RESUMO
@#Introduction: Various treatment modalities are available butno consensus has been reached for optimal treatment oflateral third clavicle fractures. Precontoured locking plateswith broad lateral end for multiple screws fixation is a newlydesigned plate for lateral third clavicle fractures. Theobjective of our study was to analyse the functionaloutcomes as well as complications of this technique in asignificant number of cases with long follow-up duration.Materials and Methods: Forty-six patients with distal thirdclavicle fractures were treated by precontoured clavicularlocking plate with broad lateral end. Functional outcomeswere assessed on the basis of Constant-Murley ShoulderOutcome Score and University of California, Los Angeles(UCLA) Shoulder Rating Score, active shoulder range ofmotion, time for fracture union and coraco-claviculardistance.Results: The mean Constant-Murley score was 92.56±4.47(range: 79-98) for injured side and 96.22±2.23 (range: 90-100) for normal side with p-Value 0.56. Mean coracoclaviculardistance at final follow-up was 10.52±1.13 mm(range 9.7 to 11.7 mm) in injured side and 10.25±0.98 mm(range 9.6 to 11.2 mm) in normal side. Mean UCLAShoulder Rating Score was 32.55±2.12 (range: 27-34) forinjured side and 33.46±1.88 (range: 31- 35) on normal sidewith p value 0.58. No major complications that necessitatedrevision of surgery occurred in our study.Conclusion: This newly designed plate seemed extremelyuseful in successful union of lateral third clavicle fractures,with reduced rate of complications like fixation failures,iatrogenic rotator cuff injury, AC joint osteoarthritis andsub-acromial bursitis, with good functional out
RESUMO
<p><b>PURPOSE</b>Fractures of the lateral end of the clavicle are relatively uncommon. These fractures are unstable due to the various deforming forces which act on the fragments as well as the small distal fracture fragment. At most times the deforming forces are not taken into consideration, and the fracture is not fixed securely. In this study, we assessed a fixation technique using the precontoured locking plates to find out whether it provided a stable fixation with good functional outcome.</p><p><b>METHODS</b>Totally, 32 patients with lateral end clavicle fracture (Neer's Type II) were included in the study. After the informed consent and preoperative investigations were obtained, open reduction and internal fixation was done using a 3.5 mm precontoured superior locking plate with lateral extension under general anesthesia. Postoperative X-rays were done on day 1 and every 6 weeks after operation, until radiological union was achieved. The postoperative pain was assessed using Visual Analogue Scale (VAS) on postoperative days 1, 2 and 10. Postoperatively arm pouch sling was given for 2 weeks followed by active mobilization. Patients were asked to do their daily routine work and avoid lifting heavy weights. The functional outcome was assessed at the end of 2nd and 6th months with the help of Disabilities of the Arm, Shoulder and Hand (DASH) scoring.</p><p><b>RESULTS</b>There were no intraoperative complications in the procedure. The mean VAS score on postoperative day 1 was found to be 5 which decreased to 3 on day 2 and 0 on day 10. The mean DASH score was calculated as 11.63 at the end of postoperative month 2 and then 4.6 at the end of month 6. There was one case of malunion in whom the overhead abduction was restricted but was not painful and was managed conservatively.</p><p><b>CONCLUSION</b>The precontoured locking plates with lateral extension may be a good method to fix the fractures of the lateral end clavicle, which provide a stable fixation with good functional outcome with very few instances of stiffness and decreased range of motion of the shoulder with the hook plates and failure of fixation in screw and K-wire fixations. It may well be the answer to the fixation questions of the lateral clavicle fractures, although larger comparative studies between the surgical treatment methods are required to confirm the same.</p>