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Robertson D, Peirce HF, Nicpon MD, Otterson EM, O’Connor L, Rissmiller JG, Binder ZW. Face-off Droop: A Case Report of Pediatric Stroke. Clin Pract Cases Emerg Med 2024; 8:120-124. [PMID: 38869333 PMCID: PMC11166058 DOI: 10.5811/cpcem.6586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 06/14/2024] Open
Abstract
Introduction Cerebrovascular accidents rarely occur in children; the incidence of ischemic stroke in patients <16 years of age is between 0.6-7.9/100,000. However, they are the fourth most common cause of acute neurological deficits in the pediatric population, and possible cases should be evaluated with a high index of suspicion to ensure timely intervention. Case Report We describe a previously healthy 17-year-old male who presented to the pediatric emergency department with a left facial droop and hemiparesis consistent with a stroke. The patient's age and lack of comorbidities made this an extremely uncommon presentation. Our patient's neurologic symptoms were believed to have been caused by a recent traumatic clavicular injury sustained two weeks prior, which subsequently led to vascular insult. Conclusion Cerebrovascular accidents are an important cause of morbidity and mortality in pediatric patients. Cerebrovascular accidents in children are most often secondary to congenital causes; however, care should be taken to assess for acquired causes, such as trauma to major blood vessels. While rarely implicated in traumatic injuries, arterial structures posterior to the medial clavicle can result in severe complications.
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Affiliation(s)
- Duncan Robertson
- University of Massachusetts, Chan Medical School, Department of Emergency Medicine, Worcester, Massachusetts
| | - Hayden F. Peirce
- University of Massachusetts, Chan Medical School, Department of Pediatrics, Worcester, Massachusetts
| | - Marek D. Nicpon
- University of Massachusetts, Chan Medical School, Department of Radiology, Worcester, Massachusetts
| | - Eric M. Otterson
- University of Massachusetts, Chan Medical School, Department of Emergency Medicine, Worcester, Massachusetts
| | - Laurel O’Connor
- University of Massachusetts, Chan Medical School, Department of Emergency Medicine, Worcester, Massachusetts
| | - Julia G. Rissmiller
- University of Massachusetts, Chan Medical School, Department of Radiology, Worcester, Massachusetts
| | - Zachary W. Binder
- University of Massachusetts, Chan Medical School, Department of Pediatrics, Worcester, Massachusetts
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Cavaliere A, Cepparulo V, Pezone G, Schonauer F. Clavicle Fracture Site Surgical Contouring: A Case Report. Arch Plast Surg 2024; 51:67-71. [PMID: 38425849 PMCID: PMC10901599 DOI: 10.1055/s-0043-1775880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/01/2023] [Indexed: 03/02/2024] Open
Abstract
Clavicle fractures are frequent injuries accounting for approximately 4% of all fractures in adults with about 35% occurring in the shoulder region among which midshaft fractures are the most common (>66%). Nonsurgical management is the treatment of choice for most clavicle fractures; however, poor functional and aesthetic outcomes may result from nonunion, symptomatic malunion, and aesthetic impairment which are the most common complications. A young woman was referred to our clinic for a "Step Deformity" resulting after primary, nonsurgical treatment of a midshaft clavicle fracture. Residual deformity was corrected with a novel simple and little invasive approach. Midshaft clavicle fractures typically only require conservative nonsurgical treatment, nevertheless suboptimal outcomes may occur. Selective osteotomies and fixation are deemed too invasive when only cosmetic impairment of the clavicle contour is present without any functional or sensitive damage and most patients are discouraged from undergoing surgery. Thus far, no specific focus on this topic, nor exploration of possible correction can be found in the published literature. These residual deformities may be very noticeable sometimes and cause psychological distress and social life impairment. Despite no related functional impairment, this deformity should still be addressed, to improve patients' quality of life.
