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Plath JE, Martetschläger F, Moroder P, Sandmann G. Instabilities and Osteoarthritis of the Sternoclavicular Joint. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2024; 162:360-367. [PMID: 37647924 DOI: 10.1055/a-2109-3190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Injury to the sternoclavicular joint (SCG) is very rare, accounting for 3% of shoulder injuries and < 1% of instabilities. Consequently, both the treatment of acute instabilities and their subsequent states (chronic instabilities/SCG arthrosis) are controversial. While treatment has so far been mostly conservative, in recent years there has been a trend towards surgical therapy.Considerable violence, such as that found in traffic accidents or contact sports, can tear the extremely stable ligaments between the medial clavicle and sternum. While anterior dislocation is easier to reduce in most cases, instability remains in up to 50% of cases. In most cases, posterior instability requires rapid reduction, particularly due to the anatomical proximity to important cardio-pulmonary structures. If this succeeds, the rate of persistent instabilities is low. For chronic instability, reconstruction/augmentation of the ligament apparatus with tendon grafts in the "Figure of 8 configuration" has proven to be the standard technique in recent years.
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Affiliation(s)
| | | | - Philipp Moroder
- Abteilung Schulterchirurgie und Ellenbogenchirurgie, Schulthess Klinik Zürich, Zürich, Schweiz
| | - Gunther Sandmann
- Sportklinik Ravensburg, Sportklinik Ravensburg, Ravensburg, Deutschland
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2
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Kritsaneephaiboon A, Jitprapaikulsarn S, Chantarapanich N, Klabklay P, Gromprasit A, Patamamongkonchai C, Dissaneewate P. The application of inverted lateral clavicle locking compression plate for medial clavicle fractures: biomechanical study and clinical implementation. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1465-1478. [PMID: 38245617 DOI: 10.1007/s00590-023-03826-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/21/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND There has been no absolute consensus on the optimal implant for fixation of medial clavicle fracture. The purpose of the present study was to test the biomechanical efficacy of inverted lateral clavicle locking compression plate (LCP-LC) in fixation of this specific fracture location by finite element analysis. METHODS Transverse and comminuted medial clavicle fracture simulated models stabilized by three different devices including inverted LCP-LC, superior clavicle LCP (LCP-SC), and dual reconstruction (LCP-RP) with LCP-SC were investigated biomechanical performance under three loading conditions, i.e., axial compression, inferior bending, and axial torsion. RESULTS EQV stress exhibited on implant and elastic strain at fracture site under inferior bending was greater than other loading cases. LCP-SC construct represented the greatest EQV stress and elastic strain. The inverted LCP-LC construct demonstrated lower EQV stress than the LCP-SC construct and was comparable to dual plating. Under axial compression and axial torsion, elastic strain produced from the inverted LCP-LC construct was comparable to dual plating, but greater than dual plating when subjected to inferior bending. CONCLUSION By the results of FE analysis, inverted LCP-LC could be a potential application for fixation of clavicle fracture with short medial fragment.
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Affiliation(s)
- Apipop Kritsaneephaiboon
- Department of Orthopedic Surgery and Physical Medicine, Prince of Songkla University, Songkla, Thailand
| | | | - Nattapon Chantarapanich
- Department of Mechanical Engineering, Faculty of Engineering at Sriracha, Kasetsart University, Sriracha, Chonburi, Thailand.
