Surgical treatment methods and classification of proximal clavicle fracture / 中国骨伤

OBJECTIVE@#To summarize the surgical treatment of different proximal clavicle fractures, and discuss the classification of proximal clavicle fractures.@*METHODS@#Total of 24 patients with displaced proximal clavicle fractures were treated from January 2017 to December 2020 including 16 males and 8 females, aged 28 to 66 years old. Among them, 20 cases were fresh fractures and 4 cases were old fractures. According to the Edinburgh classification, 14 cases were type 1B1 fractures and 10 cases were type 1B2 fractures. The different internal fixation methods were selected for internal fixation treatment according to different fracture types.The operation time, blood loss, preoperative and postoperative displacement difference, fracture healing time and Rockwood scoring system were recorded.@*RESULTS@#All patients were followed up for 12 to 24 months. There were no patients with infection or loss of reduction after the operation. Three patients had internal fixation failure after operation, and the internal fixation device was removed. Results The operation time was 30 to 65 min, and the blood loss was 15 to 40 ml. No important nerves, blood vessels, or organs were damaged. The imaging healing time was 3 to 6 months. According to the Rockwood functional score, the total score was (13.50±1.86), pain (2.57±0.50), range of motion (2.78±0.41), muscle strength (2.93±0.28), restricted daily activity (2.85±0.35), subjective results (2.63±0.61);the results were excellent in 20 cases, good in 3 cases, fair in 1 case.@*CONCLUSION@#Proximal clavicular fracture is a type of fracture with low incidence. According to different fracture types, different internal fixation methods and treatment methods can be selected, and satisfactory surgical results can be achieved.

Do We Ever Need to Fix Clavicle Fractures in Adolescents?

@#Introduction: Clavicle fractures in adults are increasingly being treated by surgical fixation following reports of symptomatic non-union, malunion and poor functional outcome with conservative treatment. This has led to a similar trend in the management of clavicle fractures in adolescents. This study aims to evaluate the outcome and complications of non-operatively treated clavicle fractures in adolescents. Materials and methods: This is a retrospective, single institution study on adolescents aged 13-17 years who sustained a closed, isolated clavicle fracture, between 1997- 2015. Clinical records were reviewed for demographic information, injury mode, time to radiographic fracture union, time to re-attainment of full shoulder range of motion (ROM), and time to return to full activities and sports. Complications and fracture-related issues were recorded. Radiographs were analysed for fracture location, displacement and shortening. Results: A total of 115 patients (98 males, 17 females; mean age:13.9 ± 0.89 years) were included for study. 101 (88%) sustained a middle-third fracture while the remainder sustained a lateral-third fracture. A total of 96 (95%) of the middle-third fractures were displaced, and 12 (86%) of the lateral-third fractures were displaced. All displaced fractures in this study had shortening. Sports-related injuries and falls accounted for 68 (59%) and 34 (30%) of the cases respectively. Overall, the mean time to radiographic fracture union was 7.8 ± 4.35 weeks; there were no cases of nonunion. Full shoulder ROM was re-attained in 6.6 ± 3.61 weeks, and full activities and sports was resumed in 11.4 ± 4.69 weeks. There were 5 cases of re-fracture and a single case of intermittent fracture site pain. Conclusion: Clavicle fractures in adolescents can and should be treated non-operatively in the first instance with the expectation of good outcomes in terms of time for fracture union, reattainment of shoulder full range of motion, and return to activities. Surgical stabilisation should be reserved for cases for which there is an absolute indication.

Recuperación total con tratamiento conservador de fractura de clavícula con criterio quirúrgico / Total Recovery With Conservative Treatment of Clavicle Fracture with Surgical Criteria

Introducción: Las fracturas de clavículas son lesiones bastante frecuentes que producen pérdida de la continuidad ósea. La fractura del tercio externo de la clavícula tipo 2B (según clasificación de Robinson), tiene criterio quirúrgico o tratamiento conservador, en el siguiente caso se consideró esta última posibilidad. Objetivo: Describir la evolución clínica de paciente que presentó fractura de clavícula con criterio quirúrgico, y que mediante acciones fisioterapéuticas oportunas logró una rápida y total recuperación. Presentación del caso: Paciente del sexo femenino con fractura del tercio externo de la clavícula de confirmación clínica radiográfica e intento fallido de reducción con alambre de Kishner y criterio quirúrgico el cual no se efectuó. Recibe tratamiento fisioterapéutico en el servicio de Rehabilitación Integral del Policlínico Docente Dr. Tomás Romay de Artemisa. Conclusiones: La paciente con fractura de clavícula Tipo 2B, según la clasificación de Robinson descrita, logró excelentes resultados funcionales. Tan solo en 8 semanas de tratamiento fisioterapéutico adecuado presentó una recuperación total de su sintomatología y la reincorporación sin limitaciones a su actividad social, por lo que se apoya el tratamiento conservador en este tipo de lesión(AU)

