS Radiographs of 20 lateral clavicle fractures representing a full spectrum of adult fracture patterns were analyzed by eight experienced shoulder specialists and eight general trauma surgeons from 10 different hospitals. All cases were graded according to the Orthopedic Trauma Association (OTA), Neer, Jäger/Breitner, and Gongji classification systems. To measure observer agreement, Fleiss' kappa coefficient (κ) was applied and assessed. RESULTS When only X-ray films were presented, both groups achieved fair agreement. However, when the 3D-CT scan images were provided, improved interobserver agreement was found in the specialist group when the OTA, Jäger/Breitner, and Gongji classification systems were used. In the generalist groups, improved agreement was found when using the Gongji classification system. In terms of interobserver reliability, the OTA, Neer, and Jäger/Breitner classification systems showed better agreement among shoulder specialists, while a slightly lower level of agreement was found using the Gongji classification system. For the OTA classification system, interobserver agreement had a mean kappa value of 0.418, ranging from 0.446 (specialist group) to 0.402 (generalist group). For the Neer classification system, interobserver agreement had a mean kappa value of 0.368, ranging from 0.402 (specialist group) to 0.390 (generalist group). For the Jäger/Breitner classification system, the inter-observer agreement had a mean kappa value of 0.380, ranging from 0.413 (specialist group) to 0.404 (generalist group). For the Gongji classification system, interobserver agreement had a mean kappa value of 0.455, ranging from 0.480 (specialist group) to 0.485 (generalist group). CONCLUSION Generally speaking, 3D-CT scans provide a richer experience that can lead to better results in most classification systems of lateral clavicle fractures, highlighting the value of digitization and specialization in diagnosis and treatment. Competitive interobserver agreement was exhibited in the generalist group using the Gongji classification system, suggesting that the Gongji classification is suitable for general trauma surgeons who are not highly experienced in the shoulder field.
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Affiliation(s)
- Jian Lin
- Department of Trauma CenterShanghai General Hospital affiliated to Shanghai Jiao Tong UniversityShanghaiChina
| | - Wei‐Jin Sun
- Department of Trauma CenterShanghai General Hospital affiliated to Shanghai Jiao Tong UniversityShanghaiChina
| | - Jian‐Hai Chen
- Department of Trauma & OrthopedicsPeking University People's HospitalBeijingChina
| | - Jing‐Ming Dong
- Department of Upper Extremity Traumatology No.2Tianjin HospitalTianjinChina
| | - Ding‐Su Bao
- Department of Orthopedics and Center for Orthopedic Diseases ResearchAffiliated Traditional Chinese Medicine Hospital of South‐West Medical UniversityLu ZhouChina
| | - Ling Yan
- Department of OrthopedicsThe First People's Hospital of Zunyi CityZunyiChina
| | - Wei‐Dong Ni
- Department of OrthopedicsThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Ming Xiang
- Department of Upper LimbSichuan Province Orthpaedic HospitalChengduChina
| | - Jian Ding
- Department of OrthopedicsShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiChina
| | - Ming Cai
- Department of OrthopedicsShanghai Tenth People's Hospital, Tongji University School of MedicineShanghaiChina
| | - Jia‐Xiang Song
- Department of OrthopedicsWuchuan Traditional Chinese Medicine HospitalZunyiChina
| | - Ming‐Gui Mao
- Department of OrthopedicsFenggang Traditional Chinese medicine hospitalZunyiChina
| | - Xiao‐Ming Wu
- Department of Trauma CenterShanghai General Hospital affiliated to Shanghai Jiao Tong UniversityShanghaiChina
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Chao YH, Chou YC, Lin CL. The deformities of acute diaphyseal clavicular fractures: a three-dimensional analysis. Biomed Eng Online 2023; 22:42. [PMID: 37161417 PMCID: PMC10170817 DOI: 10.1186/s12938-023-01112-z] [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: 03/19/2023] [Accepted: 05/02/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Although minimally invasive surgeries have gained popularity in many orthopaedic fields, minimally invasive approaches for diaphyseal clavicular fracture have not been widely performed, which is attributed to difficulties in performing a closed reduction of fracture deformities of a curved bone in a three-dimensional space. The goal of this study was to investigate the radiographic parameters of fracture deformities in a three-dimensional space and to identify the risk factors for deformities. METHODS The computed tomography images of 100 patients who sustained a clavicle fracture were included. Five parameters were used to analyze the deformities: change in clavicle length, fracture displacement, and fragment rotation around the X, Y, Z axes. The change in length was assessed using the length of the endpoint line. The displacement was assessed using the distance between the fracture midpoints. The rotation deformities were assessed using the Euler angles. The correlation between the parameters was evaluated with the Pearson correlation coefficient. The risk factors were evaluated using univariable analysis and multiple regression analysis. RESULTS The average change in length was - 5.3 ± 8.3 mm. The displacement was 11.8 ± 7.1 mm. The Euler angles in the Z-Y-X sequences were -1 ± 8, 1 ± 8, and - 8 ± 13 degrees. The correlation coefficient between the change in length and the displacement was - 0.724 (p < 0.001). The variables found to increase the risk of shortening and displacement were right-sided fracture (p = 0.037), male sex (p = 0.015), and multifragmentary type (p = 0.020). The variables found to increase the risk of rotation deformity were the number of rib fractures (p = 0.001) and scapula fracture (p = 0.025). CONCLUSIONS There was a strong correlation between shortening and displacement. The magnitude of anterorotation around the X axis was greater than the magnitude of retraction around the Z axis and depression around the Y axis. The risk factors for shortening and displacement included right-sided fracture, male sex, and multifragmentary type. The risk factor for retraction around the Z axis was the number of rib fractures, and the risk factor for depression around the Y axis was scapula fracture. These results could be useful adjuncts in guiding minimally invasive surgical planning for diaphyseal clavicular fractures.
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Affiliation(s)
- Yi-Hsuan Chao
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong Street, Taipei, 112, Taiwan
- Department of Orthopaedic Surgery, Taipei City Hospital, No. 10, Sec. 4, Ren'ai Rd., Da'an Dist., Taipei, 106, Taiwan
- Innovation & Translation Center of Medical Device, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong Street, Taipei, 112, Taiwan
| | - Ying-Chao Chou
- Department of Orthopedics, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan
| | - Chun-Li Lin
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong Street, Taipei, 112, Taiwan.
- Innovation & Translation Center of Medical Device, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong Street, Taipei, 112, Taiwan.
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10
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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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11
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Li T, Li Y, Zhang L, Pang L, Tang X, Zhu J. Venous thromboembolism after arthroscopic shoulder surgery: a systematic review. J Orthop Surg Res 2023; 18:103. [PMID: 36788620 PMCID: PMC9927062 DOI: 10.1186/s13018-023-03592-0] [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: 09/21/2022] [Accepted: 02/08/2023] [Indexed: 02/16/2023] Open
Abstract
PURPOSE To summarize the incidence, risk factors, diagnosis methods, prophylaxis methods, and treatment of venous thromboembolism (VTE) following arthroscopic shoulder surgery. METHODS Literature on VTE after arthroscopic shoulder surgeries was summarized, and all primary full-text articles reporting at least 1 case of deep vein thrombosis (DVT) or pulmonary embolism (PE) after arthroscopic shoulder surgeries were included. Articles were critically appraised and systematically analyzed to determine the incidence, risk factors, diagnosis, prophylaxis, and management of VTE following arthroscopic shoulder surgeries. RESULTS This study included 42 articles in which the incidence of VTE ranges from 0 to 5.71% and the overall incidence was 0.26%. Most VTE events took place between the operation day and the 14th day after the operation (35/51). Possible risk factors included advanced age (> 70 years), obesity (BMI ≥ 30 kg/m2), diabetes mellitus, thrombophilia, history of VTE, prolonged operation time, hormone use, and immobilization after surgery. The most common prophylaxis method was mechanical prophylaxis (13/15). No statistical difference was detected when chemoprophylaxis was applied. The management included heparinization followed by oral warfarin, warfarin alone and rivaroxaban, a direct oral anticoagulant. CONCLUSION Based on the included studies, the incidence rate of VTE after arthroscopic shoulder surgeries is relatively low. The risk factors for VTE are still unclear. CT/CTA and ultrasound were the mainstream diagnosis methods for PE and DVT, respectively. Current evidence shows that chemical prophylaxis did not deliver significant benefits, since none of the existing studies reported statistically different results. High-quality studies focusing on the prophylaxis and management of VTE population undergoing arthroscopic shoulder surgeries should be done in the future.
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Affiliation(s)
- Tao Li
- grid.13291.380000 0001 0807 1581Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37, Guoxue Road, Wuhou District, Chengdu, 610041 Sichuan Province People’s Republic of China
| | - Yinghao Li
- grid.13291.380000 0001 0807 1581Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37, Guoxue Road, Wuhou District, Chengdu, 610041 Sichuan Province People’s Republic of China
| | - Linmin Zhang
- grid.13291.380000 0001 0807 1581West China School of Medicine, Sichuan University, Chengdu, People’s Republic of China
| | - Long Pang
- grid.13291.380000 0001 0807 1581Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37, Guoxue Road, Wuhou District, Chengdu, 610041 Sichuan Province People’s Republic of China
| | - Xin Tang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan Province, People's Republic of China.
| | - Jing Zhu
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Nursing, Sichuan University, No. 37, Guoxue Road, Wuhou District, Chengdu, Sichuan Province, People's Republic of China.