| | - Prapakorn Klabklay
- Department of Orthopedic Surgery and Physical Medicine, Prince of Songkla University, Songkla, Thailand
| | - Arthit Gromprasit
- Department of Orthopedics, Buddhachinaraj Hospital, Phitsanulok, Thailand
| | | | - Pornpanit Dissaneewate
- Department of Orthopedic Surgery and Physical Medicine, Prince of Songkla University, Songkla, Thailand
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Ingoe HMA, Mohammed K, Malone AA, Beadle G, Sharpe T, Cockfield A, Lloyd R, Singh H, Colgan F. Traumatic posterior sternoclavicular joint dislocation - Current aspects of management. Injury 2023; 54:110983. [PMID: 37634999 DOI: 10.1016/j.injury.2023.110983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/19/2023] [Accepted: 08/05/2023] [Indexed: 08/29/2023]
Abstract
The posterior sternoclavicular joint dislocation is a rare and potentially life-threatening injury, as massive haemorrhage can occur at the time of trauma, during reduction manoeuvres and drilling. These injuries are rare and a collective experience of managing them is of paramount importance. We present our multidisciplinary experience of managing several of these injuries in our centre, with learning points we have identified. Assessment should include Computerised Tomography Angiography (CTA) to assess the anatomy of the joint including the proximity to the underlying innominate vein and to identify any bleeding. Both closed reduction and open reconstruction have the potential for massive haemorrhage which can be controlled successfully with direct access to the underlying vessel. We recommend that all reductions should be performed in the presence of a cardiothoracic surgeon who can gain vascular control in the head, neck, and thorax. In specific high-risk cases, pre-emptive venous catheterisation can also be considered. We recommend that a discussion and rehearsal for intra-operative bleeding should be undertaken with the whole theatre team, with roles assigned pre-emptively and to allow identification of any deficiencies in staff expertise or equipment. Of the five recent cases managed in our centre one patient had a closed reduction and four had open reductions. Success of closed reductions within 48 h is high and these can be attempted up to 10 days after injury. Our patient undergoing closed reduction had a favourable outcome and returned to professional rugby at five months. Open reduction was performed in a physeal fracture as there was a delay to surgery and callus had begun to form and had the potential to adhere to the underlying vessel. In this case we performed open reduction and stabilised with tunnelled suture fixation. Our preferred method of reconstruction uses a palmaris graft with internal figure of eight bracing. One patient had a subsequent fracture of the medial clavicle around the drill holes that healed without further intervention. Despite good reduction and stability achieved following palmaris reconstructions, two patients are experiencing ongoing symptoms of globus and one with voice change without any objective underlying cause.
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Affiliation(s)
- Helen M A Ingoe
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, 2 Riccarton Avenue, PO Box 4345, Christchurch, 8140, New Zealand; Christchurch Hospital, Riccarton Avenue, Christchurch, 8140, New Zealand.
| | - Khalid Mohammed
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, 2 Riccarton Avenue, PO Box 4345, Christchurch, 8140, New Zealand; Christchurch Hospital, Riccarton Avenue, Christchurch, 8140, New Zealand
| | - Alex A Malone
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, 2 Riccarton Avenue, PO Box 4345, Christchurch, 8140, New Zealand; Christchurch Hospital, Riccarton Avenue, Christchurch, 8140, New Zealand
| | - Gordon Beadle
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, 2 Riccarton Avenue, PO Box 4345, Christchurch, 8140, New Zealand; Christchurch Hospital, Riccarton Avenue, Christchurch, 8140, New Zealand
| | - Thomas Sharpe
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, 2 Riccarton Avenue, PO Box 4345, Christchurch, 8140, New Zealand; Christchurch Hospital, Riccarton Avenue, Christchurch, 8140, New Zealand
| | - Allen Cockfield
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, 2 Riccarton Avenue, PO Box 4345, Christchurch, 8140, New Zealand; Christchurch Hospital, Riccarton Avenue, Christchurch, 8140, New Zealand
| | - Richard Lloyd
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, 2 Riccarton Avenue, PO Box 4345, Christchurch, 8140, New Zealand; Christchurch Hospital, Riccarton Avenue, Christchurch, 8140, New Zealand
| | - Harsh Singh
- Christchurch Hospital, Riccarton Avenue, Christchurch, 8140, New Zealand; Dept of Cardiothoracic Surgery, Christchurch Hospital, Riccarton Avenue, Christchurch, 8140, New Zealand
| | - Frances Colgan
- Christchurch Hospital, Riccarton Avenue, Christchurch, 8140, New Zealand; Department of Interventional Radiology, Christchurch Hospital, Christchurch, 8011 New Zealand
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Brown L, Tamburini LM. Traumatic Sternoclavicular Dislocations in Athletes: Diagnosis, Indications for Surgical Reconstruction, and Guide for Return to Play. Clin Sports Med 2023; 42:713-722. [PMID: 37716733 DOI: 10.1016/j.csm.2023.06.019] [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
Injuries to the sternoclavicular (SC) joint are rare, however, when they occur prompt recognition, evaluation, and treatment are crucial. SC joint injuries can occur following high-energy mechanisms such as motor vehicle collisions and contact sports. Injury to the SC joint can be evaluated with the use of plain radiographs as well as computed tomography. If an injury to the SC joint is suspected, injury to vital mediastinal structures must be evaluated. SC joint dislocations can be treated by either closed reduction or open reduction and stabilization. Many stabilization methods have been described including plate stabilization and ligament reconstruction.
