1
|
Buenter IR, Kremo V, Beeres FJP, van Veelen NM, Galliker B, Link BC, Babst R, Pape HC, van de Wall BJM. Does plate position influence the outcome in midshaft clavicular fractures? A multicenter analysis. Eur J Trauma Emerg Surg 2024; 50:1023-1031. [PMID: 38231234 PMCID: PMC11249707 DOI: 10.1007/s00068-023-02400-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 11/03/2023] [Indexed: 01/18/2024]
Abstract
PURPOSE To date, it remains unclear whether superior or anterior plating is the best option for treating midshaft clavicular fractures. The aim of this study was to compare both techniques with regard to the incidence of implant removal due to implant irritation, risk of complications, time to union, and function. METHODS In this retrospective cohort study, all midshaft clavicular fractures treated operatively between 2017 and 2020 in two hospitals in Switzerland were analyzed. The participating hospitals differed with regard to their standard practice; one offered superior plating only, while the other predominantly employed an anterior plate. The primary outcome was the incidence of implant removal for irritation. Secondary outcomes were time to union, complications, re-interventions, and range of motion during the follow-up period of at least 6 months. RESULTS In total, 168 patients were included in the study of which 81 (48%) received anterior plating and 87 (52%) superior plating. The overall mean age was 45 years (SD 16). There was no significant difference between anterior and superior plating with regard to implant removal (58.5% versus 57.1%, p = 0.887), infection (5.7% versus 1.8%, p = 0.071), and time to union (median 48 weeks versus 52 weeks, p = 0.643). Data on range of motion were available in 71 patients. There was no significant difference in anteflexion (median 180 degrees anterior versus 180 degrees superior) and abduction (median 180 degrees anterior versus 180 degrees superior) between the two groups. CONCLUSION This retrospective cohort study did not find sufficient evidence to recommend one implant position over the other for midshaft clavicular fractures with regard to removal due to irritation. Time to union was similar and Infections were equally rare in both groups. Notably, a considerable number of patients in both groups had their implants removed due to irritation. Larger prospective studies are needed to determine how much plate position contributes to the occurrence of irritation and whether other patient or implant-related factors might play a role. Until this is clarified, implant position should be based on surgeons preference and experience.
Collapse
Affiliation(s)
- Isabelle Ruth Buenter
- Department of Orthopaedic and Trauma Surgery, Cantonal Hospital Lucerne, Spitalstrasse, CH-6000, Lucerne, Switzerland.
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.
| | - Valerie Kremo
- Department of Orthopaedic and Trauma Surgery, Cantonal Hospital Lucerne, Spitalstrasse, CH-6000, Lucerne, Switzerland
| | - Frank Johannes Paulus Beeres
- Department of Orthopaedic and Trauma Surgery, Cantonal Hospital Lucerne, Spitalstrasse, CH-6000, Lucerne, Switzerland
- Department of Orthopaedic and Trauma Surgery, Faculty of Health Science and Medicine University of Lucerne, Cantonal Hospital Lucerne, Spitalstrasse, CH-6000, Lucerne, Switzerland
| | - Nicole Maria van Veelen
- Department of Orthopaedic and Trauma Surgery, Cantonal Hospital Lucerne, Spitalstrasse, CH-6000, Lucerne, Switzerland
| | - Beat Galliker
- Department of Surgery, Cantonal Hospital Lucerne in Sursee, Spitalstrasse 16A, CH-6210, Sursee, Switzerland
| | - Bjoern-Christian Link
- Department of Orthopaedic and Trauma Surgery, Cantonal Hospital Lucerne, Spitalstrasse, CH-6000, Lucerne, Switzerland
| | - Reto Babst
- Department of Orthopaedic and Trauma Surgery, Faculty of Health Science and Medicine University of Lucerne, Cantonal Hospital Lucerne, Spitalstrasse, CH-6000, Lucerne, Switzerland
| | - Hans-Christoph Pape
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Bryan Joost Marinus van de Wall
- Department of Orthopaedic and Trauma Surgery, Cantonal Hospital Lucerne, Spitalstrasse, CH-6000, Lucerne, Switzerland
- Department of Orthopaedic and Trauma Surgery, Faculty of Health Science and Medicine University of Lucerne, Cantonal Hospital Lucerne, Spitalstrasse, CH-6000, Lucerne, Switzerland
| |
Collapse
|
2
|
Sangiorgio A, Previtali D, Oldrini LM, Milev SR, Filardo G, Candrian C. Comparable results of superior vs antero-inferior plating for the treatment of displaced midshaft clavicle fractures. A comparative study. Injury 2024; 55:111449. [PMID: 38422762 DOI: 10.1016/j.injury.2024.111449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Clavicle fractures represent up to 10 % of all fractures, affecting mainly a young population. Open reduction and internal plate fixation provide good results, but evidence on the best plate positioning is still unclear. Aim of this retrospective study was to compare superior and antero-inferior plating positioning in the surgical treatment of displaced midshaft clavicle fractures. MATERIALS AND METHODS 104 patients aged > 18 years, treated surgically with plate fixation (51 superior, 53 antero-inferior) for a midshaft clavicle fracture from January 2010 to April 2021 were included. At the time of the visit, mean follow-up time was 6.6 ± 2.6 years. Shoulder function was evaluated with the use of Constant-Murley Score (CMS) and