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12
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Free vascularized fibular flap for clavicle reconstruction: A systematic review with a new case. J Plast Reconstr Aesthet Surg 2023; 76:271-282. [PMID: 36538867 DOI: 10.1016/j.bjps.2022.08.078] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 05/27/2022] [Accepted: 08/17/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND/OBJECTIVES Due to the rarity of the need for claviculectomy and the subsequent clavicle reconstruction, currently there is no consensus on the reconstructive approach for the clavicle. The clavicle is an essential bony structure that is necessary for optimal upper limb anatomical and physiological functionalities. OBJECTIVE This study analyzes the reconstructive approach, vascular anastomosis, complications, and long-term outcome of clavicle reconstruction using a free vascularized fibular flap through a systematic review of the literature and a case report from our institution. METHODS A comprehensive literature search was executed in the Ovid MEDLINE, Embase, and Google Scholar databases. The search strategy was designed to capture the concept of cases that underwent clavicle reconstruction after necessary claviculectomy with sufficient clinical information for detailed analysis. Using the final included articles, we analyzed and summarized the outcomes associated with clavicle reconstruction using free fibular osteocutaneous flap. RESULTS A review of 179 articles yielded 11 publications with 26 cases that had detailed clinical information. We presented an additional case from our institution database. The systematic review of 27 cases revealed that clavicle nonunion due to various causes accounted for 73.08% of the cases for claviculectomy and the eventual reconstruction with a free fibular flap. The mean follow-up period in this study is 29.54 months with the range of 3 to 120 months. A total of 92.31% of the cases showed evidence of complete osseous consolidation. CONCLUSION When claviculectomy is necessary, a free fibular flap can be utilized for the subsequent clavicle reconstruction to provide optimal anatomical and physiological functionality of the clavicle.
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Markes AR, Garcia-Lopez E, Halvorson RT, Swarup I. Management of Displaced Midshaft Clavicle Fractures in Pediatrics and Adolescents: Operative vs Nonoperative Treatment. Orthop Res Rev 2022; 14:373-381. [PMID: 36345395 PMCID: PMC9636878 DOI: 10.2147/orr.s340538] [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: 08/16/2022] [Accepted: 10/17/2022] [Indexed: 01/24/2023] Open
Abstract
The purpose of the current review is to describe the management of displaced midshaft clavicle fractures in pediatric and adolescent patients. Midshaft clavicle fractures are relatively common in pediatric and adolescent patients. They most commonly occur from direct trauma and are often related to sports participation in adolescents. Recent literature in the management of adult midshaft clavicle fractures has supported operative management due to improved functional outcomes, decreased time to union, leading to early return to activity. A similar trend of increasing frequency in operative management has been seen in pediatric and adolescent patients with no consensus in the literature on optimal management. Nonoperative treatment consists of with a brief period of sling immobilization followed by range of motion. Operative management may be considered for open fractures, fractures with significant neurovascular compromise and soft tissue complications. Studies have shown comparable mid- to long-term functional and patient-reported outcomes after operative and nonoperative management of midshaft clavicle fractures in pediatric patients.
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Affiliation(s)
- Alexander R Markes
- Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, CA, USA
| | - Edgar Garcia-Lopez
- Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, CA, USA
| | - Ryan T Halvorson
- Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, CA, USA
| | - Ishaan Swarup
- Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, CA, USA,Correspondence: Ishaan Swarup, Email
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14
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Chen W, Wang B, Liu Z. A fluoroscopic view for midshaft clavicular fracture reduction and internal fixation: posteroanterior 25° skyline projection. BMC Surg 2022; 22:371. [PMID: 36309726 PMCID: PMC9618203 DOI: 10.1186/s12893-022-01813-7] [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: 02/03/2022] [Accepted: 09/23/2022] [Indexed: 11/10/2022] Open
Abstract
Background Open reduction and internal fixation have been frequently applied for displaced midshaft clavicular fracture. Plate and screw fixation of clavicular fractures could provide rigid fixation and rotational control. Proper implant positioning in surgical fixation is critical to prevent iatrogenic complications. Fluoroscopy plays an important role in the intraoperative evaluation of implants. This study aimed to introduce a new fluoroscopic projection to evaluate the positioning of plates and screws. Methods Adult patients with a diagnosis of acute displaced midshaft clavicular fracture were included in this study. The slope angle of the midshaft clavicle was measured on sagittal reconstructions of preoperative computed tomography (CT) scans. The incidence of screw revision based on intraoperative standard posteroanterior (PA) and PA 25° cephalic skyline projections was compared. The interobserver agreement for the two projections was calculated. Results Twenty-nine patients with midshaft clavicular fractures were enrolled from January 2020 to June 2021. The PA 25° skyline projection could clearly display the tangential line of the plate and inferior border of the clavicle. The slope angle on the superior surface of the midshaft clavicle was 26.0 ± 5.8° (range: 18.5–38.3°). The incidence of screw revision using the PA projection (72.4%) was significantly different from that using the PA 25° skyline projection (34.5%) (P < 0.05). The concordance of the screw revision rate based on the standard PA and PA 25° skyline projections was strong, with kappa coefficients of 0.680 (95% CI: 0.394–0.968) and 0.776 (95% CI: 0.537–0.998). Conclusion The PA 25° skyline projection corresponds to the slope angle of the midshaft clavicle. It can provide more accurate information regarding the proper screw length and be applied as a routine method for intraoperative evaluation.
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15
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Orlandi TV, Rogers NS, Burger MC, King PR, Lamberts RP. A prospective randomized controlled trial comparing plating augmented with coracoclavicular fixation and hook plate fixation of displaced distal-third clavicle fractures. J Shoulder Elbow Surg 2022; 31:906-913. [PMID: 35158065 DOI: 10.1016/j.jse.2022.01.114] [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: 08/02/2021] [Revised: 12/29/2021] [Accepted: 01/03/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Two popular methods used to treat distal-third clavicle fractures are the traditional hook plate and the anatomically contoured locking plate. No consensus exists on whether one method is more effective than the other. Therefore, the aim of this study was to compare the efficacy of a traditional hook plate with that of an anatomically contoured locking plate augmented with coracoclavicular fixation in the treatment of distal-third clavicle fractures. METHODS Enrolled patients were randomly assigned to either the hook plate group (n = 13) or the locking plate group (n = 17). Follow-up assessments (clinical and radiologic) were performed at 6 and 12 months postoperatively. RESULTS In both groups, union was achieved in 91% of cases at 6 months and 100% at 12 months. No differences in Disabilities of the Arm, Shoulder and Hand (DASH) and Constant-Murley shoulder scores were noted between the hook plate and locking plate groups at 12 months. From 6 to 12 months, DASH scores improved in the hook plate group (P = .007) and Constant-Murley shoulder scores tended to improve (P = .075). Surgical time was longer in the locking plate group than in the hook plate group (P < .001). CONCLUSION Similar functional outcomes and union rates were achieved in both groups at 12 months postoperatively. However, the improvement in DASH scores in the hook plate group from 6 to 12 months suggests that patients treated with an anatomically contoured locking plate make a quicker recovery than patients treated with a hook plate.
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Affiliation(s)
- Tino-Vito Orlandi
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Nicholas S Rogers
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Marilize C Burger
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Paul R King
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Robert P Lamberts
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa; Division of Biokinetics, Department of Sport Science, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.
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16
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Falk N, Pendergraph B, Meredith TJ, Le G, Hornsby H. Managing Fractures and Sprains. Prim Care 2022; 49:145-161. [DOI: 10.1016/j.pop.2021.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Junhui Cai M, Jinxiang S B, Chunyu Wan B, Siwei Zhen B, Qin Hu M. Clinical Experiences with Tranexamic Acid for Open Reduction and Internal Fixation of Clavicle Fractures. INT J PHARMACOL 2022. [DOI: 10.3923/ijp.2022.315.320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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18
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Guo PC. Clinical eff ectiveness of a pneumatic compression device combined with low-molecular-weight heparin for the prevention of deep vein thrombosis in trauma patients: A single-center retrospective cohort study. World J Emerg Med 2022; 13:189-195. [DOI: 10.5847/wjem.j.1920-8642.2022.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 01/10/2022] [Indexed: 11/19/2022] Open
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Fitzgerald EM, Moore DM, Quinlan JF. A review of outcomes after operative fixation of clavicular fractures over a 10-year period—a single tertiary trauma unit experience. JSES Int 2021; 6:264-267. [PMID: 35252924 PMCID: PMC8888173 DOI: 10.1016/j.jseint.2021.11.001] [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] [Indexed: 11/17/2022] Open
Abstract
Background Early definitive fixation of clavicular fractures is rising in popularity when compared with conservative management. Despite this, the relative risk of subsequent hardware removal or revision surgery is relatively undocumented in the literature. The aim of this study was to review all clavicle fractures treated operatively in a single tertiary referral trauma unit and determine the true incidence of hardware removal and revision rates among this cohort. Methods A retrospective electronic review was performed in a single tertiary trauma unit for all open reduction internal fixation of clavicle fractures over 10 years (2010-2019 inclusive). All patients were cross referenced for hardware removal during the same period. Patients identified as having undergone ORIF clavicle were reviewed via the National Integrated Medical Imaging System to identify the fracture pattern, fixation method, radiographic nonunion, or radiographic malunion. Age, gender, time from injury to fixation, and time from insertion to removal of hardware where relevant were also collected. Results Over the 10-year period from 2010 to 2019, 352 patients underwent ORIF of clavicular fractures. After application of inclusion and exclusion criteria, 346 patients (76% male and 24% female) were analyzed with a mean age of 34.46 years old (95% confidence interval [33.02-35.91]). In total, 54 (15.6%) patients underwent removal of hardware. When fracture type and fixation method were accounted for, only 11% of plate fixations for mid-shaft fractures (n = 29) were removed, whereas 76% of clavicular hook plates for distal fractures (n = 25) underwent removal (P < .001). No distal clavicle fractures treated with locking plates underwent removal (n = 23). Women were almost 3 times more likely to undergo removal of hardware than men (28.6% vs. 11.5%, P < .001). Seven patients (2%) underwent revision ORIF in the 10-year period for nonunion (n = 3), malunion (n = 2), and failure of fixation (n = 2). The mean follow-up time was 1 year (366 days) for those who underwent subsequent surgery and 5.7 years (2087 days) for those who did not. Conclusion Clavicular fracture fixation using either locking or hook plates is a safe method of treatment with a very low reoperation rate for either hardware removal or revision. Women are more likely to request plate removal. Distal locking plates are a safe alternative to hook plates for distal one-third clavicle fractures with lower reoperation rates. Newer techniques are emerging for the management of distal fractures such as tight rope fixation and locking plates which also appear to be successful.