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Affiliation(s)
- Leah Brown
- Banner Orthopaedic Sports Medicine, University of Arizona College of Medicine-Phoenix, 7400 North Dobson Road, Scottsdale, AZ 85256, USA.
| | - Lisa M Tamburini
- Department of Orthopaedic Surgery, University of Connecticut, UConn Musculoskeletal Institute, 120 Dowling Way, Farmington, CT 06032, USA
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Han Z, Luo Q, Deng G, Bi C, Yin G, Lin H, Wu J, Wu X. Canceling Notch Improves the Mechanical Safety of Clavicle Locking Plate: A 3D Finite Element Study. Orthop Surg 2023; 15:2152-2156. [PMID: 36349872 PMCID: PMC10432472 DOI: 10.1111/os.13558] [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: 07/12/2022] [Revised: 09/07/2022] [Accepted: 09/16/2022] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Implant failure is a disastrous complication of the operative treatment of midshaft clavicle fractures, and improving the osteosynthesis plate is a strategy for preventing this. We aimed to investigate whether canceling the notch and adding screw-hole inserts enhanced the mechanical properties of the plate. METHODS A clavicle model was generated based on the CT images of six adult volunteers (age range, 20-40 years; three males and three females; height range 160-175) using dedicated software, and a midshaft fracture model was created. The domestically made seven-hole locking plate commonly used for midshaft clavicle fractures was simulated (Model I); modifications were made to the plate (Model II). Using 3D finite element analysis, we simulated the fracture construct under three different load conditions-downward cantilever bending, axial compression, and axial torsion-and compared the stress distribution. RESULTS We found that under axial compression, Model II experienced its maximum stress on the plate at 551.9MPa, which was less than that in Model I (790.4 MPa). Moreover, a greater stress concentration at the fracture site was observed under axial torsion, despite the maximum stress of both the models being similar. CONCLUSION Canceling the notch and filling the screw holes near the fracture can ameliorate stress concentration on the internal fixation construct and enhance its reliability under axial compression. This improvement has substantial effects on the mechanical properties of implants and potentially prevents implant failure. Modern osteosynthesis anatomical implants need to be improved.
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Affiliation(s)
- Zhihua Han
- Trauma Center, Department of Orthopaedics and Traumatology, Shanghai General HospitalShanghai Jiaotong UniversityShanghaiChina
- Sino‐Euro Orthopaedics NetworkBerlinGermany
| | - Qian Luo
- Department of Radiology, Shanghai General HospitalShanghai Jiaotong UniversityShanghaiChina
| | - Guoying Deng
- Trauma Center, Department of Orthopaedics and Traumatology, Shanghai General HospitalShanghai Jiaotong UniversityShanghaiChina
| | - Chun Bi
- Trauma Center, Department of Orthopaedics and Traumatology, Shanghai General HospitalShanghai Jiaotong UniversityShanghaiChina
| | - Gang Yin
- Trauma Center, Department of Orthopaedics and Traumatology, Shanghai General HospitalShanghai Jiaotong UniversityShanghaiChina
| | - Haodong Lin
- Trauma Center, Department of Orthopaedics and Traumatology, Shanghai General HospitalShanghai Jiaotong UniversityShanghaiChina
| | - Jianhong Wu
- Trauma Center, Department of Orthopaedics and Traumatology, Shanghai General HospitalShanghai Jiaotong UniversityShanghaiChina
| | - Xiaoming Wu
- Trauma Center, Department of Orthopaedics and Traumatology, Shanghai General HospitalShanghai Jiaotong UniversityShanghaiChina
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Han Z, Dong J, Wu J, Bi C, Wang Q, Lin H, Zhang L, Wu X. A Novel and Open Classification Emphasizing on Osteoligamentous Complex for Distal Clavicle Fractures. Orthop Surg 2023; 15:2025-2032. [PMID: 36523173 PMCID: PMC10432498 DOI: 10.1111/os.13633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/14/2022] [Accepted: 11/23/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Current X-ray-based classification methods cannot describe all distal clavicle fracture (DCF) patterns, especially the osteoligamentous injury pattern of DCFs. We aimed to develop a novel classification based on the osteoligamentous injury pattern of the DCFs and investigated its reliability. METHODS All DCFs from January 2017 to January 2022 were respectively screened and 45 cases (mean age 20-78; male 31, female 14) met the including criteria and were enrolled. Based on their Zanca view X-ray radiograph and three-dimensional CT construction images, we analyzed the osteoligamentous injury pattern of each case, particularly the acromioclavicular (AC) and coracoclavicular ligaments and their bone attachment. Then we developed a novel classification method, five types in total, sorting all DCFs according to their lesion manifestations of osteoligamentous complex. Also, we investigated the inter- and intra-observer reliability using kappa value. RESULTS A novel classification method for DCF was developed, manifesting the avulsion or rupture of conoid and trapezoid ligaments, and involvement of AC joint. Forty-five cases of DCFs were included in this study. Among them, 11 (24.4%) were Type 1 fracture, three (6.7%) cases were Type 2, six cases (13.3%) were Type 3, 21 (46.7%) were Type 4, four (8.9%) were Type 5. Kappa values for inter-observer agreement were 0.57 after first evaluation and 0.61 after second evaluation. Intra-observer agreement was 0.72 for experienced shoulder specialist and 0.63 for radiologist. CONCLUSION This new classification method is reliable to use, supplementary to current classification systems, and emphasizes on the osteoligamentous complex injury when opting for the treatment.
