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Woo SH, Bae JY, Jung SW, Choi MH, Kang SW. Usefulness of double plate fixation after failed ORIF for clavicle shaft fracture. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024:10.1007/s00590-024-03927-5. [PMID: 38598169 DOI: 10.1007/s00590-024-03927-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 03/20/2024] [Indexed: 04/11/2024]
Abstract
PURPOSE We aimed to evaluate the clinical and radiological outcomes of double plate fixation for failed clavicle shaft fracture surgery. MATERIALS AND METHODS We analyzed 14 patients who underwent double plate fixation due to plate failure after clavicle shaft fracture surgery from March 2016 to March 2021. The study used 3.5 mm locking compression plates for superior clavicle and anterior reconstruction in all patients. In addition, moldable allograft bone was used to fill the bone defect. Clinical and radiological evaluation was performed immediately, at 2 and 4 weeks, and 3, 6, 9, and 12 months postoperatively. The visual analog scale (VAS), University of California at Los Angeles (UCLA) shoulder scale, and American Shoulder and Elbow Surgeons (ASES) scores and range of motion of the shoulder were evaluated as clinical results. For radiological evaluation, anteroposterior, caudal, and cephalad views of both clavicles were used. Successful bone union was defined as complete adjoining of the fracture site through callus formation. RESULTS Successful bone union was achieved in all patients, and the mean time to bone union was 16.7 ± 1.2 weeks (range, 12-24 weeks). Statistically significant improvement in forward flexion and external and internal rotation was observed from 135.5° ± 6.3, 45.2° ± 5.3, and 13° ± 2.3 preoperatively to 157.0° ± 9.3, 68.7° ± 6.3, and 9.8° ± 3.1 at the final follow-up, respectively. The VAS score improved from an average of 6.2 ± 2.8 preoperatively to 1.3 ± 0.7 at the final follow-up, which was statistically significant (P = 0.018). In addition, the ASES score significantly increased from a mean of 52.1 ± 6.3 points preoperatively to 83.6 ± 7.8 points at the final follow-up (P = 0.001). The average UCLA shoulder score was 16.7 ± 1.4 and 31.4 ± 2.2 points preoperatively and at the final follow-up, respectively, which was statistically significant (P = 0.001). CONCLUSION Double plate fixation has shown good results after failed open reduction and internal fixation (ORIF) for clavicle shaft fractures. Therefore, in complicated situations after ORIF, double plate fixation is considered a surgical treatment option.
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Affiliation(s)
- Seung Hun Woo
- Department of Orthopedics, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, 20 Geumo-ro, Mulgeum-eup, Yangsan, 626-770, Republic of Korea
| | - Jung Yun Bae
- Department of Orthopedics, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, 20 Geumo-ro, Mulgeum-eup, Yangsan, 626-770, Republic of Korea
| | - Sung Won Jung
- Department of Orthopedics, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, 20 Geumo-ro, Mulgeum-eup, Yangsan, 626-770, Republic of Korea
| | - Min-Hyeok Choi
- Department of Preventive and Occupational & Environmental Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
- Office of Public Healthcare Service, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Suk-Woong Kang
- Department of Orthopedics, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, 20 Geumo-ro, Mulgeum-eup, Yangsan, 626-770, Republic of Korea.