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Affiliation(s)
| | | | - Giuseppe Pezone
- Unit of Plastic Surgery, University “Federico II”, Naples, Italy
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Trivellas M, Wittstein J. Midshaft Clavicle Fractures: When Is Surgical Management Indicated and Which Fixation Method Should Be Used? Clin Sports Med 2023; 42:633-647. [PMID: 37716727 DOI: 10.1016/j.csm.2023.05.005] [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
For displaced midshaft clavicle fractures, operative treatment either with open reduction and plate fixation or with intramedullary fixation has been shown to provide earlier return to work and sport, improved functional outcomes, greater patient-reported satisfaction with appearance, and significantly decreased incidence of nonunion and malunion when compared with conservative treatment. Operative intervention is not without risks associated with surgery. Shared decision-making with the patient and understanding patient goals allows surgeons to recommend a management option that the patient will be comfortable with and will follow to achieve a satisfactory outcome.
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Affiliation(s)
- Myra Trivellas
- Department of Orthopaedic Surgery, Duke University School of Medicine, 3475 Erwin Road, Durham, NC 27705, USA
| | - Jocelyn Wittstein
- Department of Orthopaedic Surgery, Duke University School of Medicine, 3475 Erwin Road, Durham, NC 27705, USA.
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Hu R, Su YJ, Chien CS. Supraclavicular nerve sparing versus sacrifice during open reduction internal fixation of acute midshaft clavicle fracture. J Orthop Surg Res 2023; 18:725. [PMID: 37749619 PMCID: PMC10518922 DOI: 10.1186/s13018-023-04220-7] [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: 05/07/2023] [Accepted: 09/19/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND The branches of the supraclavicular nerve are often sacrificed during open reduction and internal fixation (ORIF) for clavicle fracture. No consensus exists on whether the supraclavicular nerve should be routinely identified and protected during ORIF. METHODS We developed a simple method to make nerve sparing easier; Wide-Awake Local Anesthesia No Tourniquet (WALANT) solution is locally injected prior to the surgical incision being made. This retrospective study enrolled 340 patients and divided them into supraclavicular-nerve-sparing (n = 45) and supraclavicular-nerve-sacrifice (n = 295) groups. Surgical outcomes-including operative time, estimated blood loss, postoperative pain, union rate, time to union, functional score, paresthesia, complications, implant removal rate, and complication rate-were recorded. RESULTS Incisional or anterior chest wall numbness and intraoperative blood loss were significantly less (p < 0.001) in the nerve-sparing group. The operative time was similar in the two groups. No significant differences were discovered in QuickDASH score, postoperative pain score, union rate, time to union, implant removal rate, complication rate, or revision rate. CONCLUSIONS Our study demonstrated that the outcomes of supraclavicular nerve sparing during ORIF with WALANT can reduce postoperative incisional and anterior chest wall numbness and intraoperative blood loss without increasing the operative time or complication rate.
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Affiliation(s)
- Ruei Hu
- Orthopedics Department, Chi-Mei Medical Center, Tainan, Taiwan.
- Department of Orthopaedics, Kaohsiung Municipal Ta-Tung Hospital, KaoHsiung, Taiwan.
| | - Yu-Jung Su
- Orthopedics Department, Chi-Mei Medical Center, Tainan, Taiwan
| | - Chi-Sheng Chien
- Orthopedics Department, Chi-Mei Medical Center, Tainan, Taiwan
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Mast J, VAN Beek N, Claes T. Fast rehab after midshaft clavicula fractures in elite cyclists and motocross riders. Acta Orthop Belg 2023; 89:525-530. [PMID: 37935238 DOI: 10.52628/89.3.11696] [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: 11/09/2023]
Abstract
Clavicle fractures are one of the most common injuries in cyclists and motocross riders. Although a fast return to sport is imperative for athletes, there is only limited literature on short-term functional outcomes after open reduction internal fixation of a clavicle fracture in a homogenous group of athletes. The aim of this study is to evaluate early (first 6 weeks) functional outcomes, return to sports and complications of elite or high-level recreational (± 8000 km per year) cyclists and motocross riders after surgical treatment of a midshaft clavicle fracture. The main study parameters were Quick Disabilities of the Arm, Shoulder and Hand (QuickDash); QuickDash sports module, pain in rest and movement (Numeric Pain Rating Score) and time to return to sports (training indoor/outdoor and competition). All parameters were taken pre-operatively and at 2/4/6/12/24 weeks post-operative. A total of 34 cyclists (6 LTFU) and 9 motocross riders (2 LTFU) were included at baseline. A significant decrease in Quick dash scores between preoperative (33 ± 1.2) and 2 weeks PO (21.5 ± 1.2) and between 2 and 4 weeks PO (16.1 ± 1.3) was found for cyclists. The QuickDash scores of the motocross riders statistically improvement from preoperative (31.6 ± 3.3) to 6 weeks PO (14.1 ± 3.3). NRS score in rest for cyclists decreased significantly from 3.6 ± 0.2 to 1.0 ± 0.2 after two weeks. After 4 weeks, 93% of cyclists and 57% of motocross riders were training outside. After 6 weeks, 56% of cyclists and 57% of motocross riders had returned to competition. Our results show that early surgical treatment of midshaft clavicle fractures in elite cyclists and motocross riders is a safe method with few complications and good functional outcomes.