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Affiliation(s)
- Eilis M. Fitzgerald
- Corresponding author: Ms Eilis M. Fitzgerald, BMed, BSurg, BSc Phys, MCh MRCSI, Ballindangan, Mitchelstown, Co Cork, Ireland.
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20
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Greve M. Acute Cycling Injuries. Phys Med Rehabil Clin N Am 2021; 33:135-158. [PMID: 34798995 DOI: 10.1016/j.pmr.2021.08.010] [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: 11/20/2022]
Abstract
The overall activity of cycling, although profoundly heterogenous, often occurs with mechanisms consistent with motor vehicle collisions. Advanced trauma life support is the standard of care. Traumatic brain injury is the leading cause of death, and concussions are common in cyclists. Road rash is the most common injury, and management should be synonymous with other kinds of burns. A unique aspect of cycling medicine is that it often is done on public roadways in close proximity to the athletes during competition. Clinicians who care for cyclists in the field setting should be prepared to manage a broad spectrum of traumatic injuries.
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Affiliation(s)
- Mark Greve
- Department of Emergency Medicine, Division of Sports Medicine, Warren Alpert School of Medicine, Brown University, 55 Claverick Street, 2nd floor, Providence, RI 02903, USA.
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21
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Wurm M, Siebenlist S, Zyskowski M, Pflüger P, Biberthaler P, Beirer M, Kirchhoff C. Excellent clinical and radiological outcome following locking compression plate fixation of displaced medial clavicle fractures. BMC Musculoskelet Disord 2021; 22:905. [PMID: 34706701 PMCID: PMC8555070 DOI: 10.1186/s12891-021-04775-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 10/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Treatment of medial clavicle fractures is still controversially discussed in the community of upper extremity surgeons. An increasing number of symptomatic non-unions following conservative treatment of displaced fractures led to the development of various surgical approaches. Aim of this study was to evaluate the clinical and radiological outcome following operative treatment of displaced medial end clavicle fractures. METHODS Patients who presented with a displaced fracture of the medial clavicle between September 2012 and December 2019 were retrospectively enrolled in this study. All patients were operatively treated with open reduction and internal fixation (ORIF) using an anatomically precontoured locking compression plate (LCP) originally designed for the lateral clavicle (Synthes®, Umkirch, Germany). Functional outcome was recorded using the American Shoulder and Elbow Surgeons (ASES) Score, the Munich Shoulder Questionnaire (MSQ), Shoulder Pain and Disability Index (SPADI) and Constant Score. RESULTS Overall 18 patients with a mean age of 54.5 ± 23.5 years suffering from a displaced fracture of the medial clavicle were identified. The mean follow-up was 40.9 ± 26.2 months. The mean ASES accounted for 88.3 ± 20.8 points, the mean MSQ was 83.1 ± 21.7 points, the mean SPADI was 85.6 ± 22.5 and a mean normative age- and sex-specific Constant Score of 77.5 ± 19.1 points resulted. No minor or major complications were observed. Radiologic fracture consolidation was achieved in all patients after a mean of 6.4 months. CONCLUSION Surgical treatment of displaced medial clavicle fractures using an anatomically precontoured locking plate originally designed for the lateral clavicle led to very good to excellent clinical and functional results. TRIAL REGISTRATION No: DRKS00024813 , retrospectively registered 19.03.2021 ( www.drks.de ).
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Affiliation(s)
- Markus Wurm
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Sebastian Siebenlist
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Michael Zyskowski
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Patrick Pflüger
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Peter Biberthaler
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Marc Beirer
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Chlodwig Kirchhoff
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.
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23
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Wu S, Chen J, Zhang J, Sujan S, Xing F, Xiang Z. [Clavicular hook plate with coracoclavicular ligament augmentation by suture anchor in the treatment of unstable distal clavicle fractures]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:978-983. [PMID: 34387425 DOI: 10.7507/1002-1892.202101094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective To evaluate the effectiveness of a clavicular hook plate with coracoclavicular ligament augmentation by suture anchor in the treatment of Neer types Ⅱ and Ⅴ distal clavicle fractures. Methods Between January 2010 and June 2016, 16 patients with Neer types Ⅱ and Ⅴ distal clavicle fractures were treated with clavicle hook plates and coracoclavicular ligament augmentation by suture anchor. There were 12 males and 4 females with an average age of 45.6 years (range, 14-81 years). The injury mechanism included falling in 10 cases, traffic accident injury in 2 cases, falling from height in 2 cases, and heavy object injury in 2 cases. The Neer classification of clavicle fractures included 2 cases of type Ⅱa, 13 cases of type Ⅱb, and 1 case of type Ⅴ. The injury severity score (ISS) was 6-29, with an average of 11.2. The time from injury to operation was 1-18 days, with an average of 6.4 days. The operation time, intraoperative blood loss, hospitalization stay, fracture healing, and postoperative complications were recorded; the disability of arm, shoulder, and hand (DASH) score, the shoulder joint Constant score, and the Oxford shoulder score (OSS) were used to evaluate the shoulder joint at last follow-up. Results All operations were successfully completed. The operation time was 50-100 minutes, with an average of 75.6 minutes; intraoperative blood loss was 30-100 mL, with an average of 52.8 mL; hospitalization stay was 4-47 days, with an average of 13.7 days. All patients were followed up 1.2-7.5 years, with an average of 3.5 years. All clavicle fractures healed, and the healing time was 9.4-13.6 weeks, with an average of 11.9 weeks. No fracture nonunion, fracture displacement, failure of internal fixation, or incision infection, etc. occurred. Fifteen patients took out the hook plate after fracture healing and functional recovery, and 1 case refused to remove the hook plate from the second operation because of no obvious discomfort. At last follow-up, the DASH score was 0-13, with an average of 2.2; the shoulder joint Constant score was 90-100, with an average of 96.8; the OSS score was 12-14, with an average of 12.3. Conclusion Clavicular hook plate with coracoclavicular ligament augmentation by suture anchor can help achieve good effectiveness with less postoperative complication in the treatment of Neer types Ⅱ and Ⅴ distal clavicular fractures.
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Affiliation(s)
- Shuang Wu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Jialei Chen
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Jie Zhang
- International Medical Center, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Shakya Sujan
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Fei Xing
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Zhou Xiang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
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Saragaglia D, Refaie R. Displaced mid-shaft clavicular fractures: state of the art for athletes and young active people. INTERNATIONAL ORTHOPAEDICS 2021; 45:2679-2686. [PMID: 34309695 DOI: 10.1007/s00264-021-05113-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 06/13/2021] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Fractures ofthe clavicle are frequent injuries (between 4 and 10% of adult fractures) and mid-shaft diaphyseal fractures represent more than 80% of clavicle fractures. In a recent study from the USA in 2019, an incidence of 22.4 fractures per year per 100,000 people was reported. Multiple injury mechanisms are recognised, with sport accounting for 50 to 85% of these injuries. There is little or no consensus as to the optimal treatment but in recent years multiple studies have suggested operative management should be favoured in athletes and young active patients. OBJECTIVES These are (1) to present the anatomy and the anatomical-pathology of the fractures of the clavicle as well as the mechanisms of injury, (2), (3) to describe non-operative and operative treatment methods, (4) to review the literature around different treatment modalities and (5) to attempt to describe the best treatment for athletes. METHODS To collect and analyse the most recent articles of the literature regarding the management of displaced mid-shaft fractures of the clavicle for athletes and young active people. RESULTS Looking at studies of the general population, the results tend to favour surgical treatment with a smaller incidence of non-union and faster return to function. These results are mirrored in the athlete population where several studies have shown excellent anatomic restoration and functional recovery after plate fixation. CONCLUSION Based on this analysis, with the exception of patients who refuse operative management after an informed discussion, the treatment of choice in displaced clavicle fractures in athletes seems to be operative treatment with a plate and screws. However, prospective randomised studies comparing non-surgical treatment and plate osteosynthesis are missing and it is not possible to state that the latter is the best treatment.