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Jafari Kafiabadi M, Sabaghzadeh A, Barazandeh Rad S, Karami A, Sadighi M, Biglari F. Clinical Outcomes of Double Mini-Plating Compared with a Single Superior Plating in Midshaft Clavicular Fractures: A Randomized Clinical Trial Study. Adv Biomed Res 2023; 12:265. [PMID: 38192890 PMCID: PMC10772796 DOI: 10.4103/abr.abr_221_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 09/30/2023] [Accepted: 10/01/2023] [Indexed: 01/10/2024] Open
Abstract
Background In the current study, we aimed to assess the clinical outcomes of the double-plating method using 2.7 mm compression plates compared with the single superior 3.5 mm compression plating method in displaced midshaft fractures of the clavicle. Materials and Methods Thirty patients with midshaft fractures of the clavicle were randomly assigned into two groups. In group A, 15 patients were fixed by a double-plating technique using two 2.7 mm compression plates on the superior and anteroinferior sides of the bone. The fractures in group B were fixed by a superior plating technique using a single 3.5 mm compression plate. Intraoperative bleeding measurement, length of surgical incision, duration of procedure time, and functional scores were assessed post-surgically through one-year follow-ups. Results There was no significant difference between groups in terms of surgery time. Device failure was not found among all recruited patients. Incision length and device prominence complaint were significantly different between groups (P value = 0.02, P value = 0.03). Mean ± standard deviation intraoperative bleeding rate was 88.67 ± 29.96 milliliter in the double-plating group and 108.67 ± 41.72 milliliter in the other group, which was not different between these two groups (P value = 0.14). There were no signs of non-union either in radiographies or clinically. Conclusion Double mini-plating of diaphyseal clavicular fractures could result in a smaller surgical incision and a lower rate of prominence without affecting fixation stability and clinical outcomes in comparison with single superior 3.5 mm plates.
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Affiliation(s)
- Meisam Jafari Kafiabadi
- Department of Orthopedic Surgery, Clinical Research Development Unit of Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Sabaghzadeh
- Department of Orthopedic Surgery, Clinical Research Development Unit of Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saber Barazandeh Rad
- Department of Orthopedic Surgery, Clinical Research Development Unit of Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amin Karami
- Department of Orthopedic Surgery, Clinical Research Development Unit of Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrdad Sadighi
- Department of Orthopedic Surgery, Clinical Research Development Unit of Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farsad Biglari
- Department of Orthopedic Surgery, Clinical Research Development Unit of Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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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.
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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.
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deMeireles AJ, Czerwonka N, Levine WN. Clavicle Nonunion and Malunion: Surgical Interventions for Functional Improvement. Clin Sports Med 2023; 42:663-675. [PMID: 37716729 DOI: 10.1016/j.csm.2023.05.012] [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 nonunion and malunion are relatively uncommon but, when symptomatic, can result in pain and dysfunction that requires surgical intervention. Various reconstructive and grafting techniques are available to achieve stable fixation and union. In the setting of persistent nonunion, vascularized bone grafting may be necessary. A thorough understanding of the patient's type of nonunion and potential for healing is crucial for achieving satisfactory results because is thoughtful preoperative planning and surgical fixation.
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Affiliation(s)
- Alirio J deMeireles
- Department of Orthopedic Surgery, Columbia University Irving Medical Center-NewYork Presbyterian Hospital, New York, NY, USA
| | - Natalia Czerwonka
- Department of Orthopedic Surgery, Columbia University Irving Medical Center-NewYork Presbyterian Hospital, New York, NY, USA
| | - William N Levine
- Department of Orthopedic Surgery, Columbia University Irving Medical Center-NewYork Presbyterian Hospital, New York, NY, USA.
