A Comparative Assessment of Functional Outcome of Clavicular Fractures Treated by Conservative and Surgical Methods: An Institutional Based Study

Background: Clavicle fracture is a common condition mostlytreated conservatively. Newer operative modalities have comeup to obtain early fixation.Materials and Methods: The present study was conducted in30 patients of clavicle mid shaft fractures which were treatedsurgically and conservatively. Closed fresh fractures in themiddle third region, open fractures of grade 1 and 2 wereincluded and grade 3 open fractures were excluded from thestudy. Patients under the age of 18 and fractures in the medialand lateral third, Pathological fractures were excluded from thestudy. The patients are divided randomly in to operative andconservative group. Sutures removed at 10-12 days. Thefunctional outcome was assessed by Constant and Murleyscore.Results: In the present study total sample size was 30.Clavicular fractures were prevalent in males (60%). Unionoccur in maximum cases in conservative treatment in 21months whereas in operative treatment union occurs inmaximum cases in18 months. The functional outcome wasexcellent in 5 cases in conservative treatment whereas inoperative treatment it was excellent in 6 cases.Conclusion: The present study concluded that operativetreatment was better than conservative treatment for clavicularfractures.

Clinical comparative study of thoracoscopic assisted reduction and traditional manual reduction with percutaneous intramedullary nail internal fixation for mid-clavicular fractures / 中国修复重建外科杂志

Objective: To compare the effectiveness of thoracoscopic assisted reduction and traditional manual reduction with percutaneous intramedullary nail internal fixation in the treatment of mid-clavicular fractures. Methods: A prospective randomized controlled trial was conducted. Twenty-two patients with mid-clavicular fractures who met the selection criteria between March 2012 and March 2017 were recruited and randomly divided into trial group (7 cases, thoracoscopic assisted reduction and percutaneous intramedullary nail fixation) and control group (15 cases, traditional manual reduction and percutaneous intramedullary nail fixation). There was no significant difference in gender, age, side, cause of injury, fracture classification, interval between injury and operation between the two groups ( P>0.05). The operation time and fracture healing time were recorded and compared between the two groups. The effectiveness was evaluated by Constant-Murley scale at 6 months after operation, which included subjective evaluation indexes (functional activity and pain) and objective evaluation indexes (range of motion of shoulder joint and muscle strength). Results: The operation time of the trial group was significantly longer than that of the control group ( t=5.881, P=0.000). Patients in both groups were followed up 7-20 months, with an average of 11 months. Satisfactory anatomical reduction achieved in all patients, and all incisions healed by first intension. In the control group, 1 patient had difficulty in removing the intramedullary nail, and 1 patient had fracture nonunion. No fracture nonunion or intramedullary nail rupture in the other patients of two groups. There was no significant difference in fracture healing time between the two groups ( t=0.764, P=0.453). At 6 months after operation, there was no significant difference in Constant-Murley scale between the two groups ( P>0.05). Conclusion: The treatment of the mid-clavicular fracture by using thoracoscopic assisted reduction with intramedullary nail internal fixation requires longer operation time, but does not require fluoroscopy. The effectiveness is comparable to that of traditional surgery.

Effectiveness of Nice knot combined with elastic intramedullary nailing fixation in treatment of Robinson type 2B midshaft clavicular fracture in adults / 中国修复重建外科杂志