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Affiliation(s)
| | - Ramsay Refaie
- Department of Trauma and Orthopaedics, South Tees NHS Foundation Trust, Middlesbrough, UK
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Menor Fusaro F, Di Felice Ardente P, Pérez Abad M, Yanguas Muns C. Three-dimensional imaging, modeling, and printing in the correction of a complex clavicle malunion. JSES Int 2021; 5:729-733. [PMID: 34223422 PMCID: PMC8246001 DOI: 10.1016/j.jseint.2021.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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López Palacios C, Sanchez-Munoz E, Pipa Muñiz I, Rodríguez García N, Maestro Fernández A. Simultaneous Clavicle Fracture and Acromioclavicular Joint Dislocation: Novel Surgical Technique: A Case Report. JBJS Case Connect 2021; 11:01709767-202106000-00129. [PMID: 34161305 DOI: 10.2106/jbjs.cc.20.00775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 41-year-old man sustained a midshaft clavicle fracture with associated type IV ipsilateral acromioclavicular joint (ACJ) dislocation. The clavicle was fixed with a locking plate and ACJ stabilized with a novel technique: 2 metal anchors with preloaded suture fixed at the coracoid process, looping the sutures over the clavicle, and passing through the plate holes without clavicle bone drilling. Excellent functional outcomes for range of motion, pain, and functional scores persisted 2 and a half years after surgery. CONCLUSION The described surgical technique achieved exceptional short-term outcomes, sparing clavicle bone stock and allowing an early return to sports.
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Affiliation(s)
- Cristina López Palacios
- Department of Orthopaedic Surgery and Traumatology, University Hospital of Toledo, Toledo, Spain
| | - Enrique Sanchez-Munoz
- Department of Orthopaedic Surgery and Traumatology, University Hospital of Toledo, Toledo, Spain.,Knee Pathology and Sports Medicine Unit, HM IMI Clinic, Toledo, Spain
| | - Iván Pipa Muñiz
- Department of Orthopaedic Surgery, Begoña Hospital, Gijón, Spain
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Reuter P, Chen K, Klestil T, Stotter C. Surgical treatment of anterior sternoclavicular dislocation associated with midshaft clavicle fracture: A case report. Jt Dis Relat Surg 2021; 32:560-565. [PMID: 34145841 PMCID: PMC8343839 DOI: 10.52312/jdrs.2021.135] [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: 03/31/2021] [Accepted: 05/07/2021] [Indexed: 12/02/2022] Open
Abstract
A combination of an anterior sternoclavicular (SC) joint dislocation with a midshaft clavicle fracture is an extremely rare injury. If left untreated, it can lead to severely impaired function of the shoulder with a high risk for complications. A 45-year-old male patient presented with pain and impaired range of motion (ROM) in the left shoulder after a mountain bike crash. Radiographs and a computed tomography scan showed an anterior dislocation of the left SC joint and an ipsilateral midshaft fracture of the clavicle. Open reduction and internal fixation (ORIF) of the clavicle combined with SC joint stabilization using transosseous sutures was performed. Postoperatively, a shoulder-arm bandage was applied with passive motion starting on the first postoperative day. During follow-up, the patient showed an improved clinical function and could return to work after three weeks. Radiographs at eight weeks showed fracture healing without any signs of recurrent SC dislocation. At the final follow-up at 12 weeks, the patient returned to his pre-injury activity level and recreational sports. Despite minimal redislocation in the SC joint, the Constant-Murley Score showed a continuous improvement with 93%, compared to the contralateral side. In conclusion, surgical treatment of anterior SC joint dislocation with a midshaft clavicle fracture can restore shoulder function with no surgery-associated complications.
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Affiliation(s)
- Philippe Reuter
- Department of Orthopaedics and Traumatology, Landesklinikum Baden-Mödling, 2340 Mödling, Austria.
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The emergency medicine management of clavicle fractures. Am J Emerg Med 2021; 49:315-325. [PMID: 34217972 DOI: 10.1016/j.ajem.2021.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 06/02/2021] [Accepted: 06/02/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Clavicle fractures are common. An emergency physician needs to understand the diagnostic classifications of clavicle fractures, have a plan for immobilization, identify associated injuries, understand the difference between treating pediatric and adult patients, and have an approach to multimodal pain control. It is also important to understand when expert orthopedic consultation or referral is indicated. OBJECTIVE OF THE REVIEW To provide an evidence-based review of clavicle fracture management in the emergency department. DISCUSSION Clavicle fractures account for up to 4% of all fractures evaluated in the emergency department. They can be separated into midshaft, distal, and proximal fractures. They are also classified in terms of their degree of displacement, comminution and shortening. Emergent referral is indicated for open fractures, posteriorly displaced proximal fractures, and those with emergent associated injuries. Urgent referral is warranted for fractures with greater than 100% displacement, fractures with >2 cm of shortening, comminuted fractures, unstable distal fractures, and floating shoulder. Nondisplaced or minimally displaced fractures with no instability or associated neurovascular injury are managed non-operatively with a sling. Pediatric fractures are generally managed conservatively, with adolescents older than 9 years-old for girls and 12 years-old for boys being treated using algorithms that are similar to adults. CONCLUSIONS When encountering a patient with a clavicle fracture in the emergency department the fracture pattern will help determine whether emergent consultation or urgent referral is indicated. Most patients can be discharged safely with sling immobilization and appropriate outpatient follow-up.
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Hu F, Liu X, Liu F, Jia H, Lv X, Wang F, Xu S, Yang J, Hu L, Wang B, Yang Y. Intraoperative Nice knots assistance for reduction in displaced comminuted clavicle fractures. BMC Musculoskelet Disord 2021; 22:467. [PMID: 34022867 PMCID: PMC8141187 DOI: 10.1186/s12891-021-04348-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/04/2021] [Indexed: 02/08/2023] Open
Abstract
PURPOSE The Nice knots have been widely used in orthopedic surgeries to fix torn soft tissue and fracture in recent years. The study aims to investigate the clinical efficacy and prognosis of intraoperative and postoperative Nice Knots-assisted reduction in the treatment of displaced comminuted clavicle fracture. METHODS From Jan 2014 to Dec 2019, 75 patients diagnosed with unilateral closed displaced comminuted clavicle fracture were treated with open reduction and internal fixation (ORIF) in this study. Nice knot group (the NK group) included 38 patients and the other 37 patients were in the traditional group (the TK group). The time of operation and the amount of bleeding during operation were recorded. Post-operative clinical outcomes and radiographic results were recorded and compared between these two groups. The Visual Analogue Scale (VAS), Neer score, Rating Scale of the American Shoulder and Elbow Surgeons, Constant-Murley score and complications such as infection, nonunion, implant loosening, fragment displacement and hardware pain were observed in the two groups. RESULTS In the comparison between the two groups, there was no significant difference in age, sex, the cause of displaced clavicle fracture, and other basic information between the two groups. The operation time, intraoperative fluoroscopy time, and intraoperative blood loss were significantly reduced in the NK group (P < 0.01). There were 2 cases of plate fracture in the TK group. The follow-up results showed that there was no significant difference in VAS, Neer score, ASES, and Constant-Murley scores between the two groups. CONCLUSION The use of Nice knot, in comminuted and displaced clavicle fractures can reduce intraoperative blood loss, shorten operation time, facilitate intraoperative reduction, and achieve satisfactory postoperative clinical results. This study demonstrates that Nice knot is a simple, safe, practical and effective auxiliary reduction method.
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Affiliation(s)
- Fangning Hu
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, No. 324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Xi Liu
- Department of Orthopaedics, Juye People's Hospital, Heze, Shandong, China
| | - Fanxiao Liu
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, No. 324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Honglei Jia
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, No. 324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Xiaolong Lv
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, No. 324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Fengrui Wang
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, No. 324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Shihong Xu
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, No. 324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Juanjuan Yang
- Department of Radiotherapy, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Lingfei Hu
- Department of Emergency Surgery, Linyi People's Hospital, Shandong First Medical University and Shandong Academy of Medical Sciences, Linyi, China
| | - Bomin Wang
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, No. 324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China.
| | - Yongliang Yang
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, No. 324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China.
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Aldon-Villegas R, Ridao-Fernández C, Torres-Enamorado D, Chamorro-Moriana G. How to Assess Shoulder Functionality: A Systematic Review of Existing Validated Outcome Measures. Diagnostics (Basel) 2021; 11:845. [PMID: 34066777 PMCID: PMC8151204 DOI: 10.3390/diagnostics11050845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/02/2021] [Accepted: 05/04/2021] [Indexed: 01/19/2023] Open
Abstract
The objective of this review was to compile validated functional shoulder assessment tools and analyse the methodological quality of their validations. Secondarily, we aimed to provide a comparison of the tools, including parameter descriptions, indications/applications, languages and operating instructions, to choose the most suitable for future clinical and research approaches. A systematic review (PRISMA) was conducted using: PubMed, WoS Scopus, CINHAL, Dialnet and reference lists until 2020. The main criteria for inclusion were that papers were original studies of validated tools or validation studies. Pre-established tables showed tools, validations, items/components, etc. The QUADAS-2 and COSMIN-RB were used to assess the methodological quality of validations. Ultimately, 85 studies were selected, 32 tools and 111 validations. Risk of bias scored lower than applicability, and patient selection got the best scores (QUADAS-2). Internal consistency had the highest quality and PROMs development the lowest (COSMIN-RB). Responsiveness was the most analysed metric property. Modified UCLA and SST obtained the highest quality in shoulder instability surgery, and SPADI in pain. The most approached topic was activities of daily living (81%). We compiled 32 validated functional shoulder assessment tools, and conducted an analysis of the methodological quality of 111 validations associated with them. Modified UCLA and SST showed the highest methodological quality in instability surgery and SPADI in pain.