Disabilities of the Arm, Shoulder, and Hand (DASH) score. Return to sport, aesthetic satisfaction, operative time, radiological outcomes, rate of implant removal, and overall patient satisfaction were documented as well. RESULTS Mean CMS was 94.1 ± 10.0 points in the superior plating group and 93.4 ± 11.6 points in the antero-inferior plating group. DASH score: 4.6 ± 11.0 superior, 5.1 ± 10.5 antero-inferior. Return to sport: 8.2 ± 2.9 superior, 8.2 ± 3.0 antero-inferior. Aesthetic satisfaction: 8.9 ± 1.6 superior, 8.8 ± 2.1 antero-inferior. Overall satisfaction: 9.1 ± 1.5 superior, 8.9 ± 1.7 antero-inferior. The comparison between groups showed no statistically significant differences (p = n.s.) for all outcome measures. Operative time: 101.6 ± 27.3 min superior, 113.0 ± 31.6 min antero-inferior (p = 0.05). Radiological follow-up documented one non-union and one mal-union in the antero-inferior plating group. Overall, 63 patients underwent plate removal: 58.8 % in the superior plating group and 62.3 % in the antero-inferior plating group (p = n.s.). Main reason for plate removal was pain/discomfort. CONCLUSIONS Both superior and antero-inferior plating provided excellent clinical, functional, and radiological results for the treatment of displaced midshaft clavicle fractures, without significant differences between groups. The superior plating group showed a statistically shorter operative time. High rate of re-interventions with implant removal was documented in both groups. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Alessandro Sangiorgio
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland.
| | - Davide Previtali
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
| | | | - Stamen Roumenov Milev
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
| | - Giuseppe Filardo
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Christian Candrian
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| |
Collapse
|
3
|
Mullis BH, Jeray KJ, Broderick S, Tanner SL, Snider BG, Everhart J. Midshaft clavicle fractures: is anterior plating an acceptable alternative to superior plating? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:3373-3377. [PMID: 37130985 DOI: 10.1007/s00590-023-03563-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 04/23/2023] [Indexed: 05/04/2023]
Abstract
PURPOSE The purpose of this study was to determine whether anterior plating is better tolerated than superior plating for midshaft clavicle fractures. METHODS This was a prospective non-randomized observational cohort study following operative vs. non-operative management of clavicle fractures from 2003 to 2018 at 7 level 1 academic trauma centers in the USA. The subset of patients treated with plate and screws is the basis for this comparative study. Adults aged 18-85 with closed clavicle fractures displaced over 100% or shortened by more than 1.5 cm were eligible for enrollment. Patients were followed for 2 years following enrollment. Allowable fixation methods at the discretion of the surgeon consisted of anterior-inferior or superior plating. A total of 412 patients were enrolled. Of these, 192 patients received either superior or anterior plating for a displaced clavicle fracture with complete documented prospective research forms capturing type of plating technique. The primary outcome measure was hardware removal (HWR). Secondary outcomes were Disability of the Arm Shoulder and Hand (DASH) score and Visual Analog Pain (VAP) score, and satisfaction score (1 = high satisfaction; 5 = low satisfaction). RESULTS There was no difference in HWR rates (7.1% superior 9/127; 6.2% anterior 4/65, p = 0.81), VAP score (mean 1.5 SD 1.0 superior; mean 1.7 SD 0.6 anterior, p = 0.21), DASH score (mean 7.5 SD 12.4 superior; mean 5.2 SD 15.2 anterior; p = 0.18) or satisfaction score (mean 1.6 SD 1.0 superior; mean 1.7 SD 0.60 anterior, p = 0.18). CONCLUSION There is no difference in HWR rates or functional outcomes when using a superior vs. anterior plating technique.
Collapse
Affiliation(s)
- Brian H Mullis
- Department of Orthopaedic Surgery, Indiana University, 1801 N Senate Blvd, Ste 535, Indianapolis, IN, 46202, USA.
| | - Kyle J Jeray
- Department of Orthopaedics, Prisma Health, Columbia, SC, USA
| | | | | | - Becky G Snider
- Department of Orthopaedics, Prisma Health, Columbia, SC, USA
| | - Joshua Everhart
- Department of Orthopaedic Surgery, Indiana University, 1801 N Senate Blvd, Ste 535, Indianapolis, IN, 46202, USA
| |
Collapse
|
4
|
Tamburini LM, Mayo BC, Edgar C. Dual- Versus Single-Plate Fixation of Clavicle Fractures: Understanding the Rationale Behind both Approaches. Clin Sports Med 2023; 42:677-684. [PMID: 37716730 DOI: 10.1016/j.csm.2023.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Clavicle fractures are a common injury resulting from a high-energy force, such as a fall onto the shoulder, motor vehicle accident, or sporting activity. Although some clavicle fractures may be treated nonoperatively, operative treatment results in higher union rates and faster return to activity. Here we discuss the operative treatment options for plating of clavicle fractures; specifically, a single plate placed either superiorly or anteriorly or two plates placed orthogonally. Because both techniques provide adequate stability, fracture and patient characteristics should guide the surgical decision making regarding single versus dual plating of clavicle fractures.
