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Liu S, OuYang L, He X, Liu J, Peng L, Rai S, Lin W, Tang X. A Rare Combined Injury in Children during Side Impact: The Possible Mechanism and Treatment Results. Orthop Surg 2024; 16:357-362. [PMID: 38111013 PMCID: PMC10834184 DOI: 10.1111/os.13958] [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: 07/08/2023] [Revised: 10/13/2023] [Accepted: 10/24/2023] [Indexed: 12/20/2023] Open
Abstract
OBJECTIVE Proximal humeral fracture combined with contralateral midshaft clavicle fracture is an extremely rare injury in children. Few studies focus on the injury mechanism and treatment scheme. The aim of this study is to propose the possible mechanism of this injury and present the treatment results. METHODS This retrospective study included children diagnosed with proximal humeral fractures combined with contralateral midshaft clavicle fractures from August 2016 to March 2019 in the corresponding author's institution. The patients received elastic stable intramedullary nails and external fixation as treatment. The radiological and clinical outcomes of treatments were evaluated using the imaging and the Constant-Murley score (CMS) in follow up. RESULTS Twelve patients (eight males and four females) with an average age of 7.83 years old (age 5-12) were included in this research. All the patients had suffered a side impact in a road traffic accident or outdoor environment. Hypothesis about the mechanism was the proximal humerus was directly impacted at first and caused the surgical neck fracture, then the contralateral shoulder hits the solid object and the contralateral midshaft clavicle was fractured. During the average 45.2 months (range 36-57) follow-up, all the patient's fractures achieved clinical and radiological union before 14 weeks without complications. Every patient had a satisfactory score (range from 92 to 100) on the CMS criteria for both shoulders. CONCLUSION The hypothesis about the mechanism of this combined injury in this study sounds reasonable. It highlights the need for safety-related education about using a safety seat or wearing a seat belt to parents and caregivers, so as to avoid such injury even if the treatment with external fixation (EF) and proximal humeral and elastic stable intramedullary nailing (ESIN) showed good results.
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Affiliation(s)
- Shuai Liu
- Pediatric Orthopedics DepartmentWuxi 9th People's Hospital Affiliated to Soochow UniversityWuxiJiangsuChina
| | - LiZhi OuYang
- Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
| | - Xi He
- Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
| | - JiaTong Liu
- Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
| | - LianQi Peng
- Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
| | - Saroj Rai
- Department of Orthopaedics and Trauma SurgeryKarama Medical CenterDubaiUnited Arab Emirates
| | - WeiFeng Lin
- Pediatric Orthopedics DepartmentWuxi 9th People's Hospital Affiliated to Soochow UniversityWuxiJiangsuChina
| | - Xin Tang
- Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
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2
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Kang Y, Zhang Q, Ma Y, Zhou M, Jia X, Lin F, Wu Y, Rui Y. Clinical effect of nice knot-assisted minimally invasive titanium elastic nail fixation to treat Robinson 2B midshaft clavicular fracture. BMC Musculoskelet Disord 2024; 25:59. [PMID: 38216916 PMCID: PMC10787378 DOI: 10.1186/s12891-024-07197-4] [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: 04/04/2023] [Accepted: 01/11/2024] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND The treatment of completely displaced midshaft clavicle fractures is still controversial, especially Robinson 2B fractures. Titanium elastic nail (TEN) fixation is a good option for simple fractures, but no reports exist on its use in complex fractures. This study aimed to present a surgical method using the Nice knot-assisted TEN fixation to treat Robinson 2B midshaft clavicular fractures. METHODS A retrospective analysis of 29 patients who underwent fixation with TEN and had a 1-year postoperative follow-up between 2016 and 2020 was performed. The fractures were classified as Robinson type 2B1 in 17 cases and type 2B2 in 12 cases. Length of the incision, postoperative shoulder function Disability of Arm Shoulder and Hand (DASH) score and Constant score, complications rate, and second surgical incision length were recorded. RESULTS The length of the incision was 2-6 cm (average 3.7 cm). All incisions healed by first intention, and no infection or nerve injury occurred. The Constant score was 92-100 (average 96) and the DASH score was 0-6.2 (mean, 2.64). TEN bending and hypertrophic nonunion occurred in one case (3.4%) and implant irritation occurred in four cases (13.8%) Fixation implants were removed at 12-26 months (mean, 14.6 months) after surgery, and the length of the second incision was 1-2.5 cm (average 1.3 cm). CONCLUSIONS Intramedullary fixation by TEN is approved as a suitable surgical technique in clavicular fracture treatment. Nice knot-assisted fixation provides multifragmentary fracture stabilization, contributing to good fracture healing. Surgeons should consider this technique in treating Robinson 2B midshaft clavicular fractures. TRIAL REGISTRATION Retrospectively registered. This study was approved by the Ethics Committee of Wuxi Ninth People's Hospital (LW20220021).
