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Background: In forensic anthropology, determining an individual’s sex is the fundamental criteria of identification, but this is a tough task that gets considerably more difficult when only a single bone, such as the clavicle, is available. In physical anthropology, determining the sex of a deceased individual is a fundamental prerequisite. Physical anthropologists have gotten more concerned about the difficulties of human identity in recent years. Traditional techniques of sexing bone are subjective and ineffective when absolute sexing precision is desired, hence this study. Methods: Measurement of clavicular length and circumference using an Osteometric board or sliding and Vernier Callipers product from 1128 dry clavicles of unknown sex and age procured from various medical institutions and departments of anthropology in south India. Length, inner angle, outer angle, the sum of angles, inner segment, middle segment, outside segment, width at the inner end at an inner angle, least width at conoid tubercle, at the outer end, and mid circumference have all been measured. Results and Discussion: The male mid-shaft circumference is 38.0±0.5mm on the right side and 36.5±0.5mm on the left side, whereas the female mid-shaft circumference is 31.4±0.3mm on the right side and 31.4±0.6mm on the left side. The length of the left clavicle is greater than the length of the right collarbone. The curvature of the right collarbone is higher than that of the left, resulting in a shorter right bone than the left. The clavicle of males has a higher mean across all parameters than females. Male clavicle length is more than female clavicle length, midshaft circumference is less in females than males, and breadth at an inner angle is shorter in females than men, all of which are statistically significant. The Mid-shaft Circumference as a sex-determination metric is statistically significant in differentiating the clavicle’s sex. This delivers a better result than clavicle weight since clavicle weight fluctuates with age and the health state of the individual. Male clavicles have a larger Midshaft Circumference than female clavicles.
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Objectives: To examine the efficacy and clinical and radiological outcomes of the use of a streamlined clavicle plate® (MEIRA, Aichi, Japan) for midshaft clavicular fractures.Methods: This was a retrospective cohort study of 155 patients with displaced midshaft clavicular fractures treated using a streamlined clavicle plate between 2015 and 2019 in 18 hospitals across Japan. A questionnaire regarding bone union and postoperative complications was used, and 136 cases were followed up for one year or until bone union. Plate fitting was evaluated retrospectively using surgical records, radiographic findings, and surgeon’s opinion.Results: During surgery, plate bending was needed in 19 cases (12.3%), poor fitting was observed in 8 cases (5.2%), and bone union was achieved in 133 cases (97.8%). Total implantation failure, including plate breakage and screw loosening, occurred in 10 cases (6.5%) from the intraoperative to postoperative period. Subjective complications were observed in 26 cases (16.8%): incongruity around the surgical scar or in the anterior chest in 23, and contracture of the shoulder in three. Plate removal was performed in 66 cases (48.5%) per patient’s request.Conclusion: The use of a streamlined clavicle plate is effective for midshaft fractures of the clavicle, and the success rates of bone union and implantation using this approach are comparable to those of other existing plates.
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We reviewed our experience in reconstructing forked corpus spongiosum (FCS) in distal/midshaft hypospadias repair and analyzed the efficacy of this surgical technique. From August 2013 to December 2018, 137 consecutive cases of distal/midshaft hypospadias operated by the same surgeon in Urology Department, Children's Hospital of Fudan University (Shanghai, China), were retrospectively analyzed. Sixty-four patients who underwent routine tubularized incised plate (TIP) or onlay island flap (ONLAY) surgery were included in the nonreconstructing group, and 73 patients who underwent reconstructing FCS during TIP or ONLAY surgery were included as the reconstructing group. Thirty-eight cases underwent TIP, and 26 underwent ONLAY in the nonreconstructing group, with a median follow-up of 44 (range: 30-70) months. Twenty-seven cases underwent TIP, and 46 underwent ONLAY in the reconstructing group, with a median follow-up of 15 (range: 6-27) months. In the nonreconstructing/reconstructing groups, the mean age at the time of surgery was 37.55 (standard deviation [s.d.]: 29.65)/35.23 (s.d.: 31.27) months, the mean operation duration was 91.95 (s.d.: 12.17)/93.84 (s.d.: 14.91) min, the mean neourethral length was 1.88 (s.d.: 0.53)/1.94 (s.d.: 0.53) cm, and the mean glans width was 11.83 (s.d.: 1.32)/11.56 (s.d.: 1.83) mm. Twelve (18.8%)/5 (6.8%) postoperative complications occurred in the nonreconstructing/reconstructing groups. These included fistula (5/2), glans dehiscence (3/0), diverticulum (1/2), residual chordee (3/0), and meatus stenosis (0/1) in each group. There was a significant difference in the overall rate of complications (P= 0.035). These results indicate that the technique of reconstructing FCS provides excellent outcomes with fewer complications in distal/midshaft hypospadias repair.