Collapse
Affiliation(s)
- Lisa M Tamburini
- Department of Orthopaedic Surgery, University of Connecticut, UConn Musculoskeletal Institute, 120 Dowling Way, Farmington, CT 06032, USA
| | - Benjamin C Mayo
- Department of Orthopaedic Surgery, University of Connecticut, UConn Musculoskeletal Institute, 120 Dowling Way, Farmington, CT 06032, USA
| | - Cory Edgar
- Department of Orthopaedic Surgery, University of Connecticut, UConn Musculoskeletal Institute, 120 Dowling Way, Farmington, CT 06032, USA.
| |
Collapse
|
5
|
Ryan PM, Wilson C, Volkmer R, Hisle G, Brennan M, Stahl D. Low rate of secondary surgery and implant removal following superior, precontoured plating of midshaft clavicle fractures. Proc AMIA Symp 2023; 36:461-467. [PMID: 37334078 PMCID: PMC10269419 DOI: 10.1080/08998280.2023.2210790] [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: 03/28/2023] [Revised: 04/26/2023] [Accepted: 05/02/2023] [Indexed: 06/20/2023] Open
Abstract
Background Surgical fixation of midshaft clavicle fractures with a single 3.5 mm superior clavicular plate has been associated with a high rate of hardware removal due to symptomatic hardware. Because of this, dual-plating techniques with lower-profile implants have been proposed. However, dual-plating systems have disadvantages, including increased cost and increased surgical morbidity. The aim of this study was to define the rate of symptomatic hardware removal for all midshaft clavicle fractures. Methods We retrospectively reviewed information on all patients from 2014 to 2018 at a single level 1 trauma institution with surgeries performed by two fellowship-trained orthopedic trauma surgeons. Documented removal of hardware and the reason for removal were recorded. We then contacted all patients at their listed telephone number to confirm the hardware was still in place and to administer patient outcome questionnaires. If patients did not answer, attempts were made to contact them multiple times on multiple days. Those who were not reached but had documented hardware removal were included in the total number of patients with hardware removal. Results The search revealed 158 patients, of whom 89 (61.8%) were included in the study. Average follow up was 4.09 years (range 2.02-6.50 years). Five patients (5.56%) underwent hardware removal. Removal was for symptomatic or irritating hardware in two of these patients (2.22%). Average abbreviated Disability of Arm, Shoulder, and Hand score was 6.27, and average American Society of Shoulder and Elbow Surgeons shoulder score was 93.6. Conclusion In our series, the rate of symptomatic hardware removal was 2.22%, well below reported removal rates. Hardware removal rates for prominent symptomatic superior clavicular plates may be significantly lower than previously reported, and these fractures may be adequately treated with a single, superior plate.
Collapse
Affiliation(s)
- Patrick M. Ryan
- Department of Orthopaedic Surgery, Baylor Scott and White Medical Center – Temple, Temple, Texas
| | - Charlie Wilson
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Randy Volkmer
- Department of Orthopaedic Surgery, Baylor Scott and White Medical Center – Temple, Temple, Texas
| | - Garret Hisle
- Department of Orthopaedic Surgery, Baylor Scott and White Medical Center – Temple, Temple, Texas
| | - Michael Brennan
- Department of Orthopaedic Surgery, Baylor Scott and White Medical Center – Temple, Temple, Texas
| | - Daniel Stahl
- Department of Orthopaedic Surgery, Baylor Scott and White Medical Center – Temple, Temple, Texas
| |
Collapse
|
6
|
Anteroinferior plating is an independent factor for decreasing symptomatic implant removal rates after plate fixation for midshaft clavicle fractures. OTA Int 2023; 6:e253. [PMID: 36846523 PMCID: PMC9953037 DOI: 10.1097/oi9.0000000000000253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 12/23/2022] [Indexed: 02/10/2023]
Abstract
Objectives The factors that significantly influence the symptomatic implant removal rates after plate fixation for midshaft clavicle fractures remain controversial. The purpose of this study was to compare the symptomatic implant removal rates between 2 different types of plating technique and to evaluate independently associated factors. Design Retrospective cohort study. Setting Acute care center. Patients/Participants A total of 71 patients 16 years or older who were diagnosed with displaced midshaft clavicle fractures from April 2016 to March 2020. Intervention Thirty-nine patients were treated with superior plating (Group SP), and the remaining 32 patients were treated with anteroinferior plating (Group AIP). Main Outcome Measurements Symptomatic implant removal rates after plate fixation for midshaft clavicle fractures. Results Symptomatic implant removal rates were significantly lower in Group AIP (28.1%) than in Group SP (53.8%) (P = 0.033). Multivariate analyses showed that symptomatic implant removal rates were significantly decreased by three independent factors, namely AIP (odds ratio [OR] = 0.323) (P = 0.037), greater age (45 years or older) (OR = 0.312) (P = 0.029), and high body mass index (≥25 kg/m2) (OR = 0.117) (P = 0.034). Conclusions AIP significantly and independently decreased the symptomatic implant removal rate. Among the three explanatory factors showing significant difference, plating technique is the only factor that can be altered by medical institutions. Therefore, we recommend this technique for displaced midshaft clavicle fractures to reduce a second surgery such as symptomatic implant removal. Level of Evidence Level 3, retrospective cohort study.