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Biz C, Pozzuoli A, Belluzzi E, Scucchiari D, Bragazzi NL, Rossin A, Cerchiaro M, Ruggieri P. An Institutional Standardised Protocol for the Treatment of Acute Displaced Midshaft Clavicle Fractures (ADMCFs): Conservative or Surgical Management for Active Patients? Healthcare (Basel) 2023; 11:1883. [PMID: 37444717 PMCID: PMC10341159 DOI: 10.3390/healthcare11131883] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The treatment of acute displaced midshaft clavicle fractures (ADMCFs) is still under debate. The aim of this study was to verify the effectiveness of our institutional protocol by comparing the clinical and radiographic outcomes of two groups of patients with ADMCFs treated operatively and non-operatively. MATERIALS AND METHODS active patients with a traumatic, isolated non-pathological ADMCF with at least 1-year clinical and radiographic follow up were included. Surgical treatment was performed in the cases where the residual displacement was higher than 140% after the application of a figure-of-eight bandage (F8-B). All other cases were treated conservatively with a F8-B. A total of 134 patients were enrolled and divided into two groups: surgical and conservative groups, with 59 and 75 patients, respectively. Radiological and clinical parameters were evaluated. RESULTS Good clinical (Constant-Murley Score, the Quick Disability of the Arm, Shoulder and Hand score, and VAS satisfaction) and radiographic outcomes (initial and residual shortening, initial and residual displacement) were obtained for ADMCFs in both groups. Multivariate analysis showed that patients treated conservatively had better clinical outcomes compared to surgically treated patients (p < 0.001). Return to sports was longer in those treated with surgery. Initial shortening was found to impact clinical outcomes as well as initial displacement. None of the patients showed signs of non-union in both groups. CONCLUSIONS Very good mid-term clinical results can be obtained in adult patients with ADMCFs, conservatively or operatively managed, by applying our institutional treatment protocol based on objective radiographic parameters evaluated in the ER.
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Affiliation(s)
- Carlo Biz
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University-Hospital of Padova, Via Giustiniani 3, 35128 Padova, Italy
- Centre for Mechanics of Biological Materials, University of Padova, 35131 Padova, Italy
| | - Assunta Pozzuoli
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University-Hospital of Padova, Via Giustiniani 3, 35128 Padova, Italy
- Centre for Mechanics of Biological Materials, University of Padova, 35131 Padova, Italy
- Musculoskeletal Pathology and Oncology Laboratory, Department of Surgery, Oncology and Gastroenterology, University of Padova, Via Giustiniani 3, 35128 Padova, Italy
| | - Elisa Belluzzi
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University-Hospital of Padova, Via Giustiniani 3, 35128 Padova, Italy
- Centre for Mechanics of Biological Materials, University of Padova, 35131 Padova, Italy
- Musculoskeletal Pathology and Oncology Laboratory, Department of Surgery, Oncology and Gastroenterology, University of Padova, Via Giustiniani 3, 35128 Padova, Italy
| | - Davide Scucchiari
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University-Hospital of Padova, Via Giustiniani 3, 35128 Padova, Italy
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON M3J 1P3, Canada
| | - Alessandro Rossin
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University-Hospital of Padova, Via Giustiniani 3, 35128 Padova, Italy
| | - Mariachiara Cerchiaro
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University-Hospital of Padova, Via Giustiniani 3, 35128 Padova, Italy
| | - Pietro Ruggieri
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University-Hospital of Padova, Via Giustiniani 3, 35128 Padova, Italy
- Centre for Mechanics of Biological Materials, University of Padova, 35131 Padova, Italy