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Affiliation(s)
- Zhihua Han
- Trauma Center, Department of Orthopaedics and Traumatology, Shanghai General HospitalShanghai Jiaotong UniversityShanghaiChina
- Sino‐Euro Orthopaedics NetworkBerlinGermany
| | - Jingming Dong
- Department of Upper ExtremityTianjin HospitalTianjinChina
| | - Jianhong Wu
- Trauma Center, Department of Orthopaedics and Traumatology, Shanghai General HospitalShanghai Jiaotong UniversityShanghaiChina
| | - Chun Bi
- Trauma Center, Department of Orthopaedics and Traumatology, Shanghai General HospitalShanghai Jiaotong UniversityShanghaiChina
| | - Qiugeng Wang
- Trauma Center, Department of Orthopaedics and Traumatology, Shanghai General HospitalShanghai Jiaotong UniversityShanghaiChina
| | - Haodong Lin
- Trauma Center, Department of Orthopaedics and Traumatology, Shanghai General HospitalShanghai Jiaotong UniversityShanghaiChina
| | - Lei Zhang
- Department of Radiology, Shanghai General HospitalShanghai Jiaotong UniversityShanghaiChina
| | - Xiaoming Wu
- Trauma Center, Department of Orthopaedics and Traumatology, Shanghai General HospitalShanghai Jiaotong UniversityShanghaiChina
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Rojas Ixtacuy L, Rius X, Molina-Creixell A, Agulló JL, Hachem AI. Treatment of Symptomatic Medial Clavicle Nonunion with Intramedullary Tendon Allograft: A Case Report. JBJS Case Connect 2023; 13:01709767-202309000-00049. [PMID: 37590425 DOI: 10.2106/jbjs.cc.23.00266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
CASE A 67-year-old patient sustained a medial clavicle fracture (MCF) treated with open reduction and fixation with cerclage sutures. A year later, he presented with symptomatic nonunion and skin prominence, which was revised with an intramedullary tendon allograft fixation including the sternoclavicular joint. At 31 months after the procedure, the patient showed no pain or clinical instability. CONCLUSION MCF is an uncommon injury. Symptomatic nonunion after the failure of fixation is rarely described. Although the best way to treat this complication is debatable, revision fixation using an intramedullary tendon allograft can be a viable option in elderly patients.