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Jo OI, Almond M, Rupansinghe HS, Ackland DC, Ernstbrunner L, Ek ET. Biomechanical analysis of plating techniques for unstable lateral clavicle fractures with coracoclavicular ligament disruption (Neer type IIB). J Shoulder Elbow Surg 2023; 32:695-702. [PMID: 36535559 DOI: 10.1016/j.jse.2022.11.008] [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: 07/19/2022] [Revised: 11/01/2022] [Accepted: 11/10/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Neer type IIB lateral clavicle fractures are inherently unstable fractures with associated disruption of the coracoclavicular (CC) ligaments. Because of the high rate of nonunion and malunion, surgical fixation is recommended; however, no consensus has been reached regarding the optimal fixation method. A new plating technique using a superior lateral locking plate with anteroposterior (AP) locking screws, resulting in orthogonal fixation in the lateral fragment, has been designed to enhance stability and reduce implant failure. The purpose of this study was to biomechanically compare 3 different clavicle plating constructs within a fresh frozen human cadaveric shoulder model. METHODS Twenty-four fresh frozen cadaveric shoulders were randomized into 3 groups (n = 8 specimens): group 1, lateral locking plate only (Medartis Aptus Superior Lateral Plate); group 2, lateral locking plate with CC stabilization (No. 2 FiberWire); and group 3, lateral locking plate with 2 AP locking screws stabilizing the lateral fragment. All specimens were subject to cyclic loading of 70 N for 500 cycles. Data were analyzed for gap formation after cyclic loading, construct stiffness, and ultimate load to failure, defined by a marked decrease in the load displacement curve. RESULTS After 500 cycles, there was no statistically significant difference between the 3 groups in gap formation (P = .179). No specimen (0/24) failed during cyclic loading. Ultimate load to failure was significantly higher in group 3 compared to group 1 (286 N vs. 167 N; P = .022), but not to group 2 (286 N vs. 246 N; P = .604). There were no statistically significant differences in stiffness (group 1: 504 N/mm; group 2: 564 N/mm; group 3: 512 N/mm; P = .712). Peri-implant fracture was the primary mode of failure for all 3 groups, with group 3 demonstrating the lowest rate of peri-implant fractures (group 1: 6/8; group 2: 7/8; group 3: 4/8; P = .243). CONCLUSION Biomechanical evaluation of the clavicle plating techniques showed effective fixation across all specimens at 500 cycles. The lateral locking plate with orthogonal AP locking screw fixation in the lateral fragment demonstrated the greatest ultimate failure load, followed by the lateral locking plate with CC stabilization. This new plating technique showed compatible stiffness and gap formation when compared to conventional lateral locking plates as well as plates with CC fixation. The use of orthogonal screw fixation in the distal fragment may negate against the need for CC stabilization in these types of fractures, thus minimizing surgical dissection around the coracoid and potential complications.
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Affiliation(s)
- Olivia I Jo
- Melbourne Orthopaedic Group, Melbourne, VIC, Australia; Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Mitchell Almond
- Department of Biomedical Engineering, University of Melbourne, Melbourne, VIC, Australia
| | - Harshi S Rupansinghe
- Department of Biomedical Engineering, University of Melbourne, Melbourne, VIC, Australia
| | - David C Ackland
- Department of Biomedical Engineering, University of Melbourne, Melbourne, VIC, Australia
| | - Lukas Ernstbrunner
- Melbourne Orthopaedic Group, Melbourne, VIC, Australia; Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, VIC, Australia; Department of Biomedical Engineering, University of Melbourne, Melbourne, VIC, Australia
| | - Eugene T Ek
- Melbourne Orthopaedic Group, Melbourne, VIC, Australia; Hand and Wrist Biomechanics Laboratory (HWBL), O'Brien Institute/St. Vincent's Institute, Fitzroy, VIC, Australia; Department of Surgery, Monash Medical Centre, Monash University, Melbourne, VIC, Australia.
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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.
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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
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Sheth U, Fernandez CE, Morgan AM, Henry P, Nam D. Are two plates better than one? A systematic review of dual plating for acute midshaft clavicle fractures. Shoulder Elbow 2022; 14:500-509. [PMID: 36199514 PMCID: PMC9527487 DOI: 10.1177/17585732211002495] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 01/11/2021] [Accepted: 02/23/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND The rate of operative fixation of acute midshaft clavicle fractures has exponentially increased in recent years; however, the rate of reoperation for symptomatic hardware removal remains high and the optimal fixation strategy unknown. This systematic review aimed to summarize available evidence for dual plating of acute displaced midshaft clavicle fractures. METHODS EMBASE, MEDLINE, and PubMed searches identified clinical studies evaluating dual plate fixation of acute midshaft clavicle fractures. Pooled analysis was performed using a random-effects model in RevMan 5.3. RESULTS Eleven studies including 672 patients were included. Hardware removal occurred in 4.4% and 12.3% of patients undergoing dual and single plate fixation, respectively. Compared to single plating, dual plating had significantly lower odds of hardware removal (P = 0.001) with no difference in union rates. There were no significant differences in reoperation (excluding hardware removal), complications, and patient-reported outcomes between the two groups (P > 0.05). CONCLUSIONS This study suggests that dual plating of acute displaced midshaft clavicle fractures may lead to lower rates of reoperation for symptomatic hardware removal without compromising fracture healing. Ultimately, well-designed randomized trials are needed to further investigate the findings from this systematic review.
