1
|
Ma T, Su H, Lu Y, Chen J, Tan W, Lei F, Wang D. Efficacy of intramedullary bridge fixation for midshaft clavicle fractures: a retrospective analysis of a novel technique. J Orthop Traumatol 2024; 25:31. [PMID: 38864994 PMCID: PMC11169189 DOI: 10.1186/s10195-024-00771-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 05/25/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND The aim of this study was to explore the efficacy of a novel intramedullary fixation technique using the ortho-bridge system (OBS) for midshaft clavicle fractures. METHODS A total of 63 patients were included in this study: 35 underwent plate internal fixation (LP group) and 28 underwent OBS intramedullary fixation (OBS group). Surgical time, intraoperative blood loss, incision length, fracture healing time, removal of the internal fixation agent, visual analog scale (VAS) score for shoulder pain, Constant-Murley shoulder score and complication occurrence were compared between the two groups. RESULTS Preoperative general data, such as sex, age and fracture type, were not significantly different between the two groups (P > 0.05). However, the OBS group exhibited better outcomes than the LP group exhibited in terms of surgical time, intraoperative blood loss and total incision length (P < 0.05). Additionally, the OBS group exhibited a significantly shorter fracture healing time and internal-fixation removal time than the LP group exhibited (P < 0.05). The VAS scores on postoperative day 1, week 1, month 1 and month 3 were lower in the OBS group than in the LP group (P < 0.05). Furthermore, the Constant-Murley shoulder scores at 1, 3, and 6 months postoperatively were higher in the OBS group than in the LP group (P < 0.05), with no significant difference at 1 year after surgery (P > 0.05). None of the patients in the OBS group experienced scarring of the surgical incision, and 6 patients in the LP group experienced scarring of the surgical incision. Finally, the complication incidence in the OBS group was lower than that in the LP group. CONCLUSION For midshaft clavicle fractures, OBS intramedullary fixation is better than locking-plate internal fixation because it led to less trauma, a faster recovery, better efficacy, and better esthetic outcomes and comfort. Therefore, this technique may have potential as a novel treatment for midshaft clavicle fractures. LEVEL OF EVIDENCE III, retrospective observational study.
Collapse
Affiliation(s)
- Tianyong Ma
- Second Department of Orthopedics, Fifth Affiliated Hospital of Zunyi Medical University, No. 1439, Zhufeng Avenue, Doumen District, Zhuhai, 519100, China
| | - Huan Su
- Second Department of Orthopedics, Fifth Affiliated Hospital of Zunyi Medical University, No. 1439, Zhufeng Avenue, Doumen District, Zhuhai, 519100, China
| | - Yihong Lu
- Second Department of Orthopedics, Fifth Affiliated Hospital of Zunyi Medical University, No. 1439, Zhufeng Avenue, Doumen District, Zhuhai, 519100, China
| | - Junping Chen
- Second Department of Orthopedics, Fifth Affiliated Hospital of Zunyi Medical University, No. 1439, Zhufeng Avenue, Doumen District, Zhuhai, 519100, China
| | - Weiyuan Tan
- Second Department of Orthopedics, Fifth Affiliated Hospital of Zunyi Medical University, No. 1439, Zhufeng Avenue, Doumen District, Zhuhai, 519100, China
| | - Fang Lei
- Second Department of Orthopedics, Fifth Affiliated Hospital of Zunyi Medical University, No. 1439, Zhufeng Avenue, Doumen District, Zhuhai, 519100, China
| | - Dewei Wang
- Second Department of Orthopedics, Fifth Affiliated Hospital of Zunyi Medical University, No. 1439, Zhufeng Avenue, Doumen District, Zhuhai, 519100, China.