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Chao YH, Chou YC, Lin CL. The deformities of acute diaphyseal clavicular fractures: a three-dimensional analysis. Biomed Eng Online 2023; 22:42. [PMID: 37161417 PMCID: PMC10170817 DOI: 10.1186/s12938-023-01112-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 05/02/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Although minimally invasive surgeries have gained popularity in many orthopaedic fields, minimally invasive approaches for diaphyseal clavicular fracture have not been widely performed, which is attributed to difficulties in performing a closed reduction of fracture deformities of a curved bone in a three-dimensional space. The goal of this study was to investigate the radiographic parameters of fracture deformities in a three-dimensional space and to identify the risk factors for deformities. METHODS The computed tomography images of 100 patients who sustained a clavicle fracture were included. Five parameters were used to analyze the deformities: change in clavicle length, fracture displacement, and fragment rotation around the X, Y, Z axes. The change in length was assessed using the length of the endpoint line. The displacement was assessed using the distance between the fracture midpoints. The rotation deformities were assessed using the Euler angles. The correlation between the parameters was evaluated with the Pearson correlation coefficient. The risk factors were evaluated using univariable analysis and multiple regression analysis. RESULTS The average change in length was - 5.3 ± 8.3 mm. The displacement was 11.8 ± 7.1 mm. The Euler angles in the Z-Y-X sequences were -1 ± 8, 1 ± 8, and - 8 ± 13 degrees. The correlation coefficient between the change in length and the displacement was - 0.724 (p < 0.001). The variables found to increase the risk of shortening and displacement were right-sided fracture (p = 0.037), male sex (p = 0.015), and multifragmentary type (p = 0.020). The variables found to increase the risk of rotation deformity were the number of rib fractures (p = 0.001) and scapula fracture (p = 0.025). CONCLUSIONS There was a strong correlation between shortening and displacement. The magnitude of anterorotation around the X axis was greater than the magnitude of retraction around the Z axis and depression around the Y axis. The risk factors for shortening and displacement included right-sided fracture, male sex, and multifragmentary type. The risk factor for retraction around the Z axis was the number of rib fractures, and the risk factor for depression around the Y axis was scapula fracture. These results could be useful adjuncts in guiding minimally invasive surgical planning for diaphyseal clavicular fractures.
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Affiliation(s)
- Yi-Hsuan Chao
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong Street, Taipei, 112, Taiwan
- Department of Orthopaedic Surgery, Taipei City Hospital, No. 10, Sec. 4, Ren'ai Rd., Da'an Dist., Taipei, 106, Taiwan
- Innovation & Translation Center of Medical Device, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong Street, Taipei, 112, Taiwan
| | - Ying-Chao Chou
- Department of Orthopedics, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan
| | - Chun-Li Lin
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong Street, Taipei, 112, Taiwan.
- Innovation & Translation Center of Medical Device, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong Street, Taipei, 112, Taiwan.
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Sivagurunathan G, Shirodkar K, Hegde G, Shamshuddin S, Proctor R, Naqvi J, Knowles D, Ali I. Musculoskeletal Computed Tomography: How to Add Value When Reporting Adult Upper Limb Trauma. J Comput Assist Tomogr 2023; 47:264-276. [PMID: 36877776 DOI: 10.1097/rct.0000000000001417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
ABSTRACT There is increasing reliance on computed tomography to evaluate fractures and dislocations following routine evaluation with plain radiography, critical in preoperative planning; computed tomography can provide multiplanar reformats and 3-dimensional volume-rendered imaging, providing a better global assessment for the orthopedic surgeon. The radiologist plays a critical role in appropriately reformatting the raw axial images to illustrate best the findings that will help determine further management. In addition, the radiologist must succinctly report the pertinent findings that will have the most significant bearing on treatment, assisting the surgeon in deciding between nonoperative and operative management. The radiologist should also carefully review imaging to look for ancillary findings in the setting of trauma beyond the bones and joints, including the lungs and rib cage when visualized.In this review article, we will systematically describe key features for fractures of the scapula, proximal humerus, distal humerus, radial head and neck, olecranon, coronoid process through a case-based approach, and distal radius. Although there are numerous detailed classification systems for each of these fractures, we aim to focus on the core descriptors that underpin these classification systems. The goal is to provide the radiologist with a checklist of critical structures they must assess and findings that they should mention in their report, emphasizing those descriptors that influence patient management.