Objective: To investigate the effectiveness of Nice knot combined with elastic intramedullary nailing fixation in treatment of Robinson type 2B midshaft clavicular fracture in adults. Methods: Between March 2016 and January 2018, 20 patients with Robinson type 2B midshaft clavicular fractures were treated with reduction and internal fixation by Nice knot and elastic intramedullary nailing. There were 13 cases and 7 cases, with an average age of 43 years (range, 18-56 years). The causes of injury included the traffic accident in 6 cases, falling in 12 cases, and falling from height in 2 cases. The interval between injury and admission ranged from 1 hour to 2 days (mean, 3.2 hours). The fractures were classified as Robinson type 2B1 in 16 cases and type 2B2 in 4 cases. The length of incision, the operation time, the visual analogue scale (VAS) score on the 2nd day after operation, the fracture healing time, the postoperative shoulder function and the Disability of Arm Shoulder and Hand (DASH) score, the complications, and the time of second surgical removal of internal fixator and incision length were recorded. Results: The length of incision was 2-6 cm (mean, 4.7cm). The operation time was 45-120 minutes (mean, 77.2 minutes). The VAS score was 1-5 (mean, 3.2) on the 2nd day after operation. All incisions healed by first intention and no infection or nerve injury occurred. All patients were followed up 12-32 months (mean, 18.6 months). All fractures healed with the healing time of 10-15 weeks (mean, 12.1 weeks). The Constant score was 92-98 (mean, 96.3) and DASH score was 0-6.4 (mean, 3.1). The elastic intramedullary nailing bending and hypertrophic nonunion occurred in 1 case and the skin stimulated by elastic nail tail in 1 case after operation. The internal fixators were removed at 12-26 months (mean, 14.6 months) after operation. And the length of incision was 1-2 cm (mean, 1.3 cm) and the operation time was 5-15 minutes (mean, 9.0 minutes). Conclusion: For the midshaft clavicular fracture in adults, the procedure of the Nice knot combined with elastic intramedullary nail has advantages of small incision, light pain, rapid fracture healing, small secondary operation injury, and avoiding the risk of clavicular epithelial nerve injury, and can obtain good effectiveness.

Simulation analysis on optimial loading scheme of resetting tensile stress for clavicular fracture / 医用生物力学

Objective To investigate the optimal scheme about the external loading of resetting tensile stress for clavicular fracture,so as to provide some mechanical references for optimal design of external fixators for clavicular fracture.Methods The shoulder CT scanning data from a volunteer were used to establish the three-dimensional model of human left shoulder by Mimics software.In order to better simulate the actual human shoulder,the ligament tissues were added in the model and the constraints of muscles were considered,and the experimental model for simulation analysis on resetting tensile stress was established.By 3 simulation experiments,the impacts from directions of resetting tensile stress,positions of action points and value ranges were simulated and analyzed,respectively.The resetting tensile stresses obtained from clavicle of the shoulder model under various external loading cases were simulated by orthogonal test methods.Results When the θ (angle between the horizontal plane projection of shoulder force which was loaded by external fixator and the coronal axis) was greater than 45°,clavicle could obtain the resetting tensile stress,which became greater with the angle θ increasing.When η (angle between the sagittal plane projection of shoulder force which was loaded by external fixator and the sagittal axis) was 30°-45°,the resetting tensile stress of clavicle was the maximum.The farther the position on which the loads from external fixator was exerted from the horizontal position of clavicle,the larger the resetting tensile stress of clavicle was.Conclusions The results of orthogonal test show that the optimal resetting tensile stress is produced with parameter combination of θ =65°,η =50°,acting on the center of humerus head of the shoulder.

Simulation analysis on optimial loading scheme of resetting tensile stress for clavicular fracture / 医用生物力学

Objective To investigate the optimal scheme about the external loading of resetting tensile stress for clavicular fracture,so as to provide some mechanical references for optimal design of external fixators for clavicular fracture.Methods The shoulder CT scanning data from a volunteer were used to establish the three-dimensional model of human left shoulder by Mimics software.In order to better simulate the actual human shoulder,the ligament tissues were added in the model and the constraints of muscles were considered,and the experimental model for simulation analysis on resetting tensile stress was established.By 3 simulation experiments,the impacts from directions of resetting tensile stress,positions of action points and value ranges were simulated and analyzed,respectively.The resetting tensile stresses obtained from clavicle of the shoulder model under various external loading cases were simulated by orthogonal test methods.Results When the θ (angle between the horizontal plane projection of shoulder force which was loaded by external fixator and the coronal axis) was greater than 45°,clavicle could obtain the resetting tensile stress,which became greater with the angle θ increasing.When η (angle between the sagittal plane projection of shoulder force which was loaded by external fixator and the sagittal axis) was 30°-45°,the resetting tensile stress of clavicle was the maximum.The farther the position on which the loads from external fixator was exerted from the horizontal position of clavicle,the larger the resetting tensile stress of clavicle was.Conclusions The results of orthogonal test show that the optimal resetting tensile stress is produced with parameter combination of θ =65°,η =50°,acting on the center of humerus head of the shoulder.