| |
Collapse
|
2
|
Hornung CM, Kramer R, Levine J, Hannink G, Hoogervorst P. Functional outcomes and complications of plate fixation for midshaft clavicle fractures by type and location: a systematic review and meta-analysis. JSES Int 2024; 8:407-422. [PMID: 38707570 PMCID: PMC11064701 DOI: 10.1016/j.jseint.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Abstract
Background Various plate types are used in the surgical treatment of displaced midshaft clavicle fractures. These plates can be positioned in different locations on the clavicle, although no studies to date have elucidated optimal plate type and location of fixation. This systematic review compares the functional outcomes and complications in the management of displaced midshaft clavicle fractures using plate fixation by stratifying by both plate type and location. Methods A systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted to identify all papers reporting functional outcomes, union rates, and/or complications using plates for the management of midshaft clavicle fractures. Multiple databases and trial registries were searched from inception until March 2022. A meta-analysis was conducted for functional outcomes and type of complication, stratified by plate type (locking, compression, or reconstruction) and location (superior or anteroinferior). Pooled estimates of functional outcome scores and incidence of complications were calculated using a random effects model. Risk of bias and quality were assessed using the risk of bias version 2 and ROBINS-I (Risk Of Bias In Non-randomised Studies - of Interventions) tools. The confidence in estimates were rated and described according to the recommendations of the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) working group. Results Forty-five studies were included in the systematic review and 43 were included in the meta-analysis. Depending on plate type and location, pooled Constant-Murley Scores ranged from 89.23 to 93.48 at 12 months. Nonunion rates were 3% (95% confidence interval [CI] 1-6) for superior locking plates (GRADE Low). Rates of any complication (nonunion, hardware failure, hardware irritation, wound dehiscence, keloid, superficial infection, deep infection, delayed union, malunion, and/or persistent pain) by plate type and location ranged from 3% to 17% (GRADE Very Low to Moderate). Superior compression plates had the highest incidence of any complications (17% [95% CI 5-44], GRADE Very Low), while anterior inferior compression plates had the lowest incidence of any complication (3% [95% CI 0-15], GRADE Very Low). Hardware irritation was the most reported individual complication for superior locking plates and superior compression plates, 11% (95% CI 7-17, GRADE Low) and 11% (95% CI 3-33, GRADE Very Low), respectively. Conclusion Although most studies were of low quality, studies reporting functional outcomes generally showed good functional results and similar incidence of any complication regardless of plate type and location. There is no evidence of a plate and location combination to optimize patient functional outcomes or complications. We were unable to reliably evaluate union rates or individual complications for most plate types stratified by location.
Collapse
Affiliation(s)
- Christopher M. Hornung
- Department of Orthopaedic Surgery, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Riley Kramer
- Department of Orthopaedic Surgery, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Joshua Levine
- Department of Orthopaedic Surgery, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Gerjon Hannink
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Paul Hoogervorst
- Department of Orthopaedic Surgery, University of Minnesota School of Medicine, Minneapolis, MN, USA
| |
Collapse
|
3
|
Ryan PM, Wilson C, Volkmer R, Hisle G, Brennan M, Stahl D. Low rate of secondary surgery and implant removal following superior, precontoured plating of midshaft clavicle fractures. Proc AMIA Symp 2023; 36:461-467. [PMID: 37334078 PMCID: PMC10269419 DOI: 10.1080/08998280.2023.2210790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/26/2023] [Accepted: 05/02/2023] [Indexed: 06/20/2023] Open
Abstract
Background Surgical fixation of midshaft clavicle fractures with a single 3.5 mm superior clavicular plate has been associated with a high rate of hardware removal due to symptomatic hardware. Because of this, dual-plating techniques with lower-profile implants have been proposed. However, dual-plating systems have disadvantages, including increased cost and increased surgical morbidity. The aim of this study was to define the rate of symptomatic hardware removal for all midshaft clavicle fractures. Methods We retrospectively reviewed information on all patients from 2014 to 2018 at a single level 1 trauma institution with surgeries performed by two fellowship-trained orthopedic trauma surgeons. Documented removal of hardware and the reason for removal were recorded. We then contacted all patients at their listed telephone number to confirm the hardware was still in place and to administer patient outcome questionnaires. If patients did not answer, attempts were made to contact them multiple times on multiple days. Those who were not reached but had documented hardware removal were included in the total number of patients with hardware removal. Results The search revealed 158 patients, of whom 89 (61.8%) were included in the study. Average follow up was 4.09 years (range 2.02-6.50 years). Five patients (5.56%) underwent hardware removal. Removal was for symptomatic or irritating hardware in two of these patients (2.22%). Average abbreviated Disability of Arm, Shoulder, and Hand score was 6.27, and average American Society of Shoulder and Elbow Surgeons shoulder score was 93.6. Conclusion In our series, the rate of symptomatic hardware removal was 2.22%, well below reported removal rates. Hardware removal rates for prominent symptomatic superior clavicular plates may be significantly lower than previously reported, and these fractures may be adequately treated with a single, superior plate.