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Affiliation(s)
| | - Xavi Rius
- Hospital Universitari de Bellvitge, Barcelona, Spain
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Feng D, Yang Y, Kang X, Heng L, Zhang J, Zhu Y. Extra-articular locking plate and trans-articular clavicle hook plate for displaced medial clavicle fractures. Injury 2023:S0020-1383(23)00279-6. [PMID: 36964034 DOI: 10.1016/j.injury.2023.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 03/16/2023] [Accepted: 03/16/2023] [Indexed: 03/26/2023]
Abstract
INTRODUCTION Fracture of the medial end of the clavicle is very rare. There is no consensus on the standard surgical strategy for medial clavicle fracture, and treatment is challenging. This study aimed to retrospectively evaluate the efficacy of internal plate fixation for displaced medial clavicle fracture. METHODS Patients who underwent internal plating of a displaced medial clavicle fracture were included in this retrospective study. Each patient underwent open reduction and fixation with an internal extra-articular locking plate or trans-articular hook plate based on their fracture type. Postoperative follow-up included radiographs for assessment of bone union, Constant-Murley score for shoulder function, Disability of the Arm, Shoulder, and Hand (DASH) questionnaire for upper limb function, and visual analog scale (VAS) for pain. Any complications were also recorded. RESULTS Between May 2014 and July 2021, 34 patients (9 females, 25 males; mean age, 50.0 ± 14.8 years) were treated with internal plate fixation and included in this study. The fracture line was located in the medial fifth of the clavicle in 32 patients, and 20 patients had intra-articular fracture. Eighteen patients had the fracture fixed with a locking plate, namely an inverted distal clavicle plate (n = 7), straight locking plate (n = 3), distal fibular plate (n = 3), and T-plate (n = 5); the other 16 patients were treated with a clavicle hook plate. During a mean follow-up of 30.7 ± 26.5 months, 33 patients achieved bone healing, the average Constant-Murley score was 90.9 ± 11.0 points, the mean DASH score was 6.0 ± 6.6 points, and the mean VAS was 0.4 ± 1.1 points. Complications occurred in five patients. CONCLUSIONS Both locking plates and hook plates are effective in treating displaced medial clavicle fracture. A locking plate is recommended when there is enough bone stock in the medial fragment for stable fixation. A clavicle hook plate is recommended for cases in which the medial clavicle fracture is too small, comminuted, or has signs of sternoclavicular joint instability.
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Affiliation(s)
- Dongxu Feng
- Department of Orthopaedic Trauma, Hong Hui Hospital, Xi'an Jiaotong University School of Medicine, Xi'an, Shaanxi, China
| | - Yang Yang
- Vaccination and immunization department, Xi'an center for disease control and prevention, Xi'an, Shaanxi, China
| | - Xiaomin Kang
- Center for Translational Medicine, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Lisong Heng
- Department of Orthopaedic Trauma, Hong Hui Hospital, Xi'an Jiaotong University School of Medicine, Xi'an, Shaanxi, China
| | - Jun Zhang
- Department of Orthopaedic Trauma, Hong Hui Hospital, Xi'an Jiaotong University School of Medicine, Xi'an, Shaanxi, China
| | - Yangjun Zhu
- Department of Orthopaedic Trauma, Hong Hui Hospital, Xi'an Jiaotong University School of Medicine, Xi'an, Shaanxi, China.
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Feng D, Jiang W, Kang X, Jiang Y, Zhu Y, Zhang J. Simultaneous bilateral traumatic clavicle fractures: incidence, characteristics, and surgical outcomes. BMC Musculoskelet Disord 2023; 24:112. [PMID: 36765310 PMCID: PMC9912484 DOI: 10.1186/s12891-023-06228-w] [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: 11/22/2022] [Accepted: 02/07/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Although clavicle fractures are common injuries in adults, simultaneous bilateral clavicle fractures are rarely reported. The present report describes 13 patients with simultaneous bilateral traumatic clavicle fractures who were treated with surgical management and followed for more than 12 months postoperatively. METHODS This retrospective chart review involved skeletally mature patients with traumatic clavicle injuries. Patients with bilateral clavicle fractures who were followed up for at least 12 months after surgery were included. Data regarding the patients' demographics, injury characteristics, fracture classification, comorbidities, concomitant injuries, and treatment strategies were collected. Each displaced fracture was managed with open reduction and internal fixation. Postoperative follow-up included radiographs for assessment of bone union; calculation of the Constant-Murley score for shoulder function; administration of the Disability of the Arm, Shoulder, and Hand questionnaire for upper limb function; determination of the visual analogue scale score for pain; and assessment of complications. RESULTS From October 2013 to November 2021, 15 patients (10 men, 5 women) were diagnosed with bilateral clavicle fractures among 1542 patients with clavicle injuries (overall incidence of 1.0%). Of these 15 patients, this study included 13 patients (8 men, 5 women; mean age, 38.3 ± 15.3 years) who were followed up for more than 12 months postoperatively. Among the 13 patients, 10 (77.0%) had associated concomitant injuries, and 25 sides were fixed with internal plate fixation. After a follow-up period of 29.9 ± 28.5 months, all fractures achieved bone healing. Eleven patients attained excellent shoulder function on both sides and returned to their pre-injury daily activities, and the remaining two patients had unilateral shoulder dysfunction. No complications occurred. CONCLUSIONS Bilateral clavicle fractures are extremely rare and associated with polytrauma. Open reduction and internal fixation is recommended for such patients, especially those with severe chest injuries, because osteosynthesis of the clavicle can improve respiratory function and reduce the duration of functional disability.