Introduction: Clavicle fractures are fairly common injuries that cause loss of bone continuity. The fracture of the external third of the clavicle type 2B, according to Robinson's classification, has surgical criteria or conservative treatment; in the following case the latter possibility was considered. Objective: To describe the clinical evolution of a patient who had clavicle fracture with surgical criteria, and who, through timely physiotherapeutic actions, achieved rapid and complete recovery. Case report: A case of a female patient with fracture of the external third of the clavicle is reported here. The clinical confirmation was achieved by radiographic studies. The attempt to reduction with Kishner wire failed. In addition, surgery was not carried out. She received physiotherapy treatment in the Comprehensive Rehabilitation service at Dr. Tomás Romay Teaching Polyclinic in Artemisa. Conclusions: The patient with type 2B clavicle fracture, according to the described Robinson classification, achieved excellent functional results. Only in 8 weeks of adequate physiotherapeutic treatment she had complete recovery of her symptoms and the reincorporation without limitations to her social activity, hence conservative treatment is supported in this type of injury(AU)

Comparison of anatomical locking plate fixation with versus without reconstruction of coracoclavicular ligament in treatment of acute and old Neer Ⅱb distal clavicle fractures / 中华创伤骨科杂志

Objective:To compare anatomical locking plate fixation with versus without reconstruction of the coracoclavicular ligament in the treatment of acute and old Neer Ⅱb unstable distal clavicle fractures.Methods:From January 2015 to November 2020, 80 Neer Ⅱb distal clavicle fractures were treated at Department of Orthopaedics, The First Hospital Affiliated to China Pharmaceutical University. There were 49 males and 31 females, aged from 32 to 78 years (average, 47.8 years). Of the 50 fresh fractures, 25 were treated by internal fixation with anatomical locking plate of distal clavicle plus reconstruction of the coracoclavicular ligament with suture anchor (reconstruction group A) while the other 25 by only internal fixation with anatomical locking plate of distal clavicle (non-reconstruction group A). Of the 30 old fractures which had not got united over 3 weeks after injury, 15 were treated by internal fixation with anatomical locking plate of distal clavicle plus reconstruction of the coracoclavicular ligament with suture anchor (reconstruction group B) while the other 15 by only internal fixation with anatomical locking plate of distal clavicle (non-reconstruction group B). At 1, 3 and 6 months postoperatively, Constant-Murley scale and visual analogue scale (VAS) were used to evaluate shoulder function and pain. X-ray follow-ups were conducted to measure the coracoclavicular distance and observe fracture union and complications at the last follow-up.Results:All the 80 patients were followed up for 6 to 24 months (average, 13.8 months). For reconstruction group A and non-reconstruction group A, respectively, the union time for fresh fractures was (11.7±2.8) weeks versus (13.4±1.3) weeks, the rate of coracoclavicular distance increase 12.7%±6.2% versus 14.2%±8.0%, the Constant-Murley score 92.2±4.4 versus 90.9±5.7, showing no statistically significant difference between the 2 groups (all P>0.05). For reconstruction group B and non-reconstruction group B, respectively, the union time for old fractures was (12.8±1.9) weeks versus (19.4±6.7) weeks, the rate of coracoclavicular distance increase 12.3%±6.7% versus 21.5%±13.1%, the Constant-Murley score 93.0±5.9 versus 83.5±8.5, showing statistically significant differences between the 2 groups (all P<0.05). Conclusions:For fresh Neer Ⅱb distal clavicle fractures, simple anatomical locking plate fixation can achieve satisfactory curative efficacy without additional reconstruction of the coracoclavicular ligament. However, for old Neer IIb distal clavicle fractures, additional reconstruction of the coracoclavicular ligament can better maintain the stability of the acromioclavicular joint, reduce the risk of internal fixation failure, and achieve better outcomes.