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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.
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The biomechanical characteristics of midshaft clavicular fractures treated with titanium elastic nail is not well studied. This study aimed to present a analysis of titanium elastic nail fixation and reconstruction plate fixation for midshaft clavicular fractures. Methods: Forty-four patients between 18 and 65 years of age were included in this study. They were randomized in two groups to be treated with either elastic intramedullary nail (ESIN) or plate. Clinical and radiological assessments were performed at regular intervals. Outcomes and complications of both groups over 2 years of follow-up time were compared. Results: Length of incision, operation time, blood loss and duration of hospital stay were significantly less for the ESIN group. American Shoulder and Elbow Surgeons (ASES) and Constant Shoulder scores were significantly higher (p\0.05) in the plating group than the EIN group for the first 2 months but there was no significant difference found between the two groups regarding functional and radiological outcome at the 2-year follow-up. Conclusion: ESIN is minimally invasive surgical technique with a lower complication rate, faster return to daily activities, excellent cosmetic and comparable functional results, and can be used as an equally effective alternative to plate fixation in displaced midshaft clavicle fractures.
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The sex determination of the individual is primary criterion of identification in Forensic anthropology but this isvery difficult problems & becomes even more challenging when only a single bone like clavicle is available. Thecorrect determination of the sex of a dead person is a critical requirement in physical anthropology. Within pastfew years, the physical anthropologists have become increasingly involved in the problems of humanidentification. The traditional methods of sexing bone are subjective and not of much help where 100% accuracyof sexing is required. For the metrical analysis of sexing of clavicle by the present study method, mid-shaftcircumference of 155 adult human clavicles of known sexes were measured with the help of measuring tape, stripof graph paper and Vernier Calipers. The mid-shaft circumference of right side male clavicles ranges from 30mmto 46mm (mean of 37.14 ± 4.10mm), where as that of female clavicles ranges from 25.5mm to 41.5mm (mean of30.50 ± 3.3mm). The mid-shaft circumference of left male clavicles ranges from 30mm to 48mm (mean of 37.04±4.2mm) where as that of female clavicles ranges from 24.5mm to 39.5mm (mean of 30.3±3.3mm). The mid-shaftcircumference of clavicles has a high significance in sex determination (P<0.001). The prediction of correct sexby mid-shaft circumference of clavicles alone is 77% for male & 83.30% for female right clavicles & 80% for ofmale & 87.50% for female left clavicles.
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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.
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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.
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BACKGROUND: Treatment of unstable clavicle fractures remains a challenge for orthopedic surgeons, but the evolution of treatment strategies has allowed for reliable results with minimal complications. Although several surgical options exist, open reduction with plating remains the treatment of choice for clavicle fractures. The purpose of this study is to determine an easy way to achieve successful preplating reduction while minimizing surrounding soft tissue damage during treatment of midshaft fractures of the clavicle. METHODS: A retrospective study included all consecutive adult patients operated on by a single surgeon for acute displaced clavicular midshaft fracture between January 2010 and October 2014. Hybrid technique with interfragmentary cerclage wiring, temporary axial K-wire pinning, or their combination was used in all patients. The demographic data and clinical outcomes, including operation time, union time, restoration of anatomy, shoulder functional score, and complications were evaluated. RESULTS: There were 54 male and 19 female patients, with an average age of 39.3 years (range, 18 to 77 years) for males and 58.3 years (range, 39 to 77 years) for females. They were followed up for 24 months (range, 12 to 44 months). All patients had reliable bone union after surgery using interfragmentary cerclage wiring and temporary axial K-wire fixation; fracture union was obtained at an average of 11.7 weeks (range, 8 to 21 weeks) postoperatively. Additionally, there was no postoperative loss of fracture reduction or plate loosening. At the final follow-up, all patients had regained excellent functional outcomes. CONCLUSIONS: The cognizant effort to achieve anatomic reduction without surrounding soft tissue insult before definitive plating allows excellent radiologic and functional outcomes. Interfragmentary cerclage wiring and temporary axial K-wire pinning can overcome difficulties associated with unstable clavicle fractures to allow proper fracture reduction. In this article, we introduce a concise technique for achieving the desired outcomes reliably and efficiently when treating unstable clavicle midshaft fractures.