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Affiliation(s)
- Rocio Aldon-Villegas
- Research Group “Area of Physiotherapy” CTS-305, Department of Physiotherapy, University of Seville, 41009 Seville, Spain; (R.A.-V.); (G.C.-M.)
| | - Carmen Ridao-Fernández
- Research Group “Area of Physiotherapy” CTS-305, Department of Physiotherapy, University of Seville, 41009 Seville, Spain; (R.A.-V.); (G.C.-M.)
| | - Dolores Torres-Enamorado
- Research Group “Women, Well-Being and Citizenship” SEJ066, Department of Nursing, University of Seville, 41930 Bormujos, Spain;
| | - Gema Chamorro-Moriana
- Research Group “Area of Physiotherapy” CTS-305, Department of Physiotherapy, University of Seville, 41009 Seville, Spain; (R.A.-V.); (G.C.-M.)
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Feng W, Cai X, Li S, Li Z, Zhang K, Wang H, Zhang J, Zhu Y, Feng D. Balser Plate Stabilization for Traumatic Sternoclavicular Instabilities or Medial Clavicle Fractures: A Case Series and Literature Review. Orthop Surg 2020; 12:1627-1634. [PMID: 32893491 PMCID: PMC7767773 DOI: 10.1111/os.12726] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 05/13/2020] [Accepted: 05/18/2020] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE This study was performed to observe the effect of internal Balser plate fixation for treating unstable sternoclavicular joints (SCJ) and displaced medial clavicle fractures. METHODS From April 2009 to September 2016, 17 consecutive patients who underwent open reduction and internal Balser plate fixation for SCJ dislocations or medial clavicle fractures were retrospectively reviewed. There were 11 male and six female patients, with a mean age of 45.6 ± 15.5 years. Standardized treatment procedures consisted of reduction, creating a space posterior dorsal osteal face of the sternal manubrium, an inverted Balser plating, and postoperative immobilization. At follow-up, plain radiographs were assessed for fracture union, implant loosening, degenerative changes, and joint congruity. Clinical evaluation included: completion of the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire; determination of the Constant and Murley score and visual analog scale (VAS) score; and assessment of intraoperative and postoperative complications. RESULTS All patients were followed up, at a mean follow-up of 20.1 ± 7.9 months, each fracture had a solid union, and each dislocation showed no sign of recurrent dislocation. The mean shoulder forward flexion was 162.9° ± 8.1°. The mean DASH score was 5.2 ± 5.2 points. The mean Constant and Murley joint function score was 93.7 ± 7.9 points, with 15 excellent cases and two good cases. The mean VAS score was 1.1 ± 1.4 points, showing significant improvement compared with the VAS score preoperatively. Postoperative complications included one wound hematoma which was healed after a debridement and one recurrent instability due to hook migration, which underwent revision reconstruction. All patients were satisfied with their treatment outcome at the final follow-up. CONCLUSION Sternoclavicular joints dislocation or medial clavicle fractures can be treated successfully with Balser plate fixation. This technique permits early functional exercise while preserving the SCJ.
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Affiliation(s)
- Wei‐lou Feng
- Department of Orthopaedic TraumaHong Hui Hospital, Xi’an Jiaotong University School of MedicineXi’anChina
| | - Xiao Cai
- Department of Orthopaedic TraumaHong Hui Hospital, Xi’an Jiaotong University School of MedicineXi’anChina
| | - Shu‐hao Li
- Department of Orthopaedic TraumaHong Hui Hospital, Xi’an Jiaotong University School of MedicineXi’anChina
| | - Zi‐jun Li
- Department of Orthopaedic TraumaHong Hui Hospital, Xi’an Jiaotong University School of MedicineXi’anChina
| | - Kun Zhang
- Department of Orthopaedic TraumaHong Hui Hospital, Xi’an Jiaotong University School of MedicineXi’anChina
| | - Hao Wang
- Department of Orthopaedic TraumaHong Hui Hospital, Xi’an Jiaotong University School of MedicineXi’anChina
| | - Jun Zhang
- Department of Orthopaedic TraumaHong Hui Hospital, Xi’an Jiaotong University School of MedicineXi’anChina
| | - Yang‐jun Zhu
- Department of Orthopaedic TraumaHong Hui Hospital, Xi’an Jiaotong University School of MedicineXi’anChina
| | - Dong‐xu Feng
- Department of Orthopaedic TraumaHong Hui Hospital, Xi’an Jiaotong University School of MedicineXi’anChina
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Fontana AD, Hoyen HA, Blauth M, Galm A, Schweizer M, Raas C, Jaeger M, Jiang C, Nijs S, Lambert S. The variance of clavicular surface morphology is predictable: an analysis of dependent and independent metadata variables. JSES Int 2020; 4:413-421. [PMID: 32939461 PMCID: PMC7479165 DOI: 10.1016/j.jseint.2020.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background The anatomy of the clavicle is specific and varied in reference to its topography and shape. These anatomic characteristics play an important role in the open treatment of clavicle fractures. The complex and variable topography creates challenges for implant placement, contouring, and position. Hardware prominence and irritation does influence the decision for secondary surgical intervention. Methods Computerized tomographic scans of 350 adult clavicles with the corresponding patients' metadata were acquired and digitized. Morphologic parameters determining the shape of the clavicle were defined and computed for each digitized bone. The extracted morphologic parameters were correlated with patient metadata to analyze the relationship between morphologic variability and patient characteristics. Results The morphologic parameters defining the shape, that is, the radius of the medial and lateral curves, the apparent clavicle height and width, and the clavicle bow position, correlate with the clavicle length. The clavicle length correlates with the patients' height. Gender differences in shape and form were dependent and related to individual height distribution and clavicle length. Asian populations showed a similarly predictable, but shifted, correlation between shape and clavicle length. Conclusion This anatomic analysis shows that the clavicle shape can be predicted through the clavicle length and patients' stature. Smaller patients have shorter and more curved clavicles, whereas taller patients have longer and less curved clavicles. This correlation will aid surgeons in fracture reduction, implant curvature selection, and in optimal adaptation of clavicle implants, and represents the basis for anatomically accurate solutions for clavicle osteosynthesis.
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Affiliation(s)
| | - Harry A Hoyen
- Department of Orthopaedic Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Michael Blauth
- Clinical Medical Department, DePuy Synthes, Zuchwil, Switzerland.,Department for Trauma Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - André Galm
- R&D Department, DePuy Synthes, Zuchwil, Switzerland
| | | | - Christoph Raas
- Department for Trauma Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Martin Jaeger
- Department of Orthopedics and Trauma Surgery, Medical Center-Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Chunyan Jiang
- Shoulder Service, Beijing Jishuitan Hospital, School of Medicine, Peking University, Beijing, China
| | - Stefaan Nijs
- Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Simon Lambert
- Department of Trauma and Orthopedic Surgery, University College London Hospital NHS Foundation Trust, London, UK
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What Is the Best Evidence for Management of Displaced Midshaft Clavicle Fractures? A Systematic Review and Network Meta-analysis of 22 Randomized Controlled Trials. Clin Orthop Relat Res 2020; 478:392-402. [PMID: 31574019 PMCID: PMC7438117 DOI: 10.1097/corr.0000000000000986] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Displaced mid-third clavicle fractures are common, and their management remains unclear. Although several meta-analyses have compared specific operative techniques with nonoperative management, it is not possible to compare different operative constructs with one another using a standard meta-analysis. Conversely, a network meta-analysis allows comparisons among more than two treatment arms, using both direct and indirect comparisons between interventions across many trials. To our knowledge, no network meta-analysis has been performed to compare the multiple treatment options for displaced clavicle fractures. QUESTIONS/PURPOSES We performed a network meta-analysis of randomized, controlled trials (RCTs) to determine from among the approaches used to treat displaced midshaft clavicle fractures: (1) the intervention with the highest chance of union at 1 year, (2) the intervention with the lowest risk of revision surgery, and (3) the intervention with the highest functional outcome scores. Secondarily, we also (4) compared the surgical subtypes in the available RCTs on the same above endpoints. METHODS MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were reviewed for relevant randomized controlled trials published up to July 25, 2018. Two hundred and eighty four papers were reviewed, with 22 meeting inclusion criteria of RCTs with appropriate randomization techniques, adult population, minimum of 1 year follow-up and including at least one operative treatment arm. In total, 1002 patients were treated with a plate construct, 378 with an intramedullary device, and 585 patients were managed nonoperatively. Treatment subtypes included locked intramedullary devices (56), unlocked intramedullary devices (322), anterior plating (89), anterosuperior plating (150), superior plating (449) or plating not otherwise specified (314). We performed a network meta-analysis to compare and rank the treatments for displaced clavicle fractures. We considered the following outcomes: union achievement, revision surgery risk and functional outcomes (DASH and Constant Scores). The minimal clinically important difference (MCID) was considered for both Constant and DASH scores to be at 8 points, representing the average of MCID scores reported for both DASH and Constant in the evidence, respectively. RESULTS Union achievement was lower in patients treated nonoperatively (88.9%), and higher in patients treated operatively (96.7%, relative risk [RR] 1.128 [95% CI 1.1 to 1.17]; p < 0.001), Number needed to treat (NNT) = 10). Union achievement increased with any plate construct (97.8%, RR 1.13 [95% CI 1.1 to 1.7]; p < 0.0001, NNT = 9) and with anterior or anterosuperior plates (99.3%, RR 1.14 [95% CI 1.1 to 1.8]; p < 0.0001, NNT = 8). Risk of reoperation, when considering planned removal of hardware, was similar across all treatment arms. Lastly, operative treatment outperformed nonoperative treatment with minor improvements in DASH and Constant scores, though not approaching the MCID. At the subtype level, anterosuperior plating ranked highest in DASH and Constant functional scores with mean differences reaching 10-point improvement for Constant scores (95% CI 4.4 to 2.5) and 7.6 point improvement for DASH (95% CI 5.2 to 20). CONCLUSIONS We found that surgical treatment led to a greater likelihood of union at 1 year of follow-up among adult patients with displaced mid-third clavicle fractures. In aggregate, surgical treatment did not increase functional scores by amounts that patients were likely to consider clinically important. Use of specific subtypes of plating (anterior, anterosuperior) resulted in improvements in the Constant score that were slightly above the MCID but did not reach the MCID for the DASH score, suggesting that any outcomes-score benefits favoring surgery were likely to be imperceptible or small. In light of these findings, we believe patients can be informed that surgery for this injury can increase the likelihood of union incrementally (about 10 patients would need to undergo surgery to avoid one nonunion), but they should not expect better function than they would achieve without surgery; most patients can avoid surgery altogether with little absolute risk of nonunion. Patients who opt for surgery must be told that the decision should be weighed against complications and the possibility of undergoing a second procedure for hardware removal. Patients opting not to have surgery for acute midshaft clavicle fractures can be told that nonunion occurs in slightly more than 10% of patients, and that these can be more difficult to manage than acute fractures. LEVEL OF EVIDENCE Level I, therapeutic study.