A Comparative Study Between Plate Fixation and Intramedullary Fixation for Displaced Mid-Shaft Clavicle Fractures in Adults

@#Introduction: Clavicle fractures are frequently encountered by orthopaedic surgeons. Though multiple treatment techniques have been described in literature, open reduction and internal fixation with plating and intramedullary nailing are preferred in adults. This study analyses the functional outcome, complications, duration of bony union of mid-shaft clavicle fractures treated with plate fixation versus intramedullary fixation. Materials and methods: A quasi- experimental study was conducted on 38 patients with mid-shaft clavicle fracture aged between 18 to 60 years at a tertiary care centre in South India. Nineteen patients were treated by plate fixation and 19 patients underwent intramedullary nail fixation. Every alternate patient with mid-shaft fracture clavicle was treated with plate osteosyntheses or nailing. Results: The average age of presentation was 42 years in plate fixation and 31 years in nail fixation group. Robinson’s classification type 2B1 was the most common type of fracture in both groups. The Visual Analogue Scale (VAS) score reduced significantly from pre-operative to postoperative day 1 in both the groups but there was no significant difference between the two groups. The Disabilities of the Arm, Shoulder and Hand (DASH) score at 6, 12 and 24 weeks reduced significantly in both the groups but showed no statistically significant difference between the two groups. However, intramedullary nail fixation group had a shorter duration of hospital stay and showed an earlier improvement in the DASH score during the first six months after surgery. Complications included implant loosening (three patients) in plating group and implant failures (two cases) in nailing group. Conclusion: There is a role for surgical intervention for certain cases of displaced and comminuted clavicle fracture in order to avoid malunion or non-union and their potential long-term sequelae. Both the surgical modalities of plating, and nailing provide good functional outcome and allow early return to occupational activities.

Osteosíntesis mínimamente invasiva con placa anatómica bloqueada en fracturas desplazadas del tercio medio de clavícula / Minimally invasive osteosynthesis with blocked anatomical plate in displaced fractures of the middle third of the clavicle

Resumen: El tratamiento quirúrgico de las fracturas desplazadas del tercio medio de clavícula ha ganado popularidad durante la última década, ya que permite acortar el período de recuperación, acelerando la reincorporación laboral y deportiva, al mismo tiempo que disminuye significativamente el riesgo de no unión. Sin embargo, las molestias relacionadas con el abordaje cutáneo como dolor e irritación a nivel de la cicatriz, las alteraciones sensitivas persistentes (hipoestesia, hiperestesia o disestesias) y la inconformidad cosmética continúan siendo motivo de preocupación por parte de los pacientes, alterando su percepción subjetiva del resultado quirúrgico obtenido. En tiempos recientes la técnica mínimamente invasiva se ha descrito para el manejo de este tipo de fracturas, demostrando reducir las posibles complicaciones de la técnica tradicional abierta mientras que mantiene sus principales beneficios, optimizando además la capacidad biológica reparativa de la clavícula, ya que respeta la vascularización del foco de fractura. El objetivo de este artículo es describir paso a paso la técnica quirúrgica mínimamente invasiva para el manejo de fracturas desplazadas del tercio medio de clavícula, reportando además los resultados clínicos obtenidos en una serie de casos intervenidos con esta técnica.

Abstract: Surgical management of displaced midshaft clavicular fractures has gained popularity in the last decade due to reductions in functional recovery times and lower rates of nonunion. However, several complications related to the open approach have been described and remain concerning for patients. These potential sequelae include scar pain, local irritation, peri-incisional numbness, and cosmetic deformity, all of which may contribute to unsatisfactory subjective outcomes. Recently, minimally invasive plate osteosynthesis (MIPO) technique has been described for the treatment of these fractures. This approach presents the opportunity to reduce shortcomings of the traditional open approach while maintaining its benefits, respecting the biological healing environment and preserving blood supply to the fracture site. The purpose of this study is to provide a step-by-step description of the MIPO surgical technique for management of displaced midshaft clavicular fractures and report the clinical outcomes of a case series using this technique.

Cerclaje coracoclavicular y banda de tensión con sutura en el tratamiento de fracturas del tercio externo de la clavícula tipos II y V / Coraco-clavicular loop and tension band suture in type II and type V distal-third clavicle fractures

Resumen: Se han descrito diferentes técnicas quirúrgicas para el tratamiento de las fracturas inestables del tercio distal de la clavícula. Las complicaciones asociadas y la necesidad de retirar los implantes siguen siendo motivo de preocupación. Proponemos una técnica quirúrgica que utiliza suturas de alta resistencia para restaurar la estabilidad vertical y horizontal en las fracturas del tercio distal de la clavícula de tipo II y V de la clasificación de Neer. Esta técnica se ha utilizado en tres casos; dos de tipo V y uno de tipo II. En todos se obtuvo la consolidación ósea y todos reanudaron sus actividades previas a la lesión, incluyendo actividad deportiva, a los seis meses de la cirugía. La técnica de cerclaje coracoclavicular y banda de tensión con sutura es un procedimiento sencillo que permite la estabilización vertical y horizontal de la fractura. Permite obtener buenos resultados clínicos y puede ser una alternativa coste-efectiva eficaz en el tratamiento de estas lesiones aunque se requiere una serie más larga y un seguimiento a largo plazo para evaluar adecuadamente los resultados.