Simulation analysis on optimial loading scheme of resetting tensile stress for clavicular fracture / 医用生物力学

Objective To investigate the optimal scheme about the external loading of resetting tensile stress for clavicular fracture,so as to provide some mechanical references for optimal design of external fixators for clavicular fracture.Methods The shoulder CT scanning data from a volunteer were used to establish the three-dimensional model of human left shoulder by Mimics software.In order to better simulate the actual human shoulder,the ligament tissues were added in the model and the constraints of muscles were considered,and the experimental model for simulation analysis on resetting tensile stress was established.By 3 simulation experiments,the impacts from directions of resetting tensile stress,positions of action points and value ranges were simulated and analyzed,respectively.The resetting tensile stresses obtained from clavicle of the shoulder model under various external loading cases were simulated by orthogonal test methods.Results When the θ (angle between the horizontal plane projection of shoulder force which was loaded by external fixator and the coronal axis) was greater than 45°,clavicle could obtain the resetting tensile stress,which became greater with the angle θ increasing.When η (angle between the sagittal plane projection of shoulder force which was loaded by external fixator and the sagittal axis) was 30°-45°,the resetting tensile stress of clavicle was the maximum.The farther the position on which the loads from external fixator was exerted from the horizontal position of clavicle,the larger the resetting tensile stress of clavicle was.Conclusions The results of orthogonal test show that the optimal resetting tensile stress is produced with parameter combination of θ =65°,η =50°,acting on the center of humerus head of the shoulder.

The relationship between the fracture of the clavicle which was fixed by torsional-shaped plate and nonunion / 中国基层医药

Objective To discuss the relationship between the fracture of the clavicle which was fixed by tor-sional-shaped plate and nonunion after operation.Methods Retrospective analysis was conducted in 426 patients with midshaft clavicle fractures.Among the patients,the A group used torsional-shaped plate to meet the anatomical structure of the clavicle:the medial plate matched under the front face of the clavicle,and the lateral plate matched the up face of the clavicle.And the traditional method was used in the B group.Patients were followed up for at least 12 months,the patients were judged by X-ray criteria for nonunion.Results A total of 28 patients with nonunion, including 4 cases in A group,24 cases in B group.After statistics processing,the difference between A group and B group was significant (χ2 =6.679,P=0.010).Conclusion We find that the treatment of the fracture of the middle part of the clavicle with torsional-shaped plate can effectively reduce the incidence of nonunion.

Spinal Canal Migration of a K-Wire Used for Fixation of a Distal Clavicular Fracture / 대한정형외과학회잡지

We report on migration of the K-wire, which is used in fixation of a distal clavicular fracture, to the spinal canal. A 39-year-old male was admitted to our hospital with pain in his right shoulder. He had undergone surgery for a right distal clavicular fracture (in another hospital) ten years ago. Plain radiographs showed an old right distal clavicle fracture fixed with three K-wires. One of the three K-wires had broken, and the broken K-wire had migrated to the spinal canal. Fortunately, the patient exhibited no neurological symptoms, however, there was a possibility of fatal complications, such as spinal cord injury. Therefore, we recommend close follow-up for patients who undergo repair of a distal clavicular fracture is fixed using a K-wire, with use of x-ray until the K-wire has been removed.