Collapse
|
7
|
Sinkler MA, Wang M, Kuo A, Furdock RJ, McMellen CJ, Boes K, Ochenjele G. Anterior and superior plate positions in diaphyseal clavicle fractures produce similar patient outcomes. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03428-3. [PMID: 36385680 DOI: 10.1007/s00590-022-03428-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/01/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE While diaphyseal clavicle fractures can be treated with plate fixation on either the superior or anteroinferior aspect of the clavicle, the optimal plate position remains controversial. The purpose of this study was to determine if anteroinferior vs. superior plating for clavicle fracture fixation leads to better patient outcomes. METHODS A retrospective review of patients who sustained clavicle fractures (OTA/AO 15.2) treated with superior or anteroinferior plating at a tertiary Level I trauma center from 2015 to 2021 was performed. The clinical outcomes of clavicle fractures were compared between groups treated with an anterior versus a superior approach via Mann-Whitney U and Chi-squared tests as appropriate to evaluate for differences in outcomes between the two plate positions. RESULTS A total of 315 diaphyseal clavicle fractures were identified. One hundred and forty patients were excluded due to inadequate follow-up. Of the remaining 175 patients, 25 were treated with an anteroinferior approach (14%) and 150 were treated with a superior approach (86%). There were no differences in age, BMI, tobacco use, or substance use between the two groups (p > 0.05 for all). On univariate analysis, there was no difference in rate of union (p = 0.60), nerve injury (p = 0.60), infection (p = 1.0), implant-related irritation (p = 0.42), implant removal (p = 0.26), or revision (p = 1.0) based on approach. Contoured plates had an association with risk of nerve injury (p = 0.04). CONCLUSION There are no differences in union, nerve injury, infection, symptomatic implant, or revision rate between anteroinferior and superior clavicle approaches. Plate positioning during diaphyseal clavicle fracture fixation can reasonably be dictated based on surgeon preference and ideal reduction quality.
Collapse
Affiliation(s)
- Margaret A Sinkler
- Department of Orthopaedics, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
- Department of Orthopaedics, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.
| | - Margaret Wang
- Department of Orthopaedics, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Andy Kuo
- Department of Orthopaedics, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Ryan J Furdock
- Department of Orthopaedics, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Christopher J McMellen
- Department of Orthopaedics, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Kirsten Boes
- Department of Orthopaedics, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - George Ochenjele
- Department of Orthopaedics, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| |
Collapse
|
8
|
Black S, Snoap T, Christiansen E, Roberts J, Stehlík KA. The anterior head of deltoid in relation to anterior clavicle plating: how much are we releasing? OTA Int 2022; 5:e166. [PMID: 36425092 PMCID: PMC9580048 DOI: 10.1097/oi9.0000000000000166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 11/06/2021] [Indexed: 06/16/2023]
Abstract
UNLABELLED Middle to distal-third clavicular shaft fractures are commonly treated with precontoured anterior plating. Some surgeons use mini-fragment plate fixation and position these plates on the anterior clavicle. Recent studies demonstrated the advantages of anterior clavicle plating, including a possible biomechanical advantage with cantilever bending forces and less subsequent implant removal. The insertion and positioning of anteriorly based clavicle plates requires the release of a portion of the anterior deltoid origin from the lateral clavicle. The purpose of this study is to evaluate the anatomy of the deltoid in relation to the clavicle and to determine the percentage of the deltoid origin released to place modern anterior precontoured plates. METHODS Six right and 4 left cadaver shoulders were dissected, each from separate cadaveric specimens (6 male and 4 female). All measurements were made with digital calipers. The length of the clavicle was measured from the acromioclavicular joint to the sternoclavicular joint. The length of deltoid origin on the lateral clavicle was measured from the acromioclavicular joint to the most medial attachment of the deltoid on the clavicle. Percentage of clavicle with deltoid origin was subsequently calculated. RESULTS The average length of the cadaveric clavicles was 164.4 mm with a range from 134.3 to 178.1 mm. The average amount of deltoid origin on the clavicle was 58.7 mm with a range from 43.4 to 69 mm. On average 35.5% of the clavicle had deltoid origin, with a range from 30.2% to 38.8%. CONCLUSION On average, 35.5% of the clavicular osseous anatomy contains deltoid origin. This should be taken into consideration when performing anterior plating for clavicle fractures. With a significant portion of deltoid origin elevated, surgeons may consider altering postoperative protocols until some interval healing has occurred to this anterior head of the deltoid.