Abstract: Many surgical techniques have been used to address unstable distal third clavicle fractures. Complications and the need for hardware removal are still a concern. We propose a surgical technical using high-strength sutures to restore vertical and horizontal stability in Neer type II and Neer type V distal-third clavicle fractures. It has been used in three cases; two type V and one type II. In all cases, bone healing was achieved uneventfully and all patients resumed their pre-injury activities including sports at six-months postoperatively. The coraco-clavicular loop and tension band suture technique is a simple procedure that allows vertical and horizontal stabilization of the fracture. It achieves good clinical results and it may be a cost-effective alternative to other techniques although a longer series and long-term follow-up is required to adequately assess the results.

Functional and radiological assessment of displaced midshaft clavicle fractures treated through open reduction and internal fixation surgery using pre-contoured locking compression plates

Background: Fractures of the clavicle constitute approximately 2.6% of all the fractures and nearly 44-66% of fractures around shoulder.Methods: This particular study is intended to assess the functional and radiological outcomes in a series of 32 patients with closed displaced midshaft clavicle fractures treated through open reduction and internal fixation surgery using pre-contoured clavicle locking compression plates.Results: All 32 patients achieved fracture union within 6 months follow up period. As per Constant-Murley scoring, 56.25% cases had excellent results, 34.37% cases had good, 6.25% cases had fair and 3.12% of the cases had poor results respectively.Conclusions: Open reduction and internal fixation surgery with pre-contoured locking compression plates in the displaced midshaft clavicle fractures restores the anatomy, biomechanics and contact loading characteristics of the clavicle and significantly reduces the incidence of non-union with improved functional outcomes resulting in better patient satisfaction.

A Comparison of Outcome after Fixation of Unstable Lateral Third Clavicle Fractures, with Clavicular Hook Plate versus Precontoured Anatomical Locking Plate.

Lateral end clavicle fractures are of three types (Neer type- I, II, & III). In Neer Type-II, the fractures are very unstable due to damage to the coracoclavicular (CC) ligament. So, it is always treated surgically. This comparative cross-sectional prospective study compares the outcome after internal fixation of these fractures with clavicular hook plate and precontoured anatomical locking plate.METHODSThirty-two (32) patients attending the OPD and ER of R.G. Kar Medical College, Kolkata, having Neer Type-II fractures, were treated surgically within three weeks of injury using either clavicular hook plate (17 patients) or precontoured anatomical locking plate (15 patients) and then systematically reviewed. The relevant literature of the two fixation methods were studied to note union, infection, hardware prominence, implant failure, metaphyseal fracture and other complications. Constant-Murley score was also used for evaluation.RESULTSIn our study, with both the fixation modalities, union was achieved in all cases by three months. No impingement was noted. Patients having fixation with precontoured anatomical locking plate had better scores and returned earlier to better function than the other group (p value <0.0001).CONCLUSIONSPrecontoured anatomical locking plate might be a better option which provides better functional outcome.

Treatment of midshaft clavicle fracture with superior plate placement / Tratamento para fratura da diáfise da clavícula com inserção de placa óssea superior

ABSTRACT Objective: To evaluate the late clinical and radiological results of patients had locking plate anatomically compatible from superior surface and muscle cover on plate due to clavicle mid-region. Materials and Methods: Forty patients were included retrospectively. Patients had a routine right shoulder anterior posterior graph after examination. The results were assessed by returning to the patient's daily activities, Constant score, the Disability of the Arm, and Shoulder and Hand scoring, followed by radiological and clinical examination. Results: Fourteen (35%) patients were female and 26 (65%) were male. The mean age was 36.2 years. Twenty-six patients had right clavicle fracture and 14 patients had left. Twenty-three fractures were type 2B1 and 17 fractures were type 2B2. Mean follow-up time was 36.4 months. Radiologic union was at a mean of 9.1 ± 1.3 weeks. All patients had excellent results. The mean Constant score was 97.2 ± 1.8, the mean Disability of the Arm, and Shoulder and Hand score was 3.8 ± 2.4. Conclusion: It is possible to obtain complete union with high patient satisfaction by avoiding the complications and difficulties of the conservative treatment with the use of the anatomically compatible locking plates in superior fixation and our surgical dissection. Level of Evidence III, Retrospective Case controlled study.