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Affiliation(s)
- Yongqiang Kang
- Medical College, Soochow University, Suzhou, Jiangsu, China
| | - Qingqing Zhang
- Department of Traumatic Orthopedics, Wuxi Ninth People's Hospital, Soochow University, Liangxi Road, No.999, Binhu District, Wuxi, Jiangsu, China
| | - Yunhong Ma
- Department of Traumatic Orthopedics, Wuxi Ninth People's Hospital, Soochow University, Liangxi Road, No.999, Binhu District, Wuxi, Jiangsu, China
| | - Ming Zhou
- Department of Traumatic Orthopedics, Wuxi Ninth People's Hospital, Soochow University, Liangxi Road, No.999, Binhu District, Wuxi, Jiangsu, China
| | - Xueyuan Jia
- Department of Traumatic Orthopedics, Wuxi Ninth People's Hospital, Soochow University, Liangxi Road, No.999, Binhu District, Wuxi, Jiangsu, China
| | - Fang Lin
- Department of Traumatic Orthopedics, Wuxi Ninth People's Hospital, Soochow University, Liangxi Road, No.999, Binhu District, Wuxi, Jiangsu, China
| | - Yongwei Wu
- Department of Traumatic Orthopedics, Wuxi Ninth People's Hospital, Soochow University, Liangxi Road, No.999, Binhu District, Wuxi, Jiangsu, China.
| | - Yongjun Rui
- Department of Traumatic Orthopedics, Wuxi Ninth People's Hospital, Soochow University, Liangxi Road, No.999, Binhu District, Wuxi, Jiangsu, China.
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Charles SJC, Kumar P, Reddy RP, Cong T, Chen S, Mittwede P, Moloney G, Siska P, Lin A. Dual Versus Single Plate Fixation of Displaced Midshaft Clavicle Fractures: A Cost-Effectiveness Analysis. J Bone Joint Surg Am 2023; 105:1886-1896. [PMID: 37967070 DOI: 10.2106/jbjs.23.00338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
BACKGROUND Prior studies have highlighted lower rates of reoperation if fixation of a displaced midshaft clavicle fracture is performed with dual plating (DP) compared with single plating (SP). Despite higher initial costs associated with the DP construct, the observed reduction in secondary surgeries compared with the SP construct may make it a more cost-effective treatment option. The objective of this study was to assess the cost-effectiveness of DP compared with SP in patients with operatively indicated displaced midshaft clavicle fractures. METHODS We developed a decision tree to model the occurrence of postoperative complications (acute hardware complications, wound healing issues, deep infection, nonunion, and symptomatic hardware) associated with secondary surgeries. Complication-specific risk estimates were pooled for both plating techniques using the available literature. The time horizon was 2 years, and the analysis was conducted from the health-care payer's perspective. The costs were estimated using direct medical costs, and the benefits were measured in quality-adjusted life-years (QALYs). We assumed that DP would be $300 more expensive than SP initially. We conducted probabilistic and 1-way sensitivity analyses. RESULTS The model predicted reoperation in 6% of patients in the DP arm compared with 14% of patients in the SP arm. In the base case analysis, DP increased QALYs by 0.005 and costs by $71 per patient, yielding an incremental cost-effectiveness ratio (ICER) of $13,242 per QALY gained. The sensitivity analysis demonstrated that the cost-effectiveness of DP was driven by the cost of the index surgery, risk of symptomatic hardware, and nonunion complications with SP and DP. At a willingness-to-pay threshold of $100,000 per QALY gained, 95% of simulations suggested that DP was cost-effective compared with SP. CONCLUSIONS When indicated, operative management of displaced midshaft clavicle fractures using DP was found to be cost-effective compared with SP. Despite its higher initial hardware costs, DP fixation appears to offset its added costs with greater health utility via lower rates of reoperation and improved patient quality of life. LEVEL OF EVIDENCE Economic and Decision Analysis Level II . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Shaquille J-C Charles
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Praveen Kumar
- Public Health Dynamics Laboratory, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Rajiv P Reddy
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Ting Cong