Collapse
Affiliation(s)
- Sarah Black
- Western Michigan University Homer Stryker MD School of Medicine
| | - Tyler Snoap
- Bronson Methodist Hospital, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan
| | | | - Jason Roberts
- Bronson Methodist Hospital, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan
| | - Kevin A Stehlík
- Western Michigan University Homer Stryker MD School of Medicine
| |
Collapse
|
9
|
Ostergaard PJ, Hall MJ, Xiong G, Zhang D, Earp BE. Risk Factors for Implant Removal After Surgical Fixation of Midshaft Clavicle Fractures. Orthopedics 2022; 45:e201-e206. [PMID: 35245147 DOI: 10.3928/01477447-20220225-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Midshaft clavicle fractures are common injuries that traditionally have been managed nonoperatively. However, recent literature has shown lower rates of nonunion and improved patient-reported outcomes with surgical management. The rate of implant removal after surgical fixation varies across the literature from 5% to 82%, depending on the method of fixation. We performed a retrospective review of all patients who underwent open reduction and internal fixation (ORIF) with plate-and-screw constructs for midshaft fractures of the clavicle at 2 level I trauma centers to determine the rate of implant removal and identify variables associated with implant removal. We collected all patient-, injury-, and treatment-specific factors as well as information on reoperation for removal of implants. Bivariate analysis and multivariable logistic regression analysis were used to assess whether explanatory factors were associated with removal of implants after ORIF for midshaft clavicle fractures. Of the 146 patients who were treated with ORIF for midshaft clavicle fractures with plate-and-screw constructs, 41 (28%) underwent removal of the implant. The median follow-up was 836 days (interquartile range, 457-1567 days). Variables associated with increased risk of implant removal included anterior plate position (odds ratio, 5.32; 95% CI, 2.01-14.1) and number of holes in the plate (odds ratio, 1.28; 95% CI, 1.00-1.63). These results question whether anterior plating results in less implant prominence and less subsequent removal of implants. [Orthopedics. 2022;45(4):e201-e206.].
Collapse
|
10
|
Salazar LM, Koso RE, Momtaz DA, Dutta AK. Results of pre-contoured titanium anterior plating of midshaft clavicle fractures. J Shoulder Elbow Surg 2022; 31:107-112. [PMID: 34174450 DOI: 10.1016/j.jse.2021.05.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 05/07/2021] [Accepted: 05/16/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Plating midshaft clavicle fractures anteriorly is gaining popularity because of low complication rates. Improvements in plate fixation constructs for midshaft clavicle fractures have unclear clinical significance. The purpose of this study was to present the early clinical and radiographic outcomes of pre-contoured titanium anterior plates for the treatment of midshaft clavicle fractures. METHODS Skeletally mature patients who underwent plate fixation of a midshaft clavicular fracture from 2008 to 2015 using pre-contoured titanium anterior plates were included in this retrospective investigation. The primary outcome measures were union rate and hardware removal rate. The secondary outcome measures included reoperation for all causes and mechanical implant failure. RESULTS A total of 26 patients were included. Complete healing occurred in 96% of patients without further surgical intervention, and all patients achieved union. Medical complications occurred in 2 patients (7.7%), consisting of cellulitis (n = 1) and chronic pain (n = 1). In 1 patient (3.8%), delayed union occurred and the use of a bone stimulator was required postoperatively to achieve union. Finally, 2 patients (7.7%) had symptomatic implants that required removal. CONCLUSIONS In the acute fracture setting, the anterior plating system used in this study led to a high rate of union with decreased rates of implant irritation. Only 7.7% of patients required hardware removal for symptomatic hardware, as opposed to the estimated 20%-60% reported in the literature in patients with symptomatic superior clavicle plates.
Collapse
Affiliation(s)
- Luis M Salazar
- Department of Orthopaedics, UT Health San Antonio, San Antonio, TX, USA.
| | - Riikka E Koso
- Department of Orthopaedics, UT Health San Antonio, San Antonio, TX, USA
| | - David A Momtaz
- Department of Orthopaedics, UT Health San Antonio, San Antonio, TX, USA
| | - Anil K Dutta
- Department of Orthopaedics, UT Health San Antonio, San Antonio, TX, USA
| |
Collapse
|
11
|
Meselhy MA, Shosha AM, Essawy OM, Eltrigy SAE. Management of Clavicular Fracture in Adults by Plating: a Systematic Review. SN COMPREHENSIVE CLINICAL MEDICINE 2021; 3:2603-2617. [DOI: 10.1007/s42399-021-01070-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/21/2021] [Indexed: 09/02/2023]
|
12
|
Nolte PC, Tross AK, Studniorz J, Grützner PA, Guehring T, Schnetzke M. No difference in mid-term outcome after superior vs. anteroinferior plate position for displaced midshaft clavicle fractures. Sci Rep 2021; 11:22101. [PMID: 34764395 PMCID: PMC8586364 DOI: 10.1038/s41598-021-01625-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 10/26/2021] [Indexed: 11/16/2022] Open
Abstract
To compare outcomes, complications, revisions, and rates of implant removal of superior compared to anteroinferior plating in displaced midshaft clavicle fractures at mid-term follow-up. We retrospectively reviewed 79 patients who underwent operative treatment for displaced midshaft clavicle fractures (Group A: 28 patients with superior plating; Group B: 51 patients with anteroinferior plating) that were at least 2 years postoperatively. Adjusted Constant Score (aCS), Visual Analog Scale (VAS), and Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score were compared. Bone union, implant removal, complications and revision surgeries were assessed. Group A had a significantly higher aCS compared to group B (90, IQR: 85.0-91.0 vs. 91, IQR: 90.0-93.0; P = 0.037). No significant differences between groups were seen in VAS (P = 0.283) and QuickDASH (P = 0.384). Bone union was achieved in 76 patients (96.2%) with no significant differences between groups (Group A: 96.4% vs. Group B: 96.1%; P > 0.999). There were no significant differences in implant removal rates (Group A: 60.7% vs. Group B: 66.7%; P = 0.630), complications (Group A: 46.4% vs. Group B: 31.4%; P = 0.226) and revisions (Group A: 25% vs. Group B: 9.8%; P = 0.102). Superior and anteroinferior plating result in high bone union rates and good clinical outcomes with similar rates of plate removal.