Sujets)
Adulte , Femelle , Humains , Mâle , Clavicule , Études de suivi , Orthopédie , Études rétrospectives , Épaule , ChirurgiensRésumé
PURPOSE: To retrospectively compare minimally invasive percutaneous plate osteosynthesis (MIPPO) with open plate fixation for the treatment of clavicle midshaft fracture. MATERIALS AND METHODS: Between November 2011 to May 2014, 40 cases that were followed for more than 1 year–among all cases of MIPPO and open plate fixation–were analyzed. The study population was divided into two groups: group A included 20 cases of MIPPO and group B included 20 open plate fixation cases. The comparative analysis between the two groups was based on the operative time, bone union, functional evaluation (American Shoulder and Elbow Society score), incision length, pain relief (visual analogue scale, VAS), and complication. RESULTS: The bone union was successful for all the cases, and the functional evaluation scores of the shoulder joint were satisfactory for both groups (p>0.05). The operative time was 47.5 minutes and 58.7 minutes for group A and B, respectively (p<0.05). The incision length for group A was 6.2 cm and that for group B was 10.7 cm with statistical significance (p<0.05). Pain relief (VAS) after surgery for group A showed a quick recuperation in the early stages. For complications, there were 2 cases of dysesthesia and 1 case of malunion due to metal fixation failure in group A. There were 6 cases of dysesthesia and 2 cases of cosmetic problem due to hypertrophic scar in group B. CONCLUSION: Surgical results of clavicle shaft fracture were satisfactory for both groups, but group A had advantages of shorter operative time, minimal incision length, and better pain relief in the early stages compared with group B. However, we need further evaluations with long-term follow-up results and complications, such as malunion and exposure on radiation.
Sujets)
Cicatrice hypertrophique , Clavicule , Coude , Études de suivi , Durée opératoire , Paresthésie , Études rétrospectives , Épaule , Articulation glénohuméraleRésumé
Sex determination plays an essential role in forensic anthropology in the identification of an individual from skeletal remains. The aim of the study was to determine sex of an individual using the clavicle in a KwaZulu-Natal population. Various morphometric and morphological parameters were measured using 100 clavicles of known sex (66 male and 34 female) and age (range 2595 years). The mean maximum length, mid-shaft circumference and maximum breadth of the sternal and acromial ends of the male clavicles were greater in females. However, the mean medial curve of the clavicle was greater in females than in males on both sides, and on the right side the female clavicles also had a greater mean lateral curve than the males. The maximum length and mid-shaft circumference alone could be used to predict sex with an accuracy of 89 %. Therefore, the provision of morphometric data pertaining to the clavicle may assist forensic investigators, anthropologists and anatomists to sex the clavicle.
La determinación del sexo juega un papel esencial en la antropología forense e identificación de un individuo con restos óseos. El objetivo fue determinar el sexo de un individuo mediante la clavícula en una población KwaZulu-Natal. Se midieron varios parámetros morfométricos y morfológicos utilizando 100 clavículas (66 hombres y 34 mujeres) con un rango etario entre 2595 años. La longitud máxima media, circunferencia media del eje y la amplitud máxima de los extremos esternal y acromial de las clavículas de los hombres fueron mayores que en las mujeres. Sin embargo, la curva medial media de la clavícula fue mayor en mujeres que en hombres en ambos lados, y en el lado derecho las mujeres también tenían una curva lateral media de las clavículas mayor que en los hombres. La circunferencia máxima y la circunferencia media del eje por sí solas podrían ser utilizadas para predecir el sexo con una precisión de 89 %. Por tanto, la información de datos morfométricos relativos a la clavícula pueden ayudar a los investigadores forenses, antropólogos y anatomistas en la determinación del sexo.