Collapse
Affiliation(s)
- Patrick M. Ryan
- Department of Orthopaedic Surgery, Baylor Scott and White Medical Center – Temple, Temple, Texas
| | - Charlie Wilson
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Randy Volkmer
- Department of Orthopaedic Surgery, Baylor Scott and White Medical Center – Temple, Temple, Texas
| | - Garret Hisle
- Department of Orthopaedic Surgery, Baylor Scott and White Medical Center – Temple, Temple, Texas
| | - Michael Brennan
- Department of Orthopaedic Surgery, Baylor Scott and White Medical Center – Temple, Temple, Texas
| | - Daniel Stahl
- Department of Orthopaedic Surgery, Baylor Scott and White Medical Center – Temple, Temple, Texas
| |
Collapse
|
4
|
Zhang J, Xu N, Yang Z, Niu W, Zhou G, Yu Z, Jia X, Zhou X, Huang Y. Bridged combined fixation system versus locking plate in the treatment of patients with implant periprosthetic refracture following proximal femoral fracture surgery: A retrospective observational study. Medicine (Baltimore) 2022; 101:e31538. [PMID: 36482553 PMCID: PMC9726297 DOI: 10.1097/md.0000000000031538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Locking plate (LP) re-fixation is mainly used to treat postoperative implant periprosthetic refractures; however, the extensive trauma and the fixation form of LP make the operation difficult. The bridge combined fixation system (BCFS) is a new clip-rod internal fixation system, and its clinical application is in its infancy. To compare the clinical effect of BCFS and LP in the treatment of geriatric postoperative implant periprosthetic refracture following proximal femoral fracture surgery. Thirty-two patients (14 with BCFS and 18 with LP) with postoperative implant periprosthetic refracture following proximal femoral fracture surgery, who underwent surgery in our hospital, were analyzed retrospectively. The incision length, operation time, intraoperative bleeding volume, postoperative drainage volume, postoperative hospital stay, fracture healing time and complications of each patient were recorded. Regular radiographs were taken after the operation to evaluate the fracture reduction and fixation. All the patients were followed for 12 months to evaluate their limb function by Johner-Wruhs scoring criteria. The patients were followed for an average of 24.1 months, and all achieved bony union, with no complications such as infection, nonunion, and internal fixation instrument falling off and loosening after the operation. Delayed healing occurred in two cases in the LP group. The average value of surgical incision length, operation time, postoperative hospitalization time and fracture healing time in the BCFS group were significantly smaller than those in the LP group, accompanied by a decrease in intraoperative bleeding and postoperative drainage volumes (P < .05). The rate of limb function in the BCFS group (85.7%) was higher than that in the LP group (83.3%), with no significance (P > .05). The BCFS in the refracture around the implant of the proximal femoral fracture exhibited many advantages such as simple operation, strong plasticity, effective reduction of surgical trauma, promotion of fracture healing and early functional rehabilitation, etc, making it an advantageous clinical application.
Collapse
Affiliation(s)
- Junjie Zhang
- Department of Orthopedics, The Affiliated Changzhou Second People’s Hospital of Nanjing Medical University, Changzhou, China
| | - Nanwei Xu
- Department of Orthopedics, The Affiliated Changzhou Second People’s Hospital of Nanjing Medical University, Changzhou, China
| | - Zhicheng Yang
- Department of Orthopedics, The Affiliated Changzhou Second People’s Hospital of Nanjing Medical University, Changzhou, China
| | - Wenli Niu
- Department of Orthopedics, The Affiliated Changzhou Second People’s Hospital of Nanjing Medical University, Changzhou, China
| | - Guoxin Zhou
- Department of Orthopedics, The Affiliated Changzhou Second People’s Hospital of Nanjing Medical University, Changzhou, China
| | - Zhongjie Yu
- Department of Orthopedics, The Affiliated Changzhou Second People’s Hospital of Nanjing Medical University, Changzhou, China
| | - Xiaojun Jia
- Department of Orthopedics, The Affiliated Changzhou Second People’s Hospital of Nanjing Medical University, Changzhou, China
| | - Xindie Zhou
- Department of Orthopedics, The Affiliated Changzhou Second People’s Hospital of Nanjing Medical University, Changzhou, China
- * Correspondence: Xindie Zhou, Department of Orthopedics, The Affiliated Changzhou Second People’s Hospital of Nanjing Medical University, Changzhou 213000, China (e-mail: )
| | - Yong Huang
- Department of Orthopedics, The Affiliated Changzhou Second People’s Hospital of Nanjing Medical University, Changzhou, China
| |
Collapse
|
5
|
Analysis of Efficacy, Complications, and Inflammatory Reactions of Bridge Combined Internal Fixation System for Periarticular Fractures of the Shoulder. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:5048172. [PMID: 36045948 PMCID: PMC9420638 DOI: 10.1155/2022/5048172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/04/2022] [Accepted: 08/03/2022] [Indexed: 11/17/2022]
Abstract
Objective The aim of the present research is to analyze the impact of the bridge combined internal fixation system (BCFS) on efficacy, complications, and inflammatory reactions of periarticular fractures of the shoulder. Methods A retrospective analysis was performed on 100 patients with periarticular fractures of the shoulder admitted between January 2016 and January 2020. Patients were assigned to the observation group (OG) and control group (CG) according to different treatment schemes, with 50 cases in each group. Patients in OG were intervened by BCFS, while those in CG were routinely given plate fixation. The treatment outcome, complications, and inflammatory reaction of the two groups were compared. Results The results showed better treatment outcome, shoulder joint function recovery, and inflammatory reaction alleviation of OG compared with CG. Besides, statistically shorter fracture healing and hospitalization time as well as fewer complications were determined in OG. Conclusion These results demonstrate that compared with the plate fixation system, BCFS can significantly improve the surgical efficacy and healing efficiency and alleviate the inflammatory response of patients, with a low complication rate, all of which contribute to faster recovery of periarticular fractures of the shoulder. Hence, BCFS is an ideal choice for periarticular fractures of the shoulder that deserves clinical promotion.
Collapse
|