Results of Hook Plate Fixation of Unstable Distal Clavicle Fractures

PURPOSE: This study evaluated the clinical and radiological outcomes of unstable distal clavicular fractures treated with an AO Hook plate. MATERIALS AND METHODS: From March 2009 to October 2010, sixteen patients with distal clavicular fractures underwent open plating using an AO Hook plate. The clinical outcomes were assessed by measuring the UCLA scores and KSS sores, and the radiological outcomes were evaluated using simple radiographs at the final follow-up. RESULTS: Fracture union was obtained in all patients at an average of 13.9 weeks (range, 9~20 weeks). The UCLA scoring system showed excellent results in 9 cases and good results in 7. The average KSS scores of distal clavicular fractures were 95.5. At the final follow-up, subacromial osteolysis developed in 11 cases (68.7%) of whom 3 suffered from pain around the acromion. Other complications occurred in 4 patients: one had a fracture adjacent to the plate proximally, two had a stiff shoulder with subacromial impingement, and one had hypoesthesia around the surgical wound. CONCLUSION: Unstable distal clavicular fractures treated with a Hook plate provided rigid fixation and satisfactory outcomes considering the high union rate. Nevertheless, potential postoperative complications related to morphometric properties of the plate should be considered.

Treatment of NeerⅡdistal clavicular fracture with small incision Dewar's operation / 中国矫形外科杂志

0.05; the holding vs neutral position, the disaster side and the healthy side all had significant difference,P0.05.This showed that the capability of stability of a-c joint were good. The Roentgenograms of shoulder elevation position raise showed that there was no impact in the a-c joint.[Conclusion]The results of small incision Dewar's operation is good in treating instability distal clavicular fracture.It has the advantages of minimally invasive,easy operation and fixation.

Clinical analysis on treatment of lateral clavicular fracture and acromioclavicular joint dislocation with clavicular hook plate / 中国医师进修杂志

Objective To analyze the effect of clavicular hook plate(CHP) in treating distal clavicular fracture and acromioclavicular joint dislocation. Methods Eighteen patients with distal clavicular fracture(NeerⅡ) and acromioclavicular joint disclocation(Tossy Ⅲ) were treated by CHP. Results Sixteen patients were observed after operation,according to Lazzcano curative effect standard, fifteen cases were excellent, take 93.75 percent,1 case was good, with 6.25 percent, the excellent and good rates were 100.00 percent. The phenomenon such as the steel plate fracture,loose,escape hook and acromioclavicular joint re-dislocation were not happened. Conclusion CHP is an effective,scientific and convenience way for distal clavicular fracture and acromioclavicular joint dislocation,it worth being promoted.

Late-onset Brachial Artery Occlusion caused by Subclavian Artery Stenosis after Clavicular Fracture: A Case Report

Although vascular injury after clavicular fracture is a extremely rare, it is a complication which is serious problem. Vascular injury associated with the fracture can be immediate or delayed. We report a case of late-onset brachial artery occlusion caused by subclavian artery stenosis with excessive scar tissue after open reduction and plate fixation for clavicular fracture and include a review of the literature.

Treatment of dislocation of acromioclavicular joint and/or fracture of distal clavicle using AO clavicular hook plate / 中华创伤骨科杂志

Objective To evaluate the clinical effects of AO clavicular hook plates in treatment of dislocation of acromioclavicular joint and/or fracture of distal clavicle in comparison with traditional means. Methods A retrospective analysis was done to compare the outcomes and complications between the treatment of dislocation of acromioclavicular joint and/or the fracture of distal clavicle by AO clavicular hook plates and the treatment by conventional devices (e.g. Kirschner’s wire, wire-cerclage, bolt, et al). Results 40 cases were followed up for 12 to 20 months and the average time was 14 months. According to Lazzcano’s criterion, the rate of excellent and fine of the clinical outcomes of the 2 groups was 100%and 78.6%respectively. After statistical Chi-square test, P=0.025. Therapeutic outcomes and complications of the former were obviously better than the latter. Conclusion Since AO clavicular hook plates display advantages of rigid fixation, non-invasion into articular surface, and possibility of early functional exercise in the treatment of acromioclavicular dislocation and fractures of distal clavicle, they are worthy of recommending.

Treatment of distal third fracture of clavicle with AO clavicular hook plate / 中华创伤骨科杂志

Objective To study the outcome of distal third clavicular fracture treated with AO clavicular hook plate. Methods From May 2001 to May 2003, 14 cases of fresh distal third clavicular fracture (Neer typeⅡ) were treated with AO clavicular hook plate in our hospital. Results All the cases obtained satisfactory results. No infection, nonunion, ineffective internal fixation, or loosening or breakage of the plate occurred. Conclusion The treatment of distal third clavicular fracture with AO clavicular hook plate is an effective surgical method.