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Humains , Mâle , Femelle , Clavicule/anatomie et histologie , Détermination du sexe à partir du squelette , République d'Afrique du SudRésumé
PURPOSE: The purpose of this study was to compare the clinical and radiological results of patients with metacarpal midshaft fracture following surgery using either intramedullary K-wire nailing or internal fixation of plates. MATERIALS AND METHODS: This study was conducted with 39 metacarpal midshaft fracture patients between October 2008 and September 2012. Of these 39 patients, 15 patients underwent intramedullary K-wire nailing and 24 patients underwent internal fixation of metal plates. We analyzed bone union time and final posterior angulation radiologically and the range of motion, grip power, and quick-disabilities of the arm, shoulder and hand (DASH) scores, visual analogue scale (VAS) score clinically. RESULTS: Bone union was observed in all cases and bone union times were not significantly different between the two surgical methods. The final follow-up radiographs showed statistically significant differences in posterior angulation, which was 14°, on average, among the patients who underwent intramedullary K-wire nailing and 5°, on average, among the patients who underwent internal fixation of plates. No significant differences were found for the range of joint motion, power, and quick-DASH scores and VAS score were not significantly different between the two groups. CONCLUSION: Intramedullary K-wire nailing showed significant differences in posterior angulations, but both intramedullary K-wire nailing and internal fixation of plates produced good clinical outcomes in the treatment of metacarpal midshaft fracture. Therefore both techniques are considered good treatment methods.
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Humains , Bras , Études de suivi , Main , Force de la main , Articulations , Amplitude articulaire , ÉpauleRésumé
Introducción: El objetivo de este trabajo es analizar los resultados de un grupo de pacientes con fracturas mediodiafisarias desplazadas de clavícula tratadas con placa precontorneada bloqueada. Se analizaron la tasa de consolidación ósea, los resultados funcionales y las complicaciones. Materiales y Métodos: Cuarenta y seis fracturas de clavícula desplazadas de tipo 2B de Edimburgo fueron tratadas con placa bloqueada precontorneada. Los pacientes eran 36 hombres (uno con fractura bilateral) y nueve mujeres, con una edad promedio de 33 años (rango 17-56). Los pacientes fueron evaluados con radiología y el puntaje de Constant, el test QuickDASH y la escala analógica visual para dolor. Resultados: El seguimiento promedio fue de 30 meses (rango 12-46). Cuarenta y cinco fracturas consolidaron y una no. El puntaje de Constant promedio fue de 96 (rango 56-100) y el de QuickDASH promedio, 2 (rango 0-32). El dolor en el seguimiento fue de 0,3 puntos (rango 0-6). Se registraron 10 complicaciones en nueve pacientes (21%), aunque solo tres (6,5%) fueron consideradas mayores. En siete pacientes (15%), se retiró la placa por intolerancia (uno de ellos fue el paciente con mala consolidación, se registró como segunda complicación en el mismo paciente). Conclusiones: La reducción y estabilización de las fracturas desplazadas del tercio medio de la clavícula con placas precontorneadas y bloqueadas son un tratamiento eficaz con un bajo índice de complicaciones mayores relacionadas, a veces, con errores técnicos.
Introduction: The aim of this paper is to analyze the results in a group of patients with displaced diaphyseal fractures treated with precontoured clavicle locking plate. The rate of bone healing, functional outcome and complications were analyzed. Methods: Forty-six displaced clavicle fractures (Edinburgh type 2B) were treated with precontoured locking plate. Thirty- six were men (one with bilateral fracture) and 9 were women, with an average age of 33 years (range 17-56). Patients were assessed with radiology and the Constant score, the QuickDASH test, and the visual analogue scale for pain. Results: The average follow-up was 30 months (range 12-46). Forty-five fractures healed and one did not. The Constant score averaged 96 points (range 56-100) and the QuickDASH test averaged 2 points (range 0-32). Pain was 0.3 points (range 0-6). There were 10 complications in 9 patients (21%), but only three (6.5%) were considered major. In 7 patients (15%) the plate had to be removed due to intolerance (one of them was a patient with malunion, registering as a second complication in the same patient). Conclusions: The reduction and stabilization of displaced midshaft fractures of the clavicle with precontoured clavicle locking plate is an effective treatment with a low rate of major complications, sometimes related to technical errors.