Collapse
Affiliation(s)
- Philip-Christian Nolte
- Clinic for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at the University of Heidelberg, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany.
| | - Anna-Katharina Tross
- Clinic for Orthopaedic Surgery, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany
| | - Julia Studniorz
- Clinic for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at the University of Heidelberg, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany
| | - Paul-Alfred Grützner
- Clinic for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at the University of Heidelberg, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany
| | - Thorsten Guehring
- Department of Shoulder and Elbow Surgery, Sportsmedicine & Traumatology, Diakonie Clinic Paulinenhilfe, Rosenbergstraße 38, 70176, Stuttgart, Germany
| | - Marc Schnetzke
- Clinic for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at the University of Heidelberg, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany
- German Joint Centre, ATOS Clinic Heidelberg, Bismarckstraße 9, 69115, Heidelberg, Germany
| |
Collapse
|
13
|
Anteroinferior versus superior plating techniques for displaced midshaft clavicle fractures: A retrospective single centre cohort study from Northern Nigeria. Surgeon 2021; 20:e248-e253. [PMID: 34429243 DOI: 10.1016/j.surge.2021.07.006] [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: 05/02/2021] [Revised: 07/17/2021] [Accepted: 07/28/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Clavicle fractures are common injuries accounting for up to 5% of all fractures in adults. Most clavicle fractures heal well with nonoperative treatment, some however, require surgical intervention especially when they are displaced. While plating remains the most popular and most successful method of clavicle fixation; the optimal position of the plate is yet to be agreed upon. PURPOSES The purpose of this study was to compare the functional outcomes of displaced clavicle fractures fixed with superior and anteroinferior plating techniques. PATIENTS AND METHODS This retrospective cohort study of 69 patients (45 males and 24 females) was carried out between January 2014 and December 2018 at a government orthopaedic hospital in north-western part of Nigeria. The study involved all consecutive patients who sustained a displaced mid-shaft clavicle fracture and had open reduction and internal fixation (ORIF) with either superior plating (SP) or anterior-inferior plating (AIP) and were followed up for at least one year. Data analyzed include: age, sex, laterality, mode of injury, the time from initial injury to surgery, type of plate used, position of the plate, union rate, functional outcome and peri-operative complications. RESULTS Fourty-two patients had SP and twenty seven patients had AIP. Fourty one (97.6%) patients had fracture union in SP group while all the twenty seven patients (100%) in the AIP group had fracture union. The mean QuickDASH scores was 3.2 ± 4.6 and 3.6 ± 4.7 in AIP and SP groups respectively. There was no significant difference in the union rates and functional outcome between the two groups. CONCLUSION Both superior and anteroinferior plating techniques are safe and effective in the surgical management of displaced mid-clavicle fractures. LEVEL OF EVIDENCE Level 3, retrospective cohort study.
Collapse
|
14
|
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.