RESUMO Objetivo: Avaliar os resultados clínicos e radiológicos tardios dos pacientes com placa óssea de trava anatomicamente compatível com a superfície superior e a cobertura muscular na placa devido à região média da clavícula. Materiais e Métodos: Quarenta pacientes foram incluídos retrospectivamente. Os pacientes apresentaram um gráfico ântero-posterior de rotina do ombro direito após o exame. Os resultados foram avaliados retornando às atividades diárias do paciente, escore de Constant, incapacidade do braço e escores de ombro e mão, seguidos de exame clínico e radiológico. Resultados: Quatorze (35%) pacientes eram do sexo feminino e 26 (65%) do sexo masculino. A idade média foi de 36,2 anos. Vinte e seis pacientes tiveram fratura da clavícula direita e 14 pacientes saíram. Vinte e três fraturas foram do tipo 2B1 e 17 fraturas do tipo 2B2. O tempo médio de acompanhamento foi de 36,4 meses. A união radiológica foi em média de 9,1 ± 1,3 semanas. Todos os pacientes tiveram excelentes resultados. A pontuação média constante foi de 97,2 ± 1,8, a média de incapacidade do braço e a pontuação do ombro e da mão foi de 3,8 ± 2,4. Conclusão: É possível obter união completa com alta satisfação do paciente, evitando as complicações e dificuldades do tratamento conservador com o uso das placas ósseas de trava anatomicamente compatíveis na fixação superior e na nossa dissecção cirúrgica. Nível de evidência III, Estudo retrospectivo controlado por caso.

Intramedullary fixation versus plate fixation in the treatment of displaced mid-shift clavicle fractures: A meta-analysis / 中国组织工程研究

BACKGROUND: Elastic intramedullary nail and steel plate are two commonly used instruments for clavicle fracture, However, there are few comparative studies on the advantages and disadvantages of them. OBJECTIVE: To systematically evaluate the treatment effects of intramedullary fixation or plate fixation for displaced mid-shift clavicle fractures. METHODS: Articles about the treatment effects of intramedullary fixation or plate fixation for displaced mid-shift clavicle fractures were searched in PubMed, Embase, Science Direct and Cochrane Library, CNKI, WanFang and VIP databases from inception to March 2017. Two reviewers independently screened the articles, extracted data and evaluated the bias risk in the included studies according to the inclusion and exclusion criteria. Meta-analysis was performed using ReMan 5.3 software. RESULTS AND CONCLUSION: (1) A total of 21 studies were included, with 859 patients in the intramedullary fixation group and 831 patients in the plate fixation group. (2) The result of meta-analysis showed that the operation time [MD=-18.62, 95%CI (-20.75, -16.49)], blood loss [MD=-56.23, 95%C/(-68.02, -62.44)], incision length [MJ=-5.53, 95%C/(-6.56, -4.49)], hospitalization time [MD=-1.01, 95%C/(-1.13, -0.89)], and healing time [MD=-1.39, 95%C/ (-1.98, -0.80)] in the intramedullary fixation group were better than those of the plate fixation group. (3) At 6 months after surgery, the Disabilities of the Arm, Shoulder and Hand scores in the intramedullary fixation group were better than those in the plate fixation group (F < 0.05). The scores showed no significant difference between two groups at 12 months after surgery. Major complications [OR=0.61, 95%C/ (0.39, 0.93)] in the intramedullary fixation group were less than those in the plate fixation group. Minor complications and implant removal were similar between two groups. (5) Meta-analysis results imply that elastic intramedullary nail fixation for treating displaced mid-shift clavicle fractures is superior to plate fixation in surgery-related indexes, functional recovery and fracture healing, which can provide effective evidence for its clinical application.

Research progress on finite element analysis of internal fixation for clavicular fracture / 中国骨伤

Clavicular fracture is a common upper limb fracture. Because of its special anatomical structure, it directly affects the function of the shoulder joint. The different injury mechanisms of clavicular fracture affect the mechanical effect of internal fixation, so the selection of internal fixation method has been puzzling orthopedists. As a modern computer based mechanical analysis, finite element analysis application in the internal fixation of clavicular fracture can not only clarify the pathogenesis of fractures, biomechanical properties of internal fixators and complications of fractures, but also provide guidance for preoperative planning. Therefore, it is beneficial to preoperative planning and individualized selection of surgical methods, and is expected to become an indispensable part in preoperative planning for clavicular fracture. In this paper, the pathogenesis, related influencing factors, selection of internal fixation and postoperative complications of clavicular fracture based on finite element analysis and problems during finite element analysis were reviewed.