Sujets)
Humains , Clavicule/traumatismes , Fractures osseuses/chirurgie , Plaques orthopédiques , Résultat thérapeutiqueRésumé
Literature searches of the Cochrane Library, PubMed, EMBASE, Web of Science, LILACS, China National Knowledge Infrastructure, and Wanfang Data databases were performed from 1966 to September 2014. Only randomized and quasi-randomized controlled clinical trials comparing operative and nonoperative treatments for displaced midshaft clavicle fractures were included. Data collection and extraction, quality assessment, and data analyses were performed according to the Cochrane standards. Thirteen studies were considered in the meta-analysis. Constant scores and the Disabilities of the Arm, Shoulder and Hand scores were improved in the operative fixation group at a follow up of one year or more. The nonunion and symptomatic malunion rates were significantly lower in the operative group. Additionally, the nonoperative group had a higher likelihood of neurological symptoms compared with the operative group. A significantly higher risk of complications was found in patients treated conservatively than in those who underwent operative fixation. However, when patients with nonunion and symptomatic malunion were excluded from the analysis, no significant differences in the complication rate were found. We concluded that based on the current clinical reports, operative treatment is superior to nonoperative treatment in the management of displaced midshaft clavicle fractures. However, we do not support the routine use of primary operative fixation for all displaced midshaft clavicle fractures in adults.
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Femelle , Humains , Mâle , Clavicule/traumatismes , Fractures osseuses/thérapie , Clous orthopédiques , Plaques orthopédiques , Ostéosynthèse interne/méthodes , Fractures osseuses/chirurgie , Biais de publication , Essais contrôlés randomisés comme sujet , Résultat thérapeutiqueRésumé
PURPOSE: To report the treatment results of anatomical reduction of all fracture fragments and internal fixation using an inter-fragmentary screw and plate in displaced mid-shaft clavicle fracture with comminution. MATERIALS AND METHODS: Between June 2005 and August 2011, 13 consecutive displaced clavicle fractures with comminution (Edinburgh classification IIB2) treated by anatomic reduction and internal fixation using inter-fragmentary screw and plate were retrospectively evaluated. There were 11 male and 2 female patients with a mean age of 37.4 years (15~55 years). The right clavicle was injured in 4 patients and the dominant arm was involved in 46%. The mean duration from trauma to surgery was 7.0 days. The cause of injury was a traffic accident in three, a fall in two, and sports activity or direct injury in eight patients. All of the fracture pieces were anatomically reduced and fixed with inter-fragmentary screws. An additional plate was applied to maintain and reinforce the reduction of the fracture. Radiographic assessments for the numbers of fragments and the amount of shortening and displacement were performed. To verify the fracture healing and determine the time from fracture surgery to union and complications, all of the radiographs taken after surgery were evaluated. RESULTS: The number of fragments was 2 in 7 cases, 3 in 5 cases, and 6 in one case. The mean shortening of the clavicle was 1.1 cm (0.3~2.1 cm) and mean displacement between the main fragments was 2.6 cm (1.3~4.5 cm). The mean duration of follow-up was 16.5 months (8~26 months). Radiographic union was achieved in all patients with a mean time to union of 10.8 weeks (8~14 weeks). There were no complications including metal failure, nonunion, or infection. CONCLUSION: Anatomical reduction of all the fracture fragments and fixation using inter-fragmentary screws in addition to the usual plate fixation showed good fracture healing in displaced clavicle fracture with comminution.