Conservative Treatment of the Displaced Clavicular Shaft Fracture in Multiple Injury

PURPOSE: To analyse the comparative clinical results between adults with multiple injury including the clavicular shaft fracture and only clavicular shaft fracture who had supportive care through retrospective aspect. MATERIALS AND METHODS: We had 48 adult patients in this hospital with simple fracture and multiple injury including the clavicular shaft whom we were able to evaluate at least more than a year. 12 of 48 patients were with only clavicular shaft fracture and the rest of them were with multiple injury. We classified patients into two groups those who had fracture with displacement for group A (A1 for the cases with over 50% of fracture surface contact rate and A2 for less than 50% from the images of simple X-ray) and those who had comminuted fracture for B. We compared the time of bone union, nonunion rate of only clavicular fractures and multiple injury, clinical results for patients who had supportive care with retrospective aspect. RESULTS: A1 (7 cases), A2 (4 cases), B (1 case) were prevalent in the group of only clavicular shaft fracture and A1 (8 cases) and A2 (16 cases) and B (12 cases) were prevalent in the group of multiple injury. For the cases with supportive care, we could find 1 nonunion case (8%) and 11 union cases on average 2.91 months in the group of only clavicular shaft fracture and 7 nonunion cases (19%) and 29 union cases on average 3.58 months in the group of multiple injury. The best clinical results had occurred in 8 cases (67%) of only clavicular shaft fracture group and 19 cases (53%) of multiple injury group. We could find out the union from all 8 nonunion cases that took operation afterward. CONCLUSION: Although the choice of treatment of clavicular fracture is supportive care, but multiple injury including the clavicular fracture is a high-energy injury, so the possibility of comminuted and displacement is high, so that nonunion rate is high. The possibility of early surgery must be considered seriously.

Operative management of type Ⅱ fracture of the distal clavicle / 中华创伤骨科杂志

Objective To introduce an operative method for the treatment of type Ⅱ fracture of distal clavicle. Methods The clavicle and coracoid proc ess were compressively fixed with screw in, and the coracoclavicular ligament wa s repaired in 24 cases of type Ⅱ fracture of the distal clavicle. Results The fractures healed in all the cases with good function of joint, and without screw loosening or traumatic arthritis. Conclusion The operative method is an ideal m anagement for the treatment of adult type Ⅱ fracture of distal clavicle, due t o its easy handling, reliable fixation, exact curative effects and less complica tions.

Clinical evaluation of the shape memory alloy embracing fixator for trea tment of clavicular fractures / 中华创伤骨科杂志

Objective To study the effect and indication of the shape memory alloy(SMA)embracing fixator for treatment of clavicular fracture.Methods Thirty-six cases with clavicular fr acture were treated with SMA embracing fixator,of which 33we re middle third fracture and 3were between middle and lateral fracture.Results Thirty-five cases were followed up f or an average of 16months(from 8to 20months)and the average clinical healing was 2.8months(between 2and 4months).The results were evaluated accordi ng to Han Pingliang' s criteria and showed that 22cases wa s excellent,and 11cases was good.The excellent and good rate was 94.3percent.Conclusion The internal fixation with SMA embra cing fixator is less traumatic,stab le,safly effective to treat clavicular fracture.It is recommendable for treatment of clavicu lar fracture located in the middle an d proximal.The SMA embracing fixator must be pru dently used when the fracture is in th e curvature of clavicle.

Delayed subclavian - Vein thrombosis Following Nonunion of the Clavicular Fracture: A Case Report / 대한정형외과학회잡지

The possibility that immediate neurovascular injury will follow fracture of the clavicle has been generally known. A case of delayed involvement of the subclavian vein following a nonunion of clavicular fracture is reported emphasizing the proper reduction and union of the clavicle fracture is essential if delayed neurovascular complication are to be avoided or treated.

A Clinical Study about the Risk Factors of the Neonatal Clavicular Fracture / 대한산부인과학회잡지

No abstract available.