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Rauer T, Boos M, Neuhaus V, Ellanti P, Kaufmann RA, Pape HC, Allemann F. Inter- and intraobserver agreement of three classification systems for lateral clavicle fractures - reliability comparison between two specialist groups. Patient Saf Surg 2020; 14:4. [PMID: 31911821 PMCID: PMC6945566 DOI: 10.1186/s13037-019-0228-y] [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] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 12/30/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Although of great value in the management of lateral clavicle fractures, substantial variation in their classification exists. We performed a retrospective study to address the inter- and intraobserver reliability of three different classification systems for lateral clavicle fractures. METHODS Radiographs of 20 lateral clavicle fractures that represented a full spectrum of adult fracture patterns were graded by five experienced radiologists and five experienced trauma surgeons according to the Orthopaedic Trauma Association (OTA), the Neer, and the Jäger/Breitner classification systems. This evaluation was performed at two different time points separated by 3 months. To measure the observer agreement, the Fleiss kappa coefficient (κ) was applied and assessed according to the grading of Landis and Koch. RESULTS The overall interobserver reliability showed a fair agreement in all three classification systems. For the OTA classification system, the interobserver agreement showed a mean kappa value of 0.338 ranging from 0.350 (radiologists) to 0.374 (trauma surgeons). Kappa values of the interobserver agreement for the Neer classification system ranged from 0.238 (trauma surgeons) to 0.276 (radiologists) with a mean κ of 0.278. The Jäger/Breitner classification system demonstrated a mean kappa value of 0.330 ranging from 0.306 (trauma surgeons) to 0.382 (radiologists).The overall intraobserver reliability was moderate for the OTA and the Jäger/Breitner classification systems, while the overall intraobserver reliability for the Neer classification system was fair.The kappa values of the intraobserver agreements showed, in all classification systems, a wide range with the OTA classification system ranging from 0.086 to 0.634, the Neer classification system ranging from 0.137 to 0.448, and a range from 0.154 to 0.625 of the Jäger/Breitner classification system. CONCLUSIONS The low inter- and intraobserver agreement levels exhibited in all three classification systems by both specialist groups suggest that the tested lateral clavicle fracture classification systems are unreliable and, therefore, of limited value. We should recognize there is considerable inconsistency in how physicians classify lateral clavicle fractures and therefore any conclusions based on these classifications should be recognized as being somewhat subjective.
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Affiliation(s)
- Thomas Rauer
- Department of Trauma Surgery, UniversityHospital Zurich, Rämistrasse 100, Zurich, Switzerland
| | - Matthias Boos
- Department of Trauma Surgery, UniversityHospital Zurich, Rämistrasse 100, Zurich, Switzerland
| | - Valentin Neuhaus
- Department of Trauma Surgery, UniversityHospital Zurich, Rämistrasse 100, Zurich, Switzerland
| | - Prasad Ellanti
- Department of Trauma Surgery, UniversityHospital Zurich, Rämistrasse 100, Zurich, Switzerland
| | | | - Hans-Christoph Pape
- Department of Trauma Surgery, UniversityHospital Zurich, Rämistrasse 100, Zurich, Switzerland
| | - Florin Allemann
- Department of Trauma Surgery, UniversityHospital Zurich, Rämistrasse 100, Zurich, Switzerland
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Zhou X, Li J, Yang H, Li D, Zhang J, Zhang Y, Huang Y, Xu N. Comparison of 2 Different Fixation Implants for Operative Treatment of Mid-Shaft Clavicle Fractures: A Retrospective Study. Med Sci Monit 2019; 25:9728-9736. [PMID: 31854381 PMCID: PMC6931238 DOI: 10.12659/msm.918773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background This retrospective analysis was designed to compare the outcomes of mid-shaft clavicle fracture operative treatment using bridge combined fixation system (BCFS) versus clavicular locking plate (CLP). Material/Methods Operative surgeries performed between January 2016 and July 2018 were included in the analysis. The surgical internal fixation implants were chosen according to surgeon preference and the choice of patients between the BCFS and CLP. Functional outcomes, fracture union, complications, pain, and patient satisfaction post-operation were assessed at a follow-up of 12 to 24 months. Results Two hundred and seventeen (217) patients, aged 21–79 years, were operated, 87 using BCFS and 130 using CLP. The operation time of the BCFS group was significantly less than the CLP group (P<0.01). We also found that BCFS group had higher degree of satisfaction (100% vs. 97%, P<0.03) and less VAS scale (0.25±0.18 vs. 0.35±0.21, P<0.001) compared with the CLP group, but the significance could only be obtained during the follow-up at 3 months after surgery. No significant differences were observed between the 2 groups when compared for fracture unions, functional scores, or complications. Conclusions BCFS significantly reduced the operation time when compared with CLP. No significant differences were observed for functional outcomes, including fracture union and complications, and there was less pain and higher patient satisfaction. Both methods appeared to be safe in terms of complications. However, the effectiveness and safety of BCFS in treating comminuted multi-fragmentary mid-shaft clavicle fractures (AO/OTA 15-2C classification) need further confirmation.
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Affiliation(s)
- Xindie Zhou
- Department of Orthopedics, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu, China (mainland)
| | - Jin Li
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China (mainland)
| | - Haoyu Yang
- Department of Orthopedics, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu, China (mainland).,Department of Orthopedics, Wuxi No. 9 People's Hospital Affiliated to Soochow University, Wuxi, Jiangsu, China (mainland)
| | - Dong Li
- Department of Orthopedics, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu, China (mainland)
| | - Junjie Zhang
- Department of Orthopedics, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu, China (mainland)
| | - Yi Zhang
- Department of Orthopedics, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu, China (mainland)
| | - Yong Huang
- Department of Orthopedics, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu, China (mainland)
| | - Nanwei Xu
- Department of Orthopedics, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu, China (mainland)
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Saragaglia D, Cavalié G, Rubens-Duval B, Pailhé R, Lateur G. Screw-plate fixation for displaced middle-third clavicular fractures with three or more fragments: A report of 172 cases. Orthop Traumatol Surg Res 2019; 105:1571-1574. [PMID: 31326370 DOI: 10.1016/j.otsr.2019.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 05/14/2019] [Accepted: 05/27/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Although mid-shaft clavicular fractures are generally thought to be non-serious injuries that nearly always heal with non-operative treatment, recent studies found non-union rates of 3%-7% in simple fractures and 20%-33% in complex fractures. The primary objective of this study was to report the functional and anatomical outcomes after screw-plate fixation of displaced mid-shaft clavicular fractures with three or more fragments. HYPOTHESIS Screw-plate fixation in this indication is an excellent treatment option that minimises the risk of complications. METHODS A search of our database from 6 January 2012 to 27 December 2016 identified 410 cases of clavicular fracture, of which 250 were managed surgically, including 172 meeting our inclusion criteria and having complete data. These 172 patients were managed using a curved pelvic reconstruction plate with 3.5-mm non-locking screws positioned over the antero-superior aspect of the clavicle. All 172 patients were re-evaluated at least 1 year after surgery by an independent assessor, who determined the UCLA score. RESULTS We studied 172 patients, 154 (89.5%) males and 18 females with a mean age of 34.5±14.5 years (range, 13-69 years). In 84.5% of cases, the fracture was a sports injury, and the most common sports were skiing (26%), cycling (21%), and mountain biking (18.5%). Of the 172 fractures, all but 1 healed, within a mean of 87 days (range, 45-120 days). After removal of the fixation material, 8 (4.5%) patients experienced a recurrent fracture, within a mean of 90 days (range, 2-210 days); 4 of these recurrent fractures were caused by high-energy traumas occurring 6 months after implant removal. The UCLA score determined at re-evaluation indicated that the outcome was excellent in 164 (95.5%), good in 5 (3%), and fair in 3 patients. CONCLUSION Internal fixation using a curved pelvic reconstruction plate fixed with 3.5-mm screws provides excellent functional and anatomical outcomes in patients who have displaced mid-shaft clavicular fractures with three or more fragments. LEVEL OF EVIDENCE IV, retrospective cohort study.