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Stephen Chen
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Peter Mittwede
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Gele Moloney
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Peter Siska
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Albert Lin
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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4
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Müller M, Bullinger Y, Pohlemann T, Orth M. [Clavicle fractures: practical approach in clinical routine]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:1045-1056. [PMID: 37702744 DOI: 10.1007/s00104-023-01958-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/04/2023] [Indexed: 09/14/2023]
Abstract
Fractures of the clavicle are among the most common fractures. They typically result from a fall onto the lateral shoulder or the extended arm and are often related to sports and bicycle accidents. Obtaining the exact trauma mechanism, proper clinical findings and adequate X‑rays usually lead to the correct diagnosis. Non-displacement fractures can be treated conservatively with good results. Unstable and displaced fractures should be treated operatively. Open fractures or looming penetration are emergencies und should be treated immediately. In addition to fracture classification and morphology, other factors such as additional injuries and patient-related factors need to be considered in order to make an individualized therapy decision. In operative treatment, angular stable plating is the therapy of choice, and in most cases early functional aftercare is possible.
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Affiliation(s)
- M Müller
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum des Saarlandes, Kirrberger Straße 100, 66421, Homburg/Saar, Deutschland.
| | - Y Bullinger
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum des Saarlandes, Kirrberger Straße 100, 66421, Homburg/Saar, Deutschland
| | - T Pohlemann
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum des Saarlandes, Kirrberger Straße 100, 66421, Homburg/Saar, Deutschland
| | - M Orth
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum des Saarlandes, Kirrberger Straße 100, 66421, Homburg/Saar, Deutschland
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5
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Reddy RP, Charles S, Como M, Chen SR, Mittwede PN, Rai A, Moloney GB, Sabzevari S, Lin A. Dual Mini-Fragment Plate Fixation of Midshaft Clavicle Fractures Reduces Risk of Reoperation Compared With Single-Plate Fixation Techniques. Am J Sports Med 2023; 51:3393-3400. [PMID: 37849249 DOI: 10.1177/03635465231203010] [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] [Indexed: 10/19/2023]
Abstract
BACKGROUND Recent studies have highlighted dual plating as a method of reducing high rates of postoperative complication after operative management of displaced midshaft clavicular fractures. However, few studies have reliably characterized reoperation rates and magnitude of risk reduction achieved when using dual versus anterior and superior single-plate techniques. HYPOTHESIS There would be lower rates of reoperation among patients who underwent open reduction and internal fixation (ORIF) of displaced midshaft clavicular fractures via dual plating. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS This was a retrospective analysis of patients who underwent ORIF for a displaced midshaft clavicular fracture between 2010 and 2021 at a level 1 trauma center with a minimum 12-month follow-up. Patients were separated into 3 cohorts based on fixation type: (1) orthogonal dual mini-fragment plate fixation, (2) superior plate fixation, and (3) anterior plate fixation. Data on patient characteristics, fracture pattern, and reoperations were documented. All-cause reoperation rates and hazard ratio (HR) estimates of dual, superior, and anterior plating were calculated using a multivariate multilevel mixed-effects parametric survival model. Significant confounders including high-risk fracture morphology and smoking status were controlled for in the final model. RESULTS A final cohort of 256 patients was identified with mean follow-up of 4.9 ± 3.8 years. In total, 