Vasos subclavios: ¿Qué tan cerca se encuentran de la clavícula? / Subclavian vessels: how close are they to the clavicle?

INTRODUCCIÓN: la lesión de los vasos subclavios durante la cirugía de clavícula es una situación rara, de suceder podría resultar incluso mortal; conocer su ubicación es indispensable para minimizar ese riesgo.OBJETIVO: determinar la ubicación y la distancia de la AS y VS respecto a la clavícula. Secundariamente, identificar las características particulares que influencien la ubicación y la distancia. MATERIALES Y MÉTODO: estudio retrospectivo, AngioTAC de tórax y cuello entre 2012 y 2017; se midió la longitud de la clavícula, distancia y dirección de los vasos subclavios en cada tercio de la clavícula, como también la angulación entre una horizontal y el centro de los vasos subclavios. Resultados: 39 AngioTC, 78 hombros. Distancia AS/clavícula tercio proximal, medio y distal 32,8mm (20,3-46,3), 15,4mm (6,8-28,0) y 62,7mm (37,0-115,4) respectivamente. La distancia VS/clavícula tercio proximal, medio y distal fue: 7,4mm (1,0-19,2), 16,2mm (6,7-34,7) y 67,1mm (29,7-117,0) respectivamente. La ubicación de AS y VS con respecto a la clavícula es posterosuperior en el tercio proximal, posteroinferior en el tercio medio e inferior en el tercio distal. CONCLUSIÓN: En el tercio proximal la vena puede estar solo a 1mm de la clavícula y la arteria a 6mm en dirección antero-posterior, resultando esa zona la más peligrosa. En el tercio medio la distancia es mayor, pudiendo estar arteria y vena a solo 6mm, la dirección de brocado más peligrosa es antero-inferior con una inclinación promedio de 45° caudal. El tercio distal es el más seguro, los vasos están al menos a 30mm de distancia hacia caudal. Nivel de evidencia III.

BACKGROUND: injury to the subclavian vessels during clavicle surgery is a rare situation, if it happens it could even be fatal; knowing their location is essential to minimize that risk. OBJECTIVE: determine location and distance of the AS and VS with respect to the clavicle. Secondarily identify particular characteristics that influence location and distance. MATERIAL AND METHODS: retrospective study, AngioTAC of thorax and neck between 2012 and 2017; it was measured the length of the clavicle, distance and direction of the subclavian vessels in each third of the clavicle and angulation between a horizontal and the center of the subclavian vessels were measured. Results: 39 AngioTC, 78 shoulders. AS / clavicle third proximal, middle and distal distance 32.8mm (20.3-46.3), 15.4mm (6.8-28.0) and 62.7mm (37.0-115.4) respectively. Distance VS / clavicle third proximal, middle and distal was: 7.4mm (1.0-19.2), 16.2mm (6.7-34.7) and 67.1mm (29.7-117.0) respectively. The location of AS and VS with respect to the clavicle is posterosuperior in the proximal third, posteroinferior in the middle third and inferior in the distal third. CONCLUSION: In the proximal third the vein can be only 1mm from the clavicle and the artery to 6mm in the anterior-posterior direction, this zone is the most dangerous. In the middle third the distance is greater, artery and vein can be only to 6mm, the most dangerous drilling direction is antero-inferior with an average inclination of 45° caudal. The distal third is the safest, the vessels are at least 30mm away from the vessels. Level of evidence III.

Comparative Analysis between Locking Compression Plate and Titanium Elastic Nail Fixation for Clavicle Fractures

Background: Clavicle fracture is one of the most common fractures of young active individuals; most of the clavicle fracturesare managed by the conservative method previously, but after understanding the fracture, biomechanics of clavicle surgicalmanagement found to have a good functional outcome and early mobilization of the patient. Fracture pattern-like displacedcomminuted, shortening <2 cm all have an impact on union and functional outcome.Methods: This is a prospective study of 40 cases of the clavicle fracture treated by ORIF with locking compression plate andclosed reduction internal fixation/open reduction internal fixation (ORIF) with an elastic nail. The period of study follow-up extendsfrom 2017 to 2019 in the Department of Orthopedics, KAPV Medical College Hospital, Tiruchirapalli.Results: In our study, we evaluated 40 cases of clavicle fracture treated by ORIF with locking plate (20 cases) and titaniumelastic nailing (20 cases). All the 20 cases of plating, two cases had a superficial infection and treated by higher antibioticsand one case after fracture healing implant exit done. The infection was settled. All the 20 cases of nailing, 18 cases are goodoutcome, one case are non-union, and two cases were superficial infection after higher antibiotics infection was settled.Conclusion: Locking compression plate is recommended for displaced midshaft comminuted clavicle fracture. When comparedto elastic nailing, locking compression plate has an excellent functional outcome and minimal complication.