Collapse
|
15
|
You DZ, Krzyzaniak H, Kendal JK, Martin CR, Schneider PS. Outcomes and complications after dual plate vs. single plate fixation of displaced mid-shaft clavicle fractures: A systematic review and meta-analysis. J Clin Orthop Trauma 2021; 17:261-266. [PMID: 33936947 PMCID: PMC8079453 DOI: 10.1016/j.jcot.2021.03.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/27/2021] [Accepted: 03/30/2021] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Open reduction and internal fixation (ORIF) of displaced midshaft clavicle fractures is associated with higher union rates and earlier functional recovery. However, ORIF with plate fixation is associated with complications including implant irritation and implant failure. Dual plate fixation provides fixation in orthogonal planes, and uses a lower profile fixation technique in comparison to pre-contoured and surgeon-contoured small-fragment locking plates, which may be more prominent. The objective of this study was to conduct a systematic review to summarize outcomes and complications associated with surgical fixation of displaced acute midshaft clavicle fractures with dual plate fixation. METHODS Using a predetermined study protocol in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, the databases MEDLINE, EMBASE, and CENTRAL were searched from inception to 2020 to identify studies reporting outcomes in acute midshaft clavicle fractures treated with dual plate fixation. All clinical studies which reported on outcomes of dual plating in patients with acute midshaft clavicle fractures were included. Baseline demographics, plate fixation constructs, fracture union rates, implant removal rates, maintenance of reduction, symptomatic implant rates, wound complications, and functional outcomes were extracted. All extracted data were recorded, and descriptive statistics were summarized. Meta-analysis was performed on fracture union rates and implant removal rates using random-effects modeling using Mantel-Haenszel weighting. RESULTS Our literature search identified 2226 unique abstracts, of which eight studies met our study inclusion criteria following review. A total of 278 patients made up of 79.8% male with an average age of 36.0 years were included. The overall dual plate implant removal rate was 4.2% with excellent rates of union reported. Moreover, single plate fixation was associated with a 3.9-fold increased implant removal rate compared to dual plate fixation. CONCLUSION Results from this systematic review demonstrate that ORIF of displaced midshaft clavicle fractures using a dual plate fixation technique is a viable option to reduce the incidence of implant removal, without negatively impacting the rate of fracture union. LEVEL OF EVIDENCE Therapeutic Level III.
Collapse
Affiliation(s)
- Daniel Z. You
- Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Canada,McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Halli Krzyzaniak
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Joseph K. Kendal
- Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Canada,McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - C. Ryan Martin
- Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Canada,McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Prism S. Schneider
- Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Canada,McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada,Corresponding author. Division of Orthopaedic Trauma, McCaig Tower, 3134 Hospital Drive NW, Calgary, Alberta, T2N 5A1, Canada.
| |
Collapse
|
16
|
Serrano Barbecho WA, Pacheco Rodríguez JP. Experiencia en fracturas de clavícula mediodiafisaria con placa de reconstrucción en posición anteroinferior en pacientes del Hospital José Carrasco Arteaga, IESS 2017 Cuenca – Ecuador. BIONATURA 2021. [DOI: 10.21931/rb/2021.06.01.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Las fracturas mediodiafisarias de clavícula corresponden del 75% al 80% de los casos de fracturas claviculares. En el contexto quirúrgico, existen dos técnicas para reparar este tipo de fracturas: la colocación de placa en posición superior y en posición anteroinferior. La primera técnica es la más usada; sin embargo, la segunda brinda una temprana recuperación, minimiza pérdida de sangre y disminuye intervenciones secundarias con reducción económica en salud. Demostrando ser más efectiva. El objetivo del presente trabajo fue evaluar las ventajas de la técnica de colocación de placa en posición anteroinferior para fractura mediodiafisaria de clavícula.
Se estudiaron una serie de casos que describe las ventajas de la técnica de colocación de placa en posición anteroinferior por fractura mediodiafisaria de clavícula en el hospital José Carrasco Arteaga, entre enero a diciembre del año 2017. Analizado mediante estadística descriptiva. Se estudiaron 12 pacientes masculinos entre los 18 y 30 años, previo consentimiento informado y cumplieron con criterios de inclusión. Los datos se obtuvieron de resultados de procedimientos quirúrgicos y fueron analizados en Microsoft Excel. Todas las fracturas mediodiafisarias de clavícula se trataron con colocación de una placa de 6 a 8 orificios de 3.5mm de reconstrucción en posición anteroinferior. No se presentaron complicaciones intra ni posoperatorios. Consolidaron al mes y medio con un buen resultado funcional. La técnica de colocación de placa en posición anteroinferior ofrece el retorno temprano de la función del hombro y evita el riesgo de lesión neurovascular. Además, presenta una baja tasa de prominencia del implante.
Collapse
|
17
|
Drayer NJ, Dukes CA, Dudevoir ML, Greenhouse AR, Rao MV, Arrington ED, Friedman RJ, Grassbaugh JA, Eichinger JK. Intraoperative Identification of Clavicle Fracture Patterns: Do Clavicles Fail in a Predictable Pattern? J Orthop Trauma 2020; 34:675-678. [PMID: 32379232 DOI: 10.1097/bot.0000000000001801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/01/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To characterize the fracture pattern and pattern of fragmentation for displaced, midshaft clavicle fractures undergoing operative management. DESIGN Prospective observational study. SETTING Two institutions. Level 1 and Level 2 Trauma Centers. PATIENTS/PARTICIPANTS Fifty-three patients who underwent operative repair of midshaft clavicle fracture. INTERVENTION All clavicles were treated by operative open reduction internal fixation. MAIN OUTCOME MEASUREMENTS All clavicles were categorized by the Robinson classification based on injury plain film bilateral upright clavicle radiographs. In addition, intraoperative fracture characteristics of fragment length and location were measured and recorded to evaluate the fracture pattern. All fractures were analyzed to determine the frequency of segmental comminution versus length-stable patterns, analyze characteristics of butterfly fragment size, number and location as well as the location of the cortical read for those length-stable fractures. RESULTS Analysis revealed 55% were Robinson 2B2 based on preoperative radiographs. Length-stable, anatomic reduction was achievable in 83%. For those in which an anatomic cortical read was achievable, 97.7% had a read present in the posterior-superior aspect of the clavicle. CONCLUSIONS Midshaft clavicle fractures that meet conventional criteria for operative repair occur in a predictable manner with butterfly fragments generated from anterior-inferior compression and simple fracture line generated from tension along the posterior-superior aspect of the clavicle. Understanding this pattern can assist in the in surgical planning.