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Wolf S, Chitnis AS, Manoranjith A, Vanderkarr M, Plaza JQ, Gador LV, Holy CE, Sparks C, Lambert SM. Surgical treatment, complications, reoperations, and healthcare costs among patients with clavicle fracture in England. BMC Musculoskelet Disord 2022; 23:135. [PMID: 35139854 PMCID: PMC8830003 DOI: 10.1186/s12891-022-05075-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/20/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The clinical and economic burden of clavicle fractures in England is not well documented. This study evaluated rates of surgical treatment, post-surgical complications, reoperations and costs in patients with clavicle fractures using the Clinical Practice Research Datalink (CPRD) database. METHODS CPRD data were linked to National Health Service Hospital Episode Statistics data. Patients with a diagnosis of clavicle fracture between 2010-2018 were selected in CPRD (date of fracture = index date). Of those, patients with surgical intervention within 180 days from index fracture were identified. Rates of post-surgical complications (i.e., infection, non-union, and mal-union), reoperations (for device removal or for postoperative complications), post-operative costs and median time to reoperations were evaluated up to 2 years after surgery. RESULTS 21,340 patients with clavicle fractures were identified (mean age 35.0 years(standard deviation (SD): 26.5), 66.7% male). Surgery was performed on 672 patients (3.2% of total cohort) at an average 17.1 (SD: 25.2) days post-fracture. Complications (i.e., infection, non-union, or malunion) affected 8.1% of surgically treated clavicle fracture patients; the rate of infection was 3.5% (95% CI, 1.7%- 5.2%), non-union 4.4% (95% CI, 2.4%-6.5%), and mal-union 0.3% (95% CI, 0%-0.7%). Adjusting for age, gender, comorbidities and time to surgery, the all-cause reoperation rate was 20.2% (13.2%-30.0%) and the adjusted rate of reoperation for implant removal was 17.0% (10.7%-25.9%)-84% of all-cause reoperations were thus performed for implant removal. Median time to implant removal was 254 days. The mean cost of reoperations for all causes was £5,000. The most expensive reoperations were for cases that involved infection (mean £6,156). CONCLUSIONS Complication rates following surgical clavicle fracture care averaged 8.1%. However, reoperation rates exceed 20%, the vast majority of reoperations being performed for device removal. Technologies to alleviate secondary device removal surgeries would address a significant clinical unmet need.
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Affiliation(s)
| | | | | | | | | | | | - Chantal E Holy
- Medical Devices Epidemiology, Johnson & Johnson, New Brunswick, NJ, USA.
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van der Water L, Macken AA, Eygendaal D, van Bergen CJA. Pediatric Clavicle Fractures and Congenital Pseudarthrosis Unraveled. CHILDREN 2022; 9:children9010049. [PMID: 35053674 PMCID: PMC8774508 DOI: 10.3390/children9010049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 12/19/2021] [Accepted: 12/22/2021] [Indexed: 01/29/2023]
Abstract
Clavicle fractures are commonly seen in the pediatric and adolescent populations. In contrast, congenital pseudarthrosis of the clavicle is rare. Although both conditions may present with similar signs and symptoms, especially in the very young, clear differences exist. Clavicle fractures are often caused by trauma and are tender on palpation, while pseudarthrosis often presents with a painless protuberance on the clavicle, which becomes more prominent as the child grows. Its presence may only become apparent after trauma, as it is usually asymptomatic. The diagnosis is confirmed on plain radiography, which shows typical features to distinguish both entities. Both clavicle fractures and congenital pseudarthrosis are generally treated conservatively with a high success rate. Operative treatment for a fracture can be indicated in the case of an open fracture, severely displaced fracture, floating shoulder, neurovascular complications or polytrauma. Congenital pseudarthrosis requires operative treatment if the patient experiences progressive pain, functional limitation and late-onset thoracic outlet symptoms, but most operations are performed due to esthetic complaints.
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Affiliation(s)
- Lisa van der Water
- Depeartment of Orthopedic Surgery, Amphia Hospital, 4818 CK Breda, The Netherlands; (A.A.M.); (D.E.); (C.J.A.v.B.)