Progressive Brachial Plexus Palsy after Fixation of Clavicle Shaft Nonunion: A Case Report

The brachial plexus palsy is a rare complication of a clavicle fracture, occurring in 0.5% to 9.0% of cases. This condition is caused by excessive callus formation, which can be recovered by a spur resection and surgical fixation. In contrast, only seven cases have been reported after surgical reduction and fixation. A case of progressive brachial plexus palsy was observed after fixation of the displaced nonunion of a clavicle fracture. The symptom were improved after removing the implant.

Scapular Dyskinesis Assessment with Low Dose Three-Dimensional Wing Computer Tomography after Anatomical Union of Clavicle Fracture / 대한스포츠의학회지

PURPOSE: Malunions after clavicle fractures are generally considered to cause scapular dyskinesis. This study aims to verify the incidence of scapular dyskinesis following anatomically reduced clavicle fracture and to verify the usefulness of low-dose three-dimensional (3D) scapular wing computed tomography (3D-scapula wing-CT) analysis.METHODS: Twenty-four patients with mid-clavicle fracture and four patients with distal clavicle fracture were recruited. After anatomical reduction and bony union, scapular dyskinesis was assessed by history taking and physical examination by two orthopedic doctors. The mean follow-up period for the assessment was 14.3±10.1 months. Low-dose 3D-scapular wing-CT analysis in prone position was performed with calculated effective dose 2.35 mSv, which means approximately 25% dose of conventional setting. Four observers evaluated five angles (upward rotation, internal rotation, anterior tilting, superior translation, protraction) from 3D-reconstructed images on both shoulders of a patient. Authors analyzed the results between injured to normal shoulder.RESULTS: Scapular dyskinesis or significant shortening of injured clavicle (mean clavicle length difference, − 1.77±6.36 mm) were not observed among the included 28 subjects. The difference values of the five angles between the fractured side and normal side showed no statistical significance (upward rotation: 1.51, p=0.13; superior translation: 0.89, p=0.327; anterior tilting: 1.7, p=0.096; protraction: 0.83, p=0.374; internal rotation: 0.98, p=0.406). As the interclass correlation coefficients of four observers was 0.988 (p=0.00), images from low-dose 3D-wing-CT are clear enough to assess scapular dyskinesis (interclass correlation coefficient, 0.996; p=0.00).CONCLUSION: It is important to make anatomical reduction and length restoration of clavicle fracture for preventing scapular dyskinesis. Low-dose 3D-scapular wing-CT is an effective tool for assessing scapular dyskinesis, which provides images of sufficient quality with little increase in morbidity from radiation hazard.

Stress Fracture of the Proximal Clavicle after Parallel Bars Exercise in a Young Male / 대한정형외과학회잡지

Although acute traumatic fractures of the clavicle are relatively common, stress fractures of the proximal clavicle are extremely rare. Stress fractures of the clavicle have often been reported after a radical neck dissection or radiation but rarely occur during excessive repetitive exercise in professional athletes. The authors report a case of a stress fracture of the proximal clavicle during exercise in a young man with no specific preceding factors, which has not been reported in the Korean literature.

Effectiveness analysis of distal radius microplate locking plate for treatment of displaced fracture of medial clavicle / 中国修复重建外科杂志

Objective: To investigate and evaluate the effectiveness of the distal radius microplate locking plate for the treatment of displaced fracture of medial clavicle. Methods: Between January 2013 and June 2017, 18 cases of obvious displaced fracture of medial clavicle were treated with distal radius microlocking plate. There were 10 males and 8 females, with an average age of 51.4 years (range, 18-88 years). Causes of injury included traffic accident injury in 15 cases, heavy object injury in 3 cases; all of them were closed injury. According to Edinburgh classification, 15 cases were ⅠB1 type and 3 cases were ⅠB2 type. Fracture displacement was 12-21 mm (mean, 16.3 mm). The time from injury to operation was 3-7 days (mean, 4.3 days). After operation, the clinical healing and complications of fracture were observed, and shoulder function was evaluated according to Rockwood's scoring criteria. Results: No incisional infection, neurovascular injury, or other early complications occurred. All 18 patients were followed up 8-15 months (mean, 12 months). All fractures reached clinical osseous union, and the healing time was 8-24 weeks (mean, 16.6 weeks). Postoperative plate loosening occurred in 1 case, which was removed surgically, while other patients did not suffer from complications such as bone nonunion, displacement, internal fixator loosening, and loss of reduction. At last follow-up, according to Rockwood's scoring criteria, the results were excellent in 12 cases and good in 6 cases. Conclusion: The distal radius microplate locking plate is effective for the treatment of displaced medial clavicle fracture, which has few complications, and is feasible for early functional exercise, and is helpful for the recovery of shoulder joint function.