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Affiliation(s)
- Dongxu Feng
- grid.452452.00000 0004 1757 9282Department of Orthopaedic Trauma, Hong Hui Hospital, Xi’an Jiaotong University School of Medicine, Xi’an, Shaanxi China
| | - Wuqiang Jiang
- grid.452452.00000 0004 1757 9282Department of Orthopaedic Trauma, Hong Hui Hospital, Xi’an Jiaotong University School of Medicine, Xi’an, Shaanxi China
| | - Xiaomin Kang
- grid.452438.c0000 0004 1760 8119Center for Translational Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi China
| | - Yuxuan Jiang
- grid.452452.00000 0004 1757 9282Department of Orthopaedic Trauma, Hong Hui Hospital, Xi’an Jiaotong University School of Medicine, Xi’an, Shaanxi China
| | - Yangjun Zhu
- grid.452452.00000 0004 1757 9282Department of Orthopaedic Trauma, Hong Hui Hospital, Xi’an Jiaotong University School of Medicine, Xi’an, Shaanxi China
| | - Jun Zhang
- Department of Orthopaedic Trauma, Hong Hui Hospital, Xi'an Jiaotong University School of Medicine, Xi'an, Shaanxi, China.
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Feng D, Liu Y, Li Z, Huang J, Fan M, Kang X, Zhang J. Treatment of bipolar clavicle injury with internal plating: a case series and literature review. BMC Musculoskelet Disord 2023; 24:8. [PMID: 36604726 PMCID: PMC9814211 DOI: 10.1186/s12891-023-06126-1] [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: 04/29/2022] [Accepted: 01/02/2023] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Bipolar clavicle injury is a rare injury involving any combination of dislocation and/or fracture at both ends of the clavicle. Most reports of bipolar clavicle injury have been based on a single case, and treatment of this injury remains controversial. The present study was performed to evaluate the efficacy of surgical management with internal plating for bipolar clavicle injuries. METHODS We performed internal plating to treat seven consecutive bipolar clavicle injuries with different injury patterns from May 2013 to June 2021. A clavicle hook plate was used for five sternoclavicular joint injuries (including a revision surgery) and three acromioclavicular joint dislocations, a T plate was used for one sternoclavicular joint injury, and an anatomic plate was used for one distal clavicle fracture. At follow-up, radiographs were assessed for bone alignment, joint congruity, fracture union or malunion, and implant failure or migration. Clinical evaluation included determination of the Disability of the Arm, Shoulder, and Hand (DASH) score; Constant-Murley score; visual analog scale (VAS) score; and complications. RESULTS The patients were regularly followed up after the operation, and functional parameters were assessed over time. At a mean follow-up of 28.1 ± 22.0 months, each fracture had solid bone union, and each dislocation showed no sign of recurrent instability. The mean shoulder forward flexion was 159.3° ± 7.9°, and the mean DASH score was 8.8 ± 5.1. The mean Constant-Murley score was 88.9 ± 7.9, with six cases assessed as excellent and one case assessed as good. The mean VAS score was 1.0 ± 1.5, and the mean patient satisfaction score was 9.3 ± 0.8. No complications occurred, and each patient was able to resume their preinjury daily activity and was highly satisfied with their treatment. CONCLUSIONS In the present study, internal plating for bipolar clavicle injury allowed early mobilization and resulted in good joint function. We recommend fixation of the more severely affected side first because the other side may be passively reduced and acquire stability once the more severely affected side has been fixed. Internal fixation of the other end may therefore be unnecessary unless residual instability exists.