- Correspondence:
| | - Arno A. Macken
- Depeartment of Orthopedic Surgery, Amphia Hospital, 4818 CK Breda, The Netherlands; (A.A.M.); (D.E.); (C.J.A.v.B.)
| | - Denise Eygendaal
- Depeartment of Orthopedic Surgery, Amphia Hospital, 4818 CK Breda, The Netherlands; (A.A.M.); (D.E.); (C.J.A.v.B.)
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Christiaan J. A. van Bergen
- Depeartment of Orthopedic Surgery, Amphia Hospital, 4818 CK Breda, The Netherlands; (A.A.M.); (D.E.); (C.J.A.v.B.)
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Scanaliato JP, Wells ME, Dunn JC, Garcia EJ. Overview of Sport-Specific Injuries. Sports Med Arthrosc Rev 2021; 29:185-190. [PMID: 34730116 DOI: 10.1097/jsa.0000000000000312] [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: 11/25/2022]
Abstract
Athletes are at risk for a variety of injuries not typically sustained in everyday life. The team physician must be capable of not only identifying and treating injuries as they occur, but he or she must be armed with the knowledge to minimize the risk of injuries before they occur. This review serves to provide an overview of the various sport-specific injuries typically encountered by team physicians. Injuries are grouped by body part and/or organ system, when possible. We do not aim to cover in detail the various treatments for these injuries; rather, we hope that this article provides a comprehensive overview of sport-specific injury, and demonstrate the well-roundedness in skills that must be possessed by team physicians.
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Park JS, Ko SH, Hong TH, Ryu DJ, Kwon DG, Kim MK, Jeon YS. Plate fixation versus titanium elastic nailing in midshaft clavicle fractures based on fracture classifications. J Orthop Surg (Hong Kong) 2021; 28:2309499020972204. [PMID: 33258399 DOI: 10.1177/2309499020972204] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The best strategy for implant selection in midshaft clavicular fractures (MCF) remains controversial. The present study aims to determine the optimal strategy for implant selection by comparing plate and Titanium Elastic Nail (TEN) with respect to outcomes and related complications and analyze the results based on fracture patterns. METHODS A total of 97 patients with MCF who underwent plate (48 patients) or TEN (49 patients) fixation were retrospectively reviewed. Both groups were divided into three subgroups by fracture type using the AO Foundation/Orthopaedic Trauma Association classification: simple fracture (type A), wedge fracture (type B), and multi-fragmentary fracture (type C). The observed outcome measures were bone union rate, related complications, functional scores, and patient satisfaction score. These outcomes were analyzed based on the fracture classification. RESULTS Both groups demonstrated excellent union rates (p = 0.495) and similar functional scores (p > 0.05). Visual analog scale (VAS) for satisfaction was better in TEN than plate fixation (p < 0.001). In type A and B subgroups, there were no significant difference in functional scores between plate and TEN fixation (p > 0.05). In type C subgroup, however, both VAS for pain and DASH score in TEN fixation were significantly worse than in plate fixation at 2 and 6 weeks postoperatively (p < 0.05). The incidences of clavicle shortening and skin irritation are higher especially in type C subgroup of TEN fixation (p < 0.05). CONCLUSION Patient satisfaction of TEN fixation was higher than that of plate fixation, but TEN fixation had a higher incidence of early postoperative pain and migration in type C fractures. Therefore, type A and B fractures can successfully be treated with plate or TEN fixation, but type C fractures should be treated with plate fixation.