101 patients underwent superior plating, 92 underwent anterior plating, and 63 underwent dual plating. Overall, 31 reoperations took place (18 in superior, 12 in anterior, 1 in dual plating) among 22 patients. Major contributors to reoperation included symptomatic hardware (n = 11), nonunion (n = 8), deep infection (n = 7), and wound dehiscence (n = 2). Superior plating revealed the highest reoperation rate of 0.031 per person-years, followed by anterior plating with 0.026 per person-years and dual plating with 0.005 per person-years. Overall, single plating (either anterior or superior placement) had a nearly 8-fold greater risk of reoperation than dual plating (HR, 7.62; 95% CI, 1.02-56.82; P = .048). Further broken down by technique, superior plating had an 8-fold greater risk of reoperation than dual plating (HR, 8.36; 95% CI, 1.10-63.86; P = .041), but anterior plating did not demonstrate a statistically significant difference compared with dual plating (HR, 6.79; 95% CI, 0.87-52.90; P = .068). CONCLUSION Dual-plate fixation represents an excellent treatment for displaced midshaft clavicular fractures, with low rates of nonunion and reoperation. When compared with single locked superior or anterior plate fixation, dual mini-fragment plate fixation has a nearly 8-fold lower risk of reoperation.
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Affiliation(s)
- Rajiv P Reddy
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Shaquille Charles
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Matthew Como
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Stephen R Chen
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Peter N Mittwede
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Ajinkya Rai
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Gele B Moloney
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Soheil Sabzevari
- Department of Orthopaedics and Rehabilitation, Division of Sports Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Albert Lin
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
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Rizzo MG, Markowitz MI, Minaie A, Greif D, Lee D, Allegra P, Muñoz J. The 50 most influential publications in clavicle fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:2793-2803. [PMID: 37014447 DOI: 10.1007/s00590-023-03541-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 03/27/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE Clavicle fractures are among the most common orthopedic fractures, and treatment methods, operative versus nonoperative, have been a point of contention. The purpose of this study was to evaluate the 50 most influential articles regarding clavicle fractures to better understand past focuses of research and to identify any gaps in knowledge. METHODS A review of the most cited articles related to clavicle fractures was conducted using Web of Science database. A search was conducted in April 2022 by one trained researcher. Two independent researchers evaluated each article based on relevance to clavicle fracture. RESULTS The mean number of citations was 179.1, ranging from 576 to 81 citations, and collectively cited 8954 times. The decade from 2000 to 2009 contributed the greatest portion of articles, with only a small portion coming from before 1980. The Journal of Bone and Joint Surgery-American Volume contributed the greatest number of articles (20%). The majority of the articles were therapeutic (n = 37) and focused on treatment and outcome (n = 32). Most of the clinically focused articles had a level of evidence of IV (n = 26). CONCLUSION There is an increased influence of recent articles focused on clavicle fracture and management, due to the idea that conventional nonoperative treatment has a high rate of nonunion. Many of the most influential studies evaluate the outcomes of various treatments. Many of these studies, however, are lower levels of evidence, leaving a paucity of high level of evidence articles to support these conclusions. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Michael G Rizzo
- Department of Orthopaedic Surgery, University of Miami, Miami, USA
| | - Moses I Markowitz
- University of Miami Miller School of Medicine, 1120 NW 14th St, Miami, Fl, 33136, USA.