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Affiliation(s)
- Dominique Saragaglia
- Service de chirurgie de l'arthrose et du sport, urgences traumatiques des membres, hôpital Sud, CHU de Grenoble-Alpes, avenue de Kimberley, 38130 Échirolles, France.
| | - Guillaume Cavalié
- Service de chirurgie de l'arthrose et du sport, urgences traumatiques des membres, hôpital Sud, CHU de Grenoble-Alpes, avenue de Kimberley, 38130 Échirolles, France
| | - Brice Rubens-Duval
- Service de chirurgie de l'arthrose et du sport, urgences traumatiques des membres, hôpital Sud, CHU de Grenoble-Alpes, avenue de Kimberley, 38130 Échirolles, France
| | - Régis Pailhé
- Service de chirurgie de l'arthrose et du sport, urgences traumatiques des membres, hôpital Sud, CHU de Grenoble-Alpes, avenue de Kimberley, 38130 Échirolles, France
| | - Gabriel Lateur
- Service de chirurgie de l'arthrose et du sport, urgences traumatiques des membres, hôpital Sud, CHU de Grenoble-Alpes, avenue de Kimberley, 38130 Échirolles, France
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Kang Y, Ma Y, Rui Y, Li F, Liu J, Gu J, Xu P, Wu Y. [Effectiveness of Nice knot combined with elastic intramedullary nailing fixation in treatment of Robinson type 2B midshaft clavicular fracture in adults]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:1394-1398. [PMID: 31650755 PMCID: PMC8337455 DOI: 10.7507/1002-1892.201901027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 09/09/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the effectiveness of Nice knot combined with elastic intramedullary nailing fixation in treatment of Robinson type 2B midshaft clavicular fracture in adults. METHODS Between March 2016 and January 2018, 20 patients with Robinson type 2B midshaft clavicular fractures were treated with reduction and internal fixation by Nice knot and elastic intramedullary nailing. There were 13 cases and 7 cases, with an average age of 43 years (range, 18-56 years). The causes of injury included the traffic accident in 6 cases, falling in 12 cases, and falling from height in 2 cases. The interval between injury and admission ranged from 1 hour to 2 days (mean, 3.2 hours). The fractures were classified as Robinson type 2B1 in 16 cases and type 2B2 in 4 cases. The length of incision, the operation time, the visual analogue scale (VAS) score on the 2nd day after operation, the fracture healing time, the postoperative shoulder function and the Disability of Arm Shoulder and Hand (DASH) score, the complications, and the time of second surgical removal of internal fixator and incision length were recorded. RESULTS The length of incision was 2-6 cm (mean, 4.7cm). The operation time was 45-120 minutes (mean, 77.2 minutes). The VAS score was 1-5 (mean, 3.2) on the 2nd day after operation. All incisions healed by first intention and no infection or nerve injury occurred. All patients were followed up 12-32 months (mean, 18.6 months). All fractures healed with the healing time of 10-15 weeks (mean, 12.1 weeks). The Constant score was 92-98 (mean, 96.3) and DASH score was 0-6.4 (mean, 3.1). The elastic intramedullary nailing bending and hypertrophic nonunion occurred in 1 case and the skin stimulated by elastic nail tail in 1 case after operation. The internal fixators were removed at 12-26 months (mean, 14.6 months) after operation. And the length of incision was 1-2 cm (mean, 1.3 cm) and the operation time was 5-15 minutes (mean, 9.0 minutes). CONCLUSION For the midshaft clavicular fracture in adults, the procedure of the Nice knot combined with elastic intramedullary nail has advantages of small incision, light pain, rapid fracture healing, small secondary operation injury, and avoiding the risk of clavicular epithelial nerve injury, and can obtain good effectiveness.
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Affiliation(s)
- Yongqiang Kang
- Department of Orthopaedics, the 9th People's Hospital of Wuxi (Wuxi Orthopedic Hospital), Wuxi Jiangsu, 214062, P.R.China
| | - Yunhong Ma
- Department of Orthopaedics, the 9th People's Hospital of Wuxi (Wuxi Orthopedic Hospital), Wuxi Jiangsu, 214062, P.R.China
| | - Yongjun Rui
- Department of Orthopaedics, the 9th People's Hospital of Wuxi (Wuxi Orthopedic Hospital), Wuxi Jiangsu, 214062, P.R.China
| | - Fengfeng Li
- Department of Orthopaedics, the 9th People's Hospital of Wuxi (Wuxi Orthopedic Hospital), Wuxi Jiangsu, 214062, P.R.China
| | - Jun Liu
- Department of Orthopaedics, the 9th People's Hospital of Wuxi (Wuxi Orthopedic Hospital), Wuxi Jiangsu, 214062, P.R.China
| | - Jun Gu
- Department of Orthopaedics, the 9th People's Hospital of Wuxi (Wuxi Orthopedic Hospital), Wuxi Jiangsu, 214062, P.R.China
| | - Peng Xu
- Department of Orthopaedics, the 9th People's Hospital of Wuxi (Wuxi Orthopedic Hospital), Wuxi Jiangsu, 214062, P.R.China
| | - Yongwei Wu
- Department of Orthopaedics, the 9th People's Hospital of Wuxi (Wuxi Orthopedic Hospital), Wuxi Jiangsu, 214062,
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Surgical treatment of mid-shaft clavicle fractures by minimally invasive internal fixation facilitated by intra-operative external fixation: A preliminary study. Orthop Traumatol Surg Res 2019; 105:847-852. [PMID: 30975635 DOI: 10.1016/j.otsr.2019.01.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/04/2018] [Accepted: 01/04/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Mid-shaft clavicle fractures are common and may require surgery. The objective of this study in adults with high-risk mid-shaft clavicle fractures was to evaluate the clinical and radiological outcomes of a minimally invasive surgical technique involving a minimally invasive approach, fracture reduction, temporary intra-operative external fixation, and locking plate internal fixation. HYPOTHESIS This minimally invasive surgical technique for mid-shaft clavicle fractures ensures satisfactory radiographic fracture healing and medium-term functional outcomes, with a short immobilisation, rapid return to sports, and low complication rate. MATERIAL AND METHOD A retrospective review was performed of patients managed using our minimally invasive surgical technique between 1 January 2012 and 31 December 2016. The primary outcome measure was the 3-month radiographic healing rate. The secondary outcome measures were duration of post-operative immobilisation, 3- and 6-month QuickDASH scores, and post-operative complications. RESULT A total of 19 patients were included, 18 males and 1 female with a mean age of 37 years. Radiographic healing was consistently achieved within 3 months. Immobilisation duration was 3 weeks. The mean QuickDASH score was 23.75 after 3 months and 7.5 after 6 months. Return to sports occurred after 3 months. The only complication was transient paraesthesia in the distribution of the C8 nerve root in 1 patient. DISCUSSION The management of mid-shaft clavicle fractures remains controversial. The high complication rates associated with conventional surgical techniques make treatment decisions difficult. A surgical technique characterised by temporary intra-operative external fixation to facilitate minimally invasive internal fixation may have a lower complication rate and shorter immobilisation requirements compared to conventional surgery. LEVEL OF EVIDENCE IV, retrospective observational study.