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Affiliation(s)
- Ujash Sheth
- Sunnybrook Orthopaedic Upper Limb (SOUL), Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada,Ujash Sheth, 2075 Bayview Avenue, MG301 Toronto, ON, Canada M4N 3M5.
| | - Claire E Fernandez
- Department of Orthopaedic Surgery, Northwestern University, Chicago, USA
| | - Allison M Morgan
- Department of Orthopaedic Surgery, Northwestern University, Chicago, USA
| | - Patrick Henry
- Sunnybrook Orthopaedic Upper Limb (SOUL), Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Diane Nam
- Sunnybrook Orthopaedic Upper Limb (SOUL), Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
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Ferguson DP, Baker HP, Dillman D, Theriault P, Trask K, MacDonald S, Trenholm A. Dual mini-fragment plate fixation of midshaft clavicle fractures is biomechanically equivalent to anatomic pre-contoured plating. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2022; 33:1109-1116. [PMID: 35412150 DOI: 10.1007/s00590-022-03268-1] [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: 03/06/2022] [Accepted: 04/05/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To biomechanically compare the stiffness of midshaft synthetic clavicle osteotomies fixed with either superior anatomic pre-contoured locking plates, anterior anatomic pre-contoured locking plates, or short-segment dual orthogonal mini-plate fixation. DESIGN AND SETTING Controlled laboratory study. Specimens Twenty-one synthetic pre-osteotomized clavicles were separated into three groups: superior plating, anterior plating, or dual-plating. Each clavicle was sequentially tested in non-destructive cycles of axial compression, three-point bending, and torsion. Load and displacement were recorded. Stiffness was calculated. RESULTS No statistically significant differences were found between construct stiffness during axial compression, three-point bending, or torsional testing. One superior plated clavicle suffered catastrophic failure during axial compression. One dual mini-fragment plated clavicle suffered catastrophic failure during torsion. CONCLUSIONS Orthogonal dual mini-fragment fixation of transverse clavicle fractures is biomechanically similar to superior and anterior pre-contoured anatomic locking plate fixation. No statistically significant differences in construct stiffness were found in axial compression, three-point bending, or torsion testing. Further clinical research is required to determine the long-term stability of dual mini-fragment plate fixation. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Devin P Ferguson
- Division of Orthopaedic Surgery, Dalhousie University, Halifax, NS, Canada
| | - Hayden P Baker
- Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago, 5841 South Maryland Avenue, Chicago, IL, 60637, USA.