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Affiliation(s)
- Dongxu Feng
- grid.43169.390000 0001 0599 1243Department of Orthopaedic Trauma, Hong Hui Hospital, Xi’an Jiaotong University School of Medicine, Xi’an, Shaanxi, China
| | - Yong Liu
- grid.43169.390000 0001 0599 1243Department of Orthopaedic Trauma, Hong Hui Hospital, Xi’an Jiaotong University School of Medicine, Xi’an, Shaanxi, China
| | - Zijun Li
- grid.43169.390000 0001 0599 1243Department of Orthopaedic Trauma, Hong Hui Hospital, Xi’an Jiaotong University School of Medicine, Xi’an, Shaanxi, China
| | - Jie Huang
- grid.43169.390000 0001 0599 1243Department of Orthopaedic Trauma, Hong Hui Hospital, Xi’an Jiaotong University School of Medicine, Xi’an, Shaanxi, China
| | - Mei Fan
- grid.43169.390000 0001 0599 1243Department of Orthopaedic Trauma, Hong Hui Hospital, Xi’an Jiaotong University School of Medicine, Xi’an, Shaanxi, China
| | - Xiaomin Kang
- grid.452438.c0000 0004 1760 8119Center for Translational Medicine, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Jun Zhang
- grid.43169.390000 0001 0599 1243Department of Orthopaedic Trauma, Hong Hui Hospital, Xi’an Jiaotong University School of Medicine, Xi’an, Shaanxi, China
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Han Y, Cho EH, Martinez A, Martineau PA. Sternoclavicular Joint Reconstruction with Semitendinosus Allograft and Suture Anchors after Recurrent Posterior Dislocation in a Professional North American Football Player. Open Orthop J 2022. [DOI: 10.2174/18743250-v16-e2208180] [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] [Indexed: 02/22/2023] Open
Abstract
Background:
Posterior sternoclavicular joint dislocations are an extremely rare but potentially life-threatening injury that can occur in sports. A variety of surgical procedures have been proposed, but there is no consensus on the treatment of choice. It is also largely unknown if a safe return to high-risk sports is possible.
Case Presentation:
We present a case of a posterior sternoclavicular joint dislocation in a 22-year-old male professional North American football player who had a recurrent irreducible posterior dislocation after initial injury management by closed reduction. The patient’s desire to return to football presented unique challenges to management. His sternoclavicular joint was subsequently reconstructed with semitendinosus allograft in a figure-of-eight augmented with suture anchors. After recovery, he returned to play as a running back in professional football symptom-free.
Conclusion:
Our patient's successful return to playing professional football after the sternoclavicular joint reconstruction suggests that this should be considered an effective treatment option when managing posterior sternoclavicular dislocation in high level contact sports players.
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Obremskey WT, Rodriguez-Baron EB, Tatman LM, Pesantez RF. Acute Dislocations of the Sternoclavicular Joint: A Review Article. J Am Acad Orthop Surg 2022; 30:148-154. [PMID: 34898528 DOI: 10.5435/jaaos-d-20-01239] [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] [Received: 01/04/2021] [Accepted: 11/01/2021] [Indexed: 02/01/2023] Open
Abstract
Acute dislocations of the sternoclavicular joint are uncommon injuries, and it is difficult for physicians to develop expertise in treating these injuries because of their infrequent nature. No level I evidence currently exists for these injuries, but several retrospective studies and surgical techniques have been described. For acute injuries, current recommendations include early treatment with closed reduction. If unable to attain or maintain reduction after a closed attempt, open management should be considered. Previous reviews have outlined relevant anatomy, physical examination findings, and imaging for these injuries. This article aims to review updated information from the past decade regarding techniques for reduction, outcomes, and complications related to the injury and surgical management.
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Affiliation(s)
- William T Obremskey
- From the Division of Orthopaedic Trauma, Vanderbilt University Medical center (Obremskey and Baron), Division of Orthopaedic Trauma, Fundacion Santa Fe de Bogota University Hospital, Bogotá D.C., Colombia (Pesantez); Division of Orthopaedic Trauma, Washington University, St. Louis, MO (Tatman)
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Schultz MJ, Barcak EA. Medial Clavicle Fracture Fixation Including the Sternum: A Case Report. JBJS Case Connect 2021; 11:01709767-202106000-00124. [PMID: 34129535 DOI: 10.2106/jbjs.cc.20.00778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 29-year-old man presented with a displaced medial clavicle fracture. Surgical repair was performed using a precontoured plate designed for the contralateral distal clavicle, and medial fixation was accomplished at the sternum. The patient had no complications and demonstrated full strength and range of motion at the 8-month follow-up. CONCLUSION Medial clavicle fractures with a small medial fragment can be immobilized using a plate designed for the contralateral distal clavicle that crosses the sternoclavicular joint to obtain medial fixation in the sternum. This technique may provide a viable treatment modality for this unique fracture pattern.
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Affiliation(s)
- Matthew J Schultz
- Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, Texas
| | - Eric A Barcak
- Department of Orthopedic Surgery, John Peter Smith Hospital, Fort Worth, Texas
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