Treatment progress in minimally invasive intramedullary fixation for midshaft clavicle fracture / 中华创伤骨科杂志

Nowadays,more and more studies on mini-invasive treatment of clavicle fractures have been reported.Firstly,based on the newly published literature about intramedullary fixation for midshaft clavicle fractures,this paper reviews its indications and advantages.Next,the design characteristics,surgical procedures,therapeutic effects and latest treatment advances concerning the intramedullary implants are systemically demonstrated and compared.Intramedullary fixation can be used in most midshaft clavicle fractures except those with neurovascular lesions or with comminuted segments,or obsolete ones.The commonly used intramedullary implants include Kirschner wires,cannulated screws,titanium elastic nails,threaded nails,and second-generation intramedullary nails.Intramedullary fixation has potential advantages of a smaller incision,fewer complications,a lower refracture risk and faster bone healing but also limitations in strength and stability.However,more and more intramedullary implants,from cannulated screws to second-generation intramedullary nails,have been used in clinic,leading to fine therapeutic effects.New products are being developed to overcome the previous shortcomings.

Fracturas complejas del tercio lateral de la clavícula / Complex fractures of the clavicle's lateral third

Resumen: Antecedentes: Las fracturas del tercio lateral de la clavícula representan 18% de todas las fracturas de clavícula. A pesar de que las fracturas no desplazadas pueden manejarse conservadoramente, las desplazadas tienen un porcentaje de no unión de 30%. Múltiples manejos han sido propuestos para las fracturas desplazadas. El objetivo de este estudio fue registrar la prevalencia de fracturas del tercio lateral de la clavícula con afectación de la articulación acromioclavicular, así como hacer una revisión breve del tratamiento realizado en nuestro centro y compararlo con la literatura actual. Material y métodos: Estudio retrospectivo, transversal, descriptivo y observacional, que consistió en una revisión de los expedientes de los pacientes con diagnóstico de fractura del tercio lateral de la clavícula con lesión de la articulación acromioclavicular. Resultados: Las fracturas del tercio lateral representaron 24% de todas las fracturas de clavícula. Distribución por sexos: 10:2, hombres:mujeres. Predominio: hombro izquierdo, 8:4. Los manejos predominantes fueron placa anatómica para tercio lateral de la clavícula (50% de los casos), técnica de cerclaje coracoclavicular más resección del tercio lateral de la clavícula (25%), placa gancho (8.3%), Mumford combinado con Waever/Dunn (8.3%), ancla más varillas Kirschner (8.3%). Discusión: La elección del tratamiento adecuado dependerá del tipo de fractura y las características específicas de cada paciente. Sugerimos el uso de la técnica de cerclaje coracoclavicular en los casos en que el fragmento lateral sea multifragmentado, irreductible o de tamaño menor al que permitiría su osteosíntesis, realizando plastía de ligamentos acromioclaviculares y coracoclaviculares.

Abstract: Background: Fractures of the lateral third of the clavicle represent 18% of all clavicle fractures. Even though non-displaced fractures can be managed conservatively, displaced fractures have a non-union percentage of 30%. Multiple approaches have been proposed to manage the displaced fractures. The objective of this study was to record the prevalence of fractures of the lateral third of the clavicle with involvement of the clavicular-acromial joint, as well as to briefly review the treatment performed in our center and compare it with the current literature. Material and methods: Retrospective, cross-sectional, descriptive and observational study, which consisted in a review of the records of patients with a diagnosis of fracture of the lateral third of the clavicle with an injury to the clavicular-acromial joint. Results: Lateral third fractures accounted for 24% of all clavicle fractures. Distribution by sex: 10: 2, men: women. Left shoulder predominance, 8:4. The predominant maneuvers were anatomical plate for the lateral third of the clavicle (50% of the cases), coracoclavicular cerclage technique plus resection of the lateral third of the clavicle (25%), plate hook (8.3%), Mumford combined with Waever/Dunn (8.3%), anchor plus Kirschner rods (8.3%). Discussion: The choice of the appropriate treatment will depend on the type of fracture and specific characteristics of each patient. We suggest the use of the coracoclavicular cerclage technique in cases in which the lateral fragment is multifragmented, irreducible or smaller in size than its osteosynthesis would allow, performing plasty of clavicular and coracoclavicular ligaments.