| | - Daryl Dillman
- Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago, 5841 South Maryland Avenue, Chicago, IL, 60637, USA
| | - Patrick Theriault
- Division of Orthopaedic Surgery, Dalhousie University, Halifax, NS, Canada
| | - Kelly Trask
- Nova Scotia Health Authority, Halifax, NS, Canada
| | | | - Andrew Trenholm
- Division of Orthopaedic Surgery, Dalhousie University, Halifax, NS, Canada
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Rompen IF, van de Wall BJM, van Heijl M, Bünter I, Diwersi N, Tillmann F, Migliorini F, Link BC, Knobe M, Babst R, Beeres FJP. Low profile dual plating for mid-shaft clavicle fractures: a meta-analysis and systematic review of observational studies. Eur J Trauma Emerg Surg 2022; 48:3063-3071. [PMID: 35237845 DOI: 10.1007/s00068-021-01845-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/22/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Low profile dual plate fixation using two mini fragment plates (< 2.7 mm thickness) is a relatively new technique and alternative to single plating for treating midshaft clavicle fractures. To date, no meta-analysis has been performed comparing these two techniques. Therefore, a systematic review and meta-analysis of observational studies and randomized clinical trials was performed comparing single plating to low profile dual plating for midshaft clavicle fractures. METHODS PubMed/Medline/Embase/CENTRAL/CINAHL were searched for both randomized clinical trials (RCT) and observational studies comparing both treatments. Effect estimates were pooled across studies using random effects models. The primary outcome is overall complication rate and re-intervention rate. Secondary outcomes include healing, operation duration and functional scores. RESULTS Low profile dual plating has favourable outcomes regarding overall complication rate (8.1% vs. 22.5%, OR 0.3, 95% CI 0.2-0.7, I2 = 16%, p = 0.007) and re-intervention rate (6.1% vs. 16.1%, OR 0.3, 95% CI 0.1-0.9, I2 = 25%, p = 0.02). The largest contributing factor behind these differences was the high incidence of implant related complaints in the single plating group (4.7% vs. 11.6%, OR 0.4, 95% CI 0.2-0.9, I2 = 0%, p = 0.02). The use of low profile dual plating does not have a detrimental effect on healing with union being attained in 99% compared to 97.4% in the single plating group (OR 1.8, 95% CI 0.3-10.7, I = 0%, p = 0.5). Data on operating time and functional results is limited. CONCLUSION This meta-analysis shows that dual plating low profile plates for midshaft clavicle fractures is a safe procedure attaining the same union rates seen in patients treated with single plating. In addition, it seems to have a lower overall complication and re-intervention rate, mostly driven by the lower incidence of implant related complaints. Low profile dual plating, however, is a fairly new technique and should be further explored in respect to more differentiated endpoints to test whether these first findings are valid. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Ingmar Florin Rompen
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalstrasse, 6000, Lucerne, Switzerland
| | - Bryan Joost Marinus van de Wall
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalstrasse, 6000, Lucerne, Switzerland
- Department of Health Science and Medicine, University of Lucerne, Frohburgstrasse 3, 6002, Lucerne, Switzerland
| | - Mark van Heijl
- Department of Surgery, Hand and Wrist Unit, Diakonessenhuis, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands
| | - Isabelle Bünter
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalstrasse, 6000, Lucerne, Switzerland
| | - Nadine Diwersi
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalstrasse, 6000, Lucerne, Switzerland
| | - Franz Tillmann
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalstrasse, 6000, Lucerne, Switzerland
| | - Filippo Migliorini
- Department of Orthopaedics, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Björn-Christian Link
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalstrasse, 6000, Lucerne, Switzerland
| | - Matthias Knobe
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalstrasse, 6000, Lucerne, Switzerland
| | - Reto Babst
- Department of Health Science and Medicine, University of Lucerne, Frohburgstrasse 3, 6002, Lucerne, Switzerland
| | - Frank Joseph Paulus Beeres
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalstrasse, 6000, Lucerne, Switzerland.