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Affiliation(s)
- Jun Sung Park
- Department of Orthopaedic Surgery,65745Inha University Hospital, Incheon, Republic of Korea
| | - Sang Hyun Ko
- Department of Orthopaedic Surgery,65745Inha University Hospital, Incheon, Republic of Korea
| | - Taek Ho Hong
- Department of Orthopaedic Surgery,65745Inha University Hospital, Incheon, Republic of Korea
| | - Dong Jin Ryu
- Department of Orthopaedic Surgery,65745Inha University Hospital, Incheon, Republic of Korea
| | - Dae Gyu Kwon
- Department of Orthopaedic Surgery,65745Inha University Hospital, Incheon, Republic of Korea
| | - Myung-Ku Kim
- Department of Orthopaedic Surgery,65745Inha University Hospital, Incheon, Republic of Korea
| | - Yoon Sang Jeon
- Department of Orthopaedic Surgery,65745Inha University Hospital, Incheon, Republic of Korea
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Davis BP, Shybut TB, Coleman MM, Shah AA. Risk factors for hardware removal following operative treatment of middle- and distal-third clavicular fractures. J Shoulder Elbow Surg 2021; 30:e103-e113. [PMID: 32663568 DOI: 10.1016/j.jse.2020.06.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/20/2020] [Accepted: 06/28/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The incidence of hardware removal (HWR) after operative fixation of clavicular fractures varies widely. Risk factors related to HWR remain incompletely understood. The aim of this study was to evaluate the incidence of and risk factors for HWR after plate fixation of middle- and distal-third clavicular fractures. We hypothesized that (1) the total HWR incidence would be <20%, (2) the HWR incidence of operatively treated distal- and middle-third clavicular fractures would not be statistically different, and (3) symptomatic implants would be the most common HWR indication. METHODS We performed a multi-hospital retrospective study of skeletally mature patients who underwent plate fixation of middle- and distal-third clavicular fractures from November 2008 to November 2018. Data included patient demographic characteristics, mechanism of injury, operative records, hardware-related symptoms, subsequent HWR, and complications. RESULTS A total of 103 patients (aged 16-75 years, 76.7% male patients) were included. Of the patients, 87 (84.5%) underwent plate fixation for midshaft clavicular fractures and 16 (15.5%) underwent plate fixation for distal-third clavicular fractures. HWR was performed in 13 patients (12.6%). A significantly higher percentage of HWR procedures were performed for distal clavicular fractures (50%) than for middle-third clavicular fractures (4.9%, P < .0001). An initial high-energy mechanism of injury was associated with HWR (P = .0025). The most common indication for HWR was symptomatic hardware (69.2%). The overall complication rate was 14.5%. CONCLUSION The overall incidence of clavicular HWR was 12.6%. A distal fracture location was associated with a significantly higher incidence of HWR. An initial high-energy mechanism of injury was a significant risk factor for HWR. The primary indication for HWR was symptomatic hardware.
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Tagliapietra J, Belluzzi E, Biz C, Angelini A, Fantoni I, Scioni M, Bolzan M, Berizzi A, Ruggieri P. Midshaft Clavicle Fractures Treated Nonoperatively Using Figure-of-Eight Bandage: Are Fracture Type, Shortening, and Displacement Radiographic Predictors of Failure? Diagnostics (Basel) 2020; 10:diagnostics10100788. [PMID: 33027989 PMCID: PMC7599597 DOI: 10.3390/diagnostics10100788] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/02/2020] [Accepted: 10/04/2020] [Indexed: 12/16/2022] Open
Abstract
As there are no clear and unique radiographic predictors of healing disturbances for acute midshaft clavicle fractures, their treatment is still controversial. The aim of the study was to evaluate in midshaft clavicle fractures treated nonoperatively if fracture type (FT), shortening, and displacement, assessed before and after figure-of-eight bandage (F8-B) application, could be considered prognostic factors of delayed union and nonunion. One hundred twenty-two adult patients presenting a closed displaced midshaft clavicle fracture, managed nonoperatively with an F8-B, were enrolled. FT, initial shortening (IS), and initial displacement (ID) were radiographically evaluated at diagnosis, and both residual shortening (RS) and displacement (RD) were measured after F8-B application. The patients were followed up 1, 3, 6, and 12 months post-injury. Multivariate statistical analysis was performed. RD should be considered as radiological predictor of sequelae. Further, an RD equal to 104% of clavicle width was identified as an optimal cut-off point to distinguish between healed and unhealed fractures, and 140% between delayed union and nonunion. Our data pointed out the effectiveness of the F8-B in reducing fracture fragments and restoring clavicular length. In midshaft clavicle fractures of adults, fracture comminution and clavicular shortening did not influence bone healing. On the contrary, RD has been shown as the most likely predictor of both delayed union and nonunion.