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Saranteas T, Koliantzaki I, Savvidou O, Tsoumpa M, Eustathiou G, Kontogeorgakos V, Souvatzoglou R. Acute pain management in trauma: anatomy, ultrasound-guided peripheral nerve blocks and special considerations. Minerva Anestesiol 2019; 85:763-773. [DOI: 10.23736/s0375-9393.19.13145-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ochen Y, Frima H, Houwert RM, Heng M, van Heijl M, Verleisdonk EJMM, van der Velde D. Surgical treatment of Neer type II and type V lateral clavicular fractures: comparison of hook plate versus superior plate with lateral extension: a retrospective cohort study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:989-997. [PMID: 30847678 PMCID: PMC6570672 DOI: 10.1007/s00590-019-02411-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 03/01/2019] [Indexed: 11/30/2022]
Abstract
Purpose Different fixation methods are used for treatment of unstable lateral clavicle fractures (LCF). Definitive consensus and guidelines for the surgical fixation of LCF have not been established. The aim of this study was to compare patient-reported functional outcome after open reduction and internal fixation with the clavicle hook plate (CHP) and the superior clavicle plate with lateral extension (SCPLE). Methods A dual-center retrospective cohort study was performed. All patients operatively treated for unstable Neer type II and type V LCF between 2011 and 2016, with the CHP (n = 23) or SCPLE (n = 53), were eligible for inclusion. The primary outcome was the QuickDASH score. Secondary outcomes were the numerical rating scale (NRS) pain score, complications, and implant removal. Results A total of 67 patients (88%) were available for the final follow-up. There was a significant difference in bicortical lateral fragment size, 15 mm (± 4, range 6–21) in the CPH group compared to 20 mm (± 8, range 8–43) in the SCPLE group (p ≤ 0.001). There was no significant difference in median QuickDASH score (CHP; 0.00 [IQR 0.0–0.0], SCPLE; 0.00 [IQR 0.0–4.5]; p = 0.073) or other functional outcome scores (NRS at rest; p = 0.373, NRS during activity; p = 0.559). There was no significant difference in median QuickDASH score or other functional outcome scores between Neer type II and type V fractures. There was no significant difference in complication rate, CHP 11% and SCPLE 8% (relative risk 1.26; [95% CI 0.25–6.33; p = 0.777]). The implant removal rate was 100% in the CHP group compared to 42% in the SCPLE group (relative risk 2.40; [95% CI 1.72–3.35; p ≤ 0.001]). Conclusion Both the CHP and SCPLE are effective fixation methods for the treatment of unstable LCF, resulting in excellent patient-reported functional outcome and similar complication rates. SCPLE fixation is an effective fixation method for the treatment of both Neer type II and type V LCF. The SCPLE has a lower implant removal rate. Therefore, if technically feasible, we recommend SCPLE fixation for the treatment of unstable LCF.
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Affiliation(s)
- Yassine Ochen
- Department of Surgery, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands. .,Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands. .,Department of Orthopedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Massachusetts General Hospital, Boston, USA.
| | - Herman Frima
- Department of Surgery, Kantonsspital Graubünden, Chur, Switzerland
| | - R Marijn Houwert
- Department of Surgery, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Marilyn Heng
- Department of Orthopedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Massachusetts General Hospital, Boston, USA
| | - Mark van Heijl
- Department of Surgery, Diakonessenhuis Hospital, Utrecht, The Netherlands.,Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
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Zheng Y, Yuan XH, Yin YH, Wang WB, Fu QS, Pang QJ. T-plate fixation for unstable proximal clavicula fractures. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2018; 52:464-468. [PMID: 30545590 PMCID: PMC6318499 DOI: 10.1016/j.aott.2018.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 10/30/2018] [Accepted: 11/28/2018] [Indexed: 11/25/2022]
Abstract
Objective The aim of this study was to evaluate the clinical results of T-plate fixation and anterior sternoclavicular ligament repair in proximal clavicle fractures. Methods Between August 2013 and August 2016, a total 12 patients (10 men and 2 women; mean age: 44.1 ± 9.1 years (range, 25–59 years)) with unstable proximal clavicle fractures (Throckmorton, type D) were treated with T-type plate fixation, bridging the sternoclavicular joint, and anterior sternoclavicular ligament repair. Average operative time, associated injuries, postoperative complications, postoperative fracture healing time and follow-up time were recorded. The outcomes were evaluated with radiographic assessment, visual analog scale (VAS) pain score and Rockwood SCJ scoring system. All the patients were evaluated on postoperative 3rd, 6th, and 12th months. Results The average surgery time was 78.0 ± 8.47 minutes while fracture healing time was 4.51 ± 0.95 months. According to Rockwood SCJ scoring system, 9 cases (75%) were in excellent, 2 cases (16.7%) in good and 1 case (8.3%) in fair condition at 12 months follow-up. The average Rockwood SCJ score was 7.7 ± 0.75 preoperatively, 12.7 ± 0.86 by 3 months, 13.0 ± 0.73 by 6 months and 13.3 ± 0.49 by 12 months. The VAS pain score was 7.9 ± 1.15 (preoperative score), 3.4 ± 1.52 (3 months follow-up), 3.0 ± 1.32 (6 months follow-up) and 2.1 ± 1.07 (12 months follow-up). The VAS and Rockwood SCJ scores were significantly improved postoperatively (p < 0.05). There was no intraoperative complication, while one patient had redislocation of the sternoclavicular joint after implant removal. Conclusion T-type plate fixation with anterior sternoclavicular ligament repair might be a reliable and effective treatment method in unstable proximal clavicle fractures (type D) with few complications and satisfactory clinical results after 12 months follow-up. Level of evidence Level IV, therapeutic study.
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Affiliation(s)
- Yi Zheng
- Department of Orthopaedics, Ningbo, People's Republic of China.
| | - Xin-Hua Yuan
- Department of Orthopaedics, Ningbo, People's Republic of China.
| | - Yi-Hong Yin
- Ningbo Municipal Hospital of TCM, Ningbo, People's Republic of China
| | - Wei-Bin Wang
- Department of Orthopaedics, Ningbo, People's Republic of China
| | - Qing-Song Fu
- Department of Orthopaedics, Ningbo, People's Republic of China
| | - Qing-Jiang Pang
- Department of Orthopaedics, Ningbo, People's Republic of China
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Conant SH, Hickerson LE. Arteriovenous Fistula Development After Nonoperative Treatment of a Clavicular Fracture: A Case Report. JBJS Case Connect 2018; 8:e65. [PMID: 30134262 DOI: 10.2106/jbjs.cc.18.00016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We report a case of prominent venous dilation in the supraclavicular area with an underlying arteriovenous fistula following nonoperative management of a fracture in the medial third of the clavicle in an adult. The venous dilation indicated elevated venous pressures, likely caused by hypertrophic callus formation and/or fistula development. CONCLUSION Arteriovenous fistula and prominent venous dilation are possible sequelae of nonoperative treatment of clavicular fractures. Surgeons should be aware of their possibility when planning either operative or nonoperative treatment. More information is needed to guide management of these issues when they occur.
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Affiliation(s)
- Scott H Conant
- Department of Orthopedic Surgery and Rehabilitation, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Lindsay E Hickerson
- Department of Orthopedic Surgery and Rehabilitation, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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Bakota B, Chan G, Staresinic M, Rajput V, Phadnis J, Korac Z. Safe intramedullary fixation of displaced midshaft clavicle fractures with 2.5mm Kirschner wires - technique description and a two-part versus multifragmentary fracture fixation outcome comparison. Injury 2017; 48 Suppl 5:S27-S33. [PMID: 29122118 DOI: 10.1016/s0020-1383(17)30735-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The aim of this study was to present a modified Murray and Schwarz 2.5-mm Kirschner wire (K-wire) intramedullary (IM) technique for fixation of displaced midshaft clavicle fractures (DMCF), and to compare the differences in treatment outcome of two-part (Robinson 2B.1) and multifragmentary (Robinson 2B.2) DMCF. METHODS A retrospective analysis of 91 patients who underwent IM fixation with a 2.5-mm K-wire for DMCF and had a 1-year post-operative follow-up between 2000 and 2012 was performed. The patients were allocated into two groups: Robinson 2B.1 (n = 64) and Robinson 2B.2 (n = 27). Assessed outcomes were non-union, reoperation rate, wire migration and infection. RESULTS There was no statistically significant difference in the rate of non-union (2B.1,2B.2; 3.13%, 7.41%; p = 0.365), reoperation (2B.1, 2B.2; 3.13%, 7.41%; p = 0.365), K-wire migration (2B.1, 2B.2; 0.00%, 0.00%; p = 1.00) and clavicle shortening at 12-months (2B.1, 2B.2; 3.13%, 7.41%; p = 0.365). CONCLUSION Intramedullary clavicle fixation with a 2.5-mm K-wire is a safe surgical technique. 2B.1 injuries treated with 2.5-mm IM K-wire fixation have relatively improved outcome compared with displaced 2B.2 fractures for both non-union and reoperation rates. There were no occurrences of implant migration with either 2B.1 or 2B.2 injuries, and a non-significant difference in implant irritation was documented with IM K-fixation. The non-union rate with K-wire IM fixation of 2B.1 injuries concords with the published results of other IM devices and thus this technique should be added to the surgeon's armamentarium when considering surgical treatment of such injuries.
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Affiliation(s)
- Bore Bakota
- Department of Trauma & Orthopaedics, Brighton & Sussex University Hospitals NHS Trust, United Kingdom; Department of Trauma & Orthopaedics, General Hospital Karlovac, Croatia.
| | - Gareth Chan
- Department of Trauma & Orthopaedics, Brighton & Sussex University Hospitals NHS Trust, United Kingdom
| | - Mario Staresinic
- Department of Trauma & Orthopaedics, University Hospital Merkur, Zagreb, Croatia
| | - Vishal Rajput
- Department of Trauma & Orthopaedics, Pilgrim Hospital, United Lincolnshire Hospitals NHS Trust, United Kingdom
| | - Joideep Phadnis
- Department of Trauma & Orthopaedics, Brighton & Sussex University Hospitals NHS Trust, United Kingdom
| | - Zelimir Korac
- Department of Trauma & Orthopaedics, General Hospital Karlovac, Croatia
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