Clinical and Radiological Outcomes after Various Treatments of Midshaft Clavicle Fractures in Adolescents.

BACKGROUD: Controversy exists about the optimal treatment of midshaft clavicle fractures in the presence of significant displacement, comminution, or shortening of the fracture in adolescents. The purpose of this study was to compare the clinical and radiological outcomes of 4 different treatments for midshaft clavicle fractures in adolescents: conservative treatment with a figure-of-8 (FO8) brace, open reduction and internal fixation with a plate (OPL), minimally invasive plate osteosynthesis (MIPO), and intramedullary nail fixation with a threaded Steinmann pin (TSP). METHODS: A total of 94 teenagers with midshaft clavicle fractures were divided into the FO8, OPL, MIPO, and TSP groups (n = 24, 33, 16, and 21, respectively). We analyzed clinical and radiological outcomes and complications in each group and compared the results among the groups. RESULTS: All groups showed satisfactory clinical and radiological outcomes, but each group showed different results for the assessment items. The Constant-Murley scores were higher in the operated groups than in the FO8 group. Recovery of joint motion was faster in the operated groups. The TSP group had the highest cosmetic satisfaction with respect to the satisfaction score and measured scar length. Fracture union was achieved in all patients. At the final follow-up, the bone length was closer to normal in the OPL and TSP groups than in the FO8 and MIPO groups, and angulation was less in the OPL and TSP groups than in the MIPO and FO8 groups. The TSP and MIPO groups obtained faster bone healing than the OPL and FO8 groups. In the operated groups, 9 patients had metal-induced irritating symptoms; 1, supraclavicular nerve injury symptoms; and 4, refractures after plate removal. CONCLUSIONS: The nonoperatively treated group had no iatrogenic complications. The operated groups complained of various disadvantages induced by surgery; however, these groups achieved faster functional recovery and slightly better radiological and functional results than the nonoperative group.

The Operative Treatment of Mid-Shaft Clavicular Nonunions: Intramedullary Fixation with Threaded Steinmann Pin and Bone Grafting

PURPOSE: To evaluate the clinical and radiological results of the treatment of mid-shaft clavicular nonunions using intramedullary fixation with threaded Steinmann pin and bone grafting. MATERIAL AND METHODS: In 16 patients treated with intramedullary fixation of threaded Steinmann pin and autogenous iliac bone grafting for the mid-shaft clavicular nonunions, 10 patients with follow-up over 1 year were investigated. All patients (10 clavicle fractures) underwent conservative treatment initially. The average age of patients was 56 years old (range, 18~70 years old). Eight cases were atrophic nonunions, two hypertrophic. A clinical assessment was evaluated postoperatively after 5 months according to the evaluation method of Kona et al. RESULTS: According to the evaluation method of Kona et al, four cases achieved excellent results, five cases good, and one case achieved a fair result. The average period until bony union was 9 weeks (range, 7~12.5 weeks) without infection, pin migration or breakage. One case showed skin irritation by lateral margin of Steinmann pin, which was subsided by pin removal after bony union. CONCLUSION: We obtained satisfactory results and have concluded that intramedullary fixation with threaded Steinmann pin and bone grafting could appropriately treat nonunions of the mid-clavicular fracture occurred after conservative treatment, because it minimizes soft tissue injury, gets relatively stable fixation and early ROM, predicts early bone union, facilitates pin removal under local anesthesia.

Atlantoaxial Dislocation in Down Syndrome Treated by Occipitocervical Fusion Using Threaded Steinmann Pin: A Case Report

Atlantoaxial dislocation is common in patients with Down syndrome, and an increased incidence was first noted by Tishler and Martel in 1965. Laxity of the transverse atlantal ligament is thought to be responsible for atlantoaxial dislocation, and surgical stabilization has been recommended for pateints who have instability, with or without myelopathy. Various surgical techniques and hardwares have been developed for occipitcervical fusion with varying degrees of results. The authors presents a case of Down syndrome with cervical myelopathy treated by occipitocervical fusion with an anatomically contoured threaded Steinmann-pin, which was secured to the occiput via small burr holes and to the vertebrae by sublaminar wiring, and supplemental autograft. This technique has the advantage over bone grafting, in that it affords rigid stabilization, allows early mobilization and may contribute to eventual bony fusion.