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Affiliation(s)
- Jacopo Tagliapietra
- Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, 35128 Padova, Italy
| | - Elisa Belluzzi
- Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, 35128 Padova, Italy
- Musculoskeletal Pathology and Oncology Laboratory, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, 35128 Padova, Italy
| | - Carlo Biz
- Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, 35128 Padova, Italy
| | - Andrea Angelini
- Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, 35128 Padova, Italy
| | - Ilaria Fantoni
- Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, 35128 Padova, Italy
| | - Manuela Scioni
- Department of Statistical Sciences, University of Padova, 35121 Padova, Italy
| | - Mario Bolzan
- Department of Statistical Sciences, University of Padova, 35121 Padova, Italy
| | - Antonio Berizzi
- Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, 35128 Padova, Italy
| | - Pietro Ruggieri
- Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, 35128 Padova, Italy
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King PR, Lamberts RP. Management of clavicle shaft fractures with intramedullary devices: a narrative review. Expert Rev Med Devices 2020; 17:807-815. [PMID: 32635794 DOI: 10.1080/17434440.2020.1793668] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Displaced and shortened clavicle fractures are frequently treated surgically. Although extramedullary fixation using a plate and screws is most commonly used, intramedullary nailing has become increasingly popular over the last decade. Traditional intramedullary nailing is usually associated with a high risk of hardware migration as well as hardware irritation at its entry point. Newer devices, however, seem to mitigate these problems. The aim of this narrative review is to provide an overview of clavicle shaft fractures and treatment with intramedullary nails, in particular the newer, locked devices. AREAS COVERED In general, this review covers current literature related to clavicle shaft fractures with a specific focus on the treatment of displaced and shortened fractures with intramedullary nails. EXPERT OPINION Clavicle shaft fractures can be effectively treated with an intramedullary nail. The risk of hardware migration when employing the newer, improved designs appears to be minimal. The advantages of using intramedullary fixation include smaller incision sizes as well as the avoidance of routine procedures generally associated with the removal of prominent subcutaneous hardware as per extramedullary fixation.
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Affiliation(s)
- Paul Reginald King
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University , Tygerberg, South Africa
| | - Robert Patrick Lamberts
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University , Tygerberg, South Africa
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Bong YR, Vrancic S. Recurrent acute limb ischaemia and thoracic outlet syndrome secondary to a clavicle fracture malunion. ANZ J Surg 2020; 90:E121-E122. [DOI: 10.1111/ans.15893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/27/2020] [Accepted: 03/22/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Yi Ren Bong
- Department of Orthopedic Surgery, Australian Capital Territory Health The Canberra Hospital Canberra Australian Capital Territory Australia
| | - Sindy Vrancic
- Department of Orthopedic Surgery, Australian Capital Territory Health The Canberra Hospital Canberra Australian Capital Territory Australia
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Vaishya R. Shoulder trauma update. J Clin Orthop Trauma 2019; 10:461. [PMID: 31061569 PMCID: PMC6491922 DOI: 10.1016/j.jcot.2019.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Kirschner Wire Temporary Intramedullary Fixation Combined with a Locking Anatomical Plate versus a Reconstruction Plate in the Treatment of Comminuted Clavicular Fractures: A Retrospective Study. BIOMED RESEARCH INTERNATIONAL 2019; 2018:5017162. [PMID: 30671456 PMCID: PMC6323430 DOI: 10.1155/2018/5017162] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 11/24/2018] [Accepted: 12/05/2018] [Indexed: 11/17/2022]
Abstract
We investigate the clinical efficacy of Kirschner wire temporary intramedullary fixation combined with a locking anatomical plate for the treatment of comminuted clavicular fractures. We retrospectively studied 112 patients [80 (71%) men] treated between February 2007 and February 2014. The patients were allocated to treatment with Kirschner wire temporary intramedullary fixation combined with a locking anatomical plate [minimally invasive group (GM)] or a reconstruction plate [traditional group (GT)]. The 112 patients were followed up for 12-48 months (mean, 14 months). The operation time was significantly shorter in GM than in GT. Intraoperative blood loss was significantly less in GM than in GT. The total incision length was significantly shorter and the visual analog scale pain score 24 h after surgery was significantly lower in GM than in GT. Fracture healing time was significantly shorter and the complication rate was significantly lower in GM than in GT. No significant difference in shoulder function score was observed between groups. We recommend Kirschner wire temporary intramedullary fixation combined with a locking anatomical plate as the treatment of choice for comminuted clavicular fractures because of the shorter operation time, lesser intraoperative blood loss, easier reduction of the operation, quicker fracture healing, and lower postoperative complication rate.
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