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Femelle , Humains , Mâle , Accidents de la route , Bras , Clavicule , Déplacement psychologique , Études de suivi , Consolidation de fracture , Fractures comminutives , Études rétrospectives , SportsRésumé
PURPOSE: To compare clinical outcomes of the plate and threaded K-wire for fixation of midshaft clavicular fractures. MATERIALS AND METHODS: From 2005 Jan to 2009 May, medical records of 18 patients who underwent open reduction and internal fixation with plate (group 1) and 13 others who underwent intramedullary fixation with threaded K-wire (group 2) were reviewed. The mean follow up periods were 21.9 and 18.9months. The Functional results were evaluated with The Disabilities of the Arm, Shoulder and Hand (DASH) score and Constant shoulder score. The statistical evaluation was assessed with Paired T-test, Chi-square test. RESULTS: The DASH score were 11.5+/-2.7 in group 1 and 12.4+/-4.3 in group 2. The constant shoulder score were 92.0+/-3.1 in group 1 and 87.1+/-2.8 in group 2. Length of surgical wound (cm) were 10.6+/-3.4 in group 1 and 4.8+/-1.5 in group 2. Postoperative pain and range of motion change were superior in group 1. CONCLUSION: There was no significant difference between the two groups in functional and radiological results. But, there were patient's complaints about length of surgical wound in group 1 and hardware irritation in group 2.
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Humains , Bras , Clavicule , Études de suivi , Main , Dossiers médicaux , Douleur postopératoire , Amplitude articulaire , ÉpauleRésumé
BACKGROUND: To compare the outcomes of reconstruction plate and reconstruction locking compression plate (LCP) for the treatment of clavicle midshaft fractures. METHODS: Forty one patients with a clavicle midshaft fracture were treated by internal fixation with a reconstruction plate (19 patients) or reconstruction LCP (22 patients). The clinical and radiological results were evaluated according to the Quick Disability of the Arm, Shoulder, and Hand (DASH) score and plain radiographs. RESULTS: The mean time to union was 14.6 weeks in the reconstruction plate group compared to 13.2 weeks in the reconstruction LCP group (p > 0.05). The mean score to Quick DASH was 33.85 points in the reconstruction plate group compared to 34.81 points in the reconstruction LCP group (p > 0.05). The complications in the reconstruction plate were hypertrophic scarring in 2 cases, painful shoulder in 2 cases, limitation of shoulder motion in 2 cases, and screw loosening in 3 cases. In addition, the complications in the reconstruction LCP group was hypertrophic scarring in 4 cases, painful shoulder in 1 case and a limitation of shoulder motion in 1case (p > 0.05). CONCLUSIONS: This study showed radiologically and clinically satisfactory results in both groups. Overall, operative treatment with a Reconstruction plate or reconstruction LCP for clavicle shaft fractures can be used to obtain stable fixation.
Sujets)
Adulte , Sujet âgé , Femelle , Humains , Mâle , Adulte d'âge moyen , Jeune adulte , Plaques orthopédiques , Clavicule/traumatismes , Ostéosynthèse interne/instrumentation , Consolidation de fracture , Fractures osseuses/imagerie diagnostique , Complications postopératoiresRésumé
PURPOSE: Several authors have reported excellent results of delayed reconstruction of non-union & malunion in displaced mid-shaft fractures of the clavicle and these results were equal to that of immediate fixation. But direct comparison between these treatments is rare. We evaluated the results between the immediate fixation group and delayed reconstruction group for treating displaced mid-shaft fractures of the clavicle. MATERIALS AND METHODS: We studied the results of 18 cases with immediate fixation of displaced mid-shaft fractures of the clavicle and 15 cases with delayed reconstruction of non-union & malunion after conservative management, and these cases were seen from March 2000 to February, 2006. The final postoperative outcome was analyzed according to the clinical outcomes with using the Constant score and the radiological findings of bony union. RESULTS: The constant score was low in the delayed reconstruction group compare to that of the immediate fixation group (p value=0.045). For the pain score & the activities of daily living score, a statistically significant difference was seen between the two groups (p0.05). Radiological findings of bony union were seen for both groups at an average of 8.8 weeks for the immediate fixation group and at an average of 9.8 weeks for the delayed reconstruction group. CONCLUSION: Though the delayed reconstruction group was shown good clinical and radiological results, the immediate fixation group had a significantly better pain score, a better activities of daily living score and a better Constant score. It is important to choose the initial treatment option for displaced mid-shaft fractures of the clavicle after sufficient explanation to patients about the merits and demerits between these two treatment options