Collapse
Affiliation(s)
- Nicholas J Drayer
- Department of Orthopaedic Surgery, Madigan Army Medical Center, Tacoma, WA; and
| | - Chase A Dukes
- Department of Orthopaedic Surgery, Madigan Army Medical Center, Tacoma, WA; and
| | - Michelle L Dudevoir
- Department of Orthopaedic Surgery, Madigan Army Medical Center, Tacoma, WA; and
| | - Alyssa R Greenhouse
- Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, SC
| | - Meghana V Rao
- Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, SC
| | - Edward D Arrington
- Department of Orthopaedic Surgery, Madigan Army Medical Center, Tacoma, WA; and
| | - Richard J Friedman
- Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, SC
| | - Jason A Grassbaugh
- Department of Orthopaedic Surgery, Madigan Army Medical Center, Tacoma, WA; and
| | - Josef K Eichinger
- Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, SC
| |
Collapse
|
18
|
Abstract
Midshaft clavicle fractures are frequently encountered orthopaedic injuries. Significant displacement portends a higher likelihood of nonunion and symptomatic malunion after nonoperative treatment. Surgical fixation has been shown to reduce the rate of these adverse outcomes. However, the benefit of surgery is narrowly defined and the decision to offer operative treatment involves a careful analysis of patient clinical factors, expectations, and concomitant injuries. In North America, fixation is most commonly performed with a precontoured plate and screw construct. Frequently, fracture patterns are amenable to direct reduction and primary bone healing, but the plate may also be used as a bridging construct for comminuted fractures. This video demonstrates the superior approach to clavicular plating. We detail the exposure, reduction, and fixation using lag screws and stabilization with a plate and screw construct.
Collapse
|
19
|
Technique Tip: Platysma-flap Approach to the Clavicle. Tech Hand Up Extrem Surg 2018; 23:31-32. [PMID: 30489457 DOI: 10.1097/bth.0000000000000219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The surgical treatment of a displaced fracture of the clavicular shaft generally consists in an open reduction and plate fixation. The most common complications of the classic direct "transplatysma" approach are hardware related. These consist of simple hardware irritations requiring secondary plate removal but also feared wound healing problems ranging from dehiscence to superficial and deep wound infections. In the present article, we describe the so-called "platysma-flap" approach in which the platysma muscle is entirely preserved and distally raised as a flap. This modified exposure allows to cover the osteosynthesis with a viable, well perfused soft tissue envelope and is a safe alternative to the standard "transplatysma" approach.
Collapse
|
20
|
Open Reduction and Internal Fixation Versus Nonsurgical Treatment in Displaced Midshaft Clavicle Fractures: A Meta-Analysis. J Orthop Trauma 2018; 32:e276-e283. [PMID: 29672340 DOI: 10.1097/bot.0000000000001174] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To compare open reduction and internal fixation (ORIF) and nonsurgical treatment outcomes in displaced midshaft clavicle fractures. DATA SOURCES PubMed, MEDLINE, EMBASE, Web of Science, Cochrane Library, and ClinicalTrials.gov were searched in September 2017. STUDY SELECTION Inclusion criteria were randomized controlled trials reporting nonunion, shoulder functional outcomes, and subsequent surgery rates or pain scores. We excluded studies with patients younger than 16 years, maximum follow-up less than 9 months, and inaccessible full text. DATA EXTRACTION Extracted data included the first author, publication year, number of patients, number of nonunions, Constant scores, disabilities of the arm, shoulder, and hand (DASH) scores, number of subsequent surgeries, and pain measured using the visual analog scale. DATA SYNTHESIS The risk ratio of nonunion was 0.15 [95% confidence interval (CI), 0.08-0.31] in ORIF compared with that of nonsurgical treatment. Constant and DASH scores were significantly better in ORIF up to 6 months. The mean difference (MD) in DASH scores at 12 months was statistically insignificant in both treatments (MD, -4.19; 95% CI, -9.34 to 0.96). Constant scores remained significant in ORIF (MD, 4.39; 95% CI, 1.03-7.75). Subsequent surgeries and pain scores were similar in both treatments. CONCLUSIONS Significant reduction in nonunions and favorable early functional outcomes are associated with ORIF. Nevertheless, late functional outcomes, subsequent surgeries, and pain scores are similar to those of nonsurgical treatment. Although patients treated with ORIF mainly had subsequent elective plate removals, nonsurgically treated patients had more surgical fixations for nonunions. As a result, there remains inconsistent evidence regarding the best treatment for displaced midshaft clavicle fractures. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Collapse
|