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Kitzen J, Paulson K, Korley R, Duffy P, Martin CR, Schneider PS. Biomechanical Evaluation of Different Plate Configurations for Midshaft Clavicle Fracture Fixation: Single Plating Compared with Dual Mini-Fragment Plating. JB JS Open Access 2022; 7:JBJSOA-D-21-00123. [PMID: 35265785 PMCID: PMC8901219 DOI: 10.2106/jbjs.oa.21.00123] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background: Dual-plate constructs have become an increasingly common fixation technique for midshaft clavicle fractures and typically involve the use of mini-fragment plates. The goal of this technique is to reduce plate prominence and implant irritation. However, limited biomechanical data exist for these lower-profile constructs. The study aim was to compare dual mini-fragment orthogonal plating with small-fragment clavicle plates for biomechanical noninferiority and to determine if an optimal plate configuration could be identified using a cadaveric model. Methods: Twenty-four cadaveric clavicles were randomized to 1 of 6 groups, stratified by computed tomography-based bone mineral content (BMC): precontoured superior or anterior fixation using a single 3.5-mm Locking Compression Plate (LCP), and 4 different dual-plating constructs utilizing 2.4-mm and 2.7-mm Adaptation plates or LCPs. An inferior butterfly fracture was created. Axial, torsional, and bending (anterior and superior surface loading) stiffnesses were determined through nondestructive cyclic testing, followed by a load-to-failure test in 3-point superior surface bending. Results: For axial stiffness, the 2 dual-plate constructs with a superior 2.4-mm and anterior 2.7-mm plate (either Adaptation or LCP) were significantly stiffer than the other 4 constructs (p = 0.021 and p = 0.034). For both superior and anterior bending, the superior 2.4-mm and anterior 2.7-mm plate constructs were significantly stiffer when compared with the 3.5-mm superior plate (p = 0.043). No significant differences were found in torsional stiffness or load to failure between the different constructs. Conclusions: Dual plating using mini-fragment plates is biomechanically superior for the fixation of midshaft clavicle fractures when compared with a single, superior, 3.5-mm plate and has biomechanical properties similar to those of a 3.5-mm plate placed anteriorly. With the exception of axial stiffness, no significant differences were found when different dual-plating constructs were compared with each other. Clinical Relevance: This study validates the use of dual plating for midshaft clavicle fractures.
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Affiliation(s)
- Joep Kitzen
- Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada.,McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Orthopaedic Surgery, Maasstad Hospital, Rotterdam, the Netherlands
| | - Kent Paulson
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Robert Korley
- Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada.,McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Paul Duffy
- Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada.,McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - C Ryan Martin
- Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada.,McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Prism S Schneider
- Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada.,McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Examining the novel use of continuous compression implants in clavicle reconstruction: A biomechanical study. Clin Biomech (Bristol, Avon) 2021; 88:105437. [PMID: 34311318 DOI: 10.1016/j.clinbiomech.2021.105437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 06/15/2021] [Accepted: 07/15/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Current implants for clavicle fractures are known to cause poor cosmesis and irritation, which may require implant removal. Low-profile shape-memory staples provide an attractive alternative, but their biomechanical utility in clavicle reconstruction is unknown. We hypothesized that shape-memory reconstructions would be more compliant compared to traditional constructs but would also outperform conventional plates during cyclic loading to failure. METHODS This study was performed with 36 synthetic clavicles and 12 matched pairs of cadaveric specimens. The synthetic study tested four reconstructions: a single superiorly placed staple (n = 6), a single anteroinferiorly-placed staple (n = 6), a 3.5 mm reconstruction plate (n = 12), and two orthogonally placed staples (n = 12). The cadaveric study tested three constructs: reconstruction plate (n = 8), two orthogonal staples (n = 8), and a 2.7 mm reconstruction plate combined with a superior staple (n = 8). Non-destructive 4-point bending, compression, and torsion assays were performed prior to destructive cantilever bending and cyclic torsion tests. FINDINGS The single staple and double staple groups demonstrated significantly decreased resistance to bending (p < 0.001) and torsion (p ≤ 0.027) when compared to reconstruction plate groups. The double staple group sustained significantly fewer cycles to failure than the reconstruction plate group in cyclic torsional tests (p = 0.012). The synthetic models produced higher stiffness and failure mechanisms that were completely different from cadaveric specimens. INTERPRETATION Shape memory alloy implants provided inadequate stiffness for clavicle fixation but may have utility in other orthopaedic applications when used as a supplementary compression device in conjunction with traditional plated constructs. Synthetic bones have limited capacity for modeling fragility fractures.
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