| | - Arya Minaie
- Department of Orthopaedic Surgery, University of Miami, Miami, USA
| | - Dylan Greif
- Department of Orthopaedic Surgery, University of Rochester, Rochester, USA
| | - Danny Lee
- Department of Orthopaedic Surgery, University of Miami, Miami, USA
| | - Paul Allegra
- Department of Orthopaedic Surgery, University of Miami, Miami, USA
| | - Julianne Muñoz
- Department of Orthopaedic Surgery, University of Miami, Miami, USA
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7
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von Rüden C, Rehme-Röhrl J, Augat P, Friederichs J, Hackl S, Stuby F, Trapp O. Evidence on treatment of clavicle fractures. Injury 2023; 54 Suppl 5:110818. [PMID: 37217399 DOI: 10.1016/j.injury.2023.05.049] [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: 02/03/2023] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 05/24/2023]
Abstract
Depending on the severity of the injury and the involvement of the soft tissue envelope, clavicle fractures can be treated operatively or non-operatively. In the past, displaced fractures of the clavicle shaft in adults have been treated non-operatively. However, the rate of nonunion following non-operative treatment seems to be higher than previously reported. In addition, publications reporting better functional outcomes following operative treatment are increasing. In recent years this has led to a paradigm shift towards an increase of operative fracture treatment. The aim of this review article was to summarize the currently available evidence on the treatment of clavicle fractures. Classifications, indications, and treatment options for different fracture patterns of the medial, midshaft, and lateral clavicles are presented and discussed.
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Affiliation(s)
- Christian von Rüden
- Department of Trauma Surgery, Orthopaedics and Hand Surgery, Weiden Medical Center, Weiden/ Oberpfalz, Germany; Department of Trauma Surgery, BG Unfallklinik Murnau, Murnau, Germany; Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria.
| | - Julia Rehme-Röhrl
- Department of Trauma Surgery, BG Unfallklinik Murnau, Murnau, Germany
| | - Peter Augat
- Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria; Institute for Biomechanics, BG Unfallklinik Murnau, Murnau, Germany
| | - Jan Friederichs
- Department of Trauma Surgery, BG Unfallklinik Murnau, Murnau, Germany
| | - Simon Hackl
- Department of Trauma Surgery, BG Unfallklinik Murnau, Murnau, Germany; Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria
| | - Fabian Stuby
- Department of Trauma Surgery, BG Unfallklinik Murnau, Murnau, Germany
| | - Oliver Trapp
- Department of Trauma Surgery, BG Unfallklinik Murnau, Murnau, Germany
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8
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Haouzi M, Amraoui B, Akkoumi A, Dinia M, Bassir R, Boufettal M, Mekkaoui J, Lamrani M, Kharmaz M, Berrada M. Bilateral clavicle fracture: A case report. Trauma Case Rep 2023; 46:100861. [PMID: 37347004 PMCID: PMC10279895 DOI: 10.1016/j.tcr.2023.100861] [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] [Accepted: 06/03/2023] [Indexed: 06/23/2023] Open
Abstract
Clavicle fractures are among the most common fractures in adults. Nevertheless, bilateral fractures are rarely reported in the literature. We present the case of a 35-year-old male patient who was admitted with a bilateral clavicle fracture following a motorcycle accident. The patient underwent open reduction and bilateral intramedullary fixation with Kirschner wires. After six months of follow-up, the functional result was satisfactory; the patient achieved full range of motion in both shoulders and was free from pain. X-rays showed a complete fusion of the fracture on both sides.
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9
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Tandron M, Cohen L, Cohen J, Allegra P, Munoz J, Kaplan L, Baraga M. The fifty most-cited articles regarding midshaft clavicle fractures. J Orthop 2023; 39:50-58. [PMID: 37125014 PMCID: PMC10130696 DOI: 10.1016/j.jor.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 02/17/2023] [Accepted: 03/30/2023] [Indexed: 05/02/2023] Open
Abstract
Introduction The clavicle is the most frequently fractured bone in the human body, and up to 80% of clavicle fractures occur in the middle third diaphyseal region of the clavicle (midshaft). We conducted a bibliometric analysis to identify and evaluate the 50 most-cited publications pertaining to midshaft clavicle fractures (MCF). Materials and methods Two independent reviewers conducted separate queries on Web of Science in December 2021 for "midshaft clavicle fractures". The publications yielded were organized from highest to lowest number of citations. We included articles, review articles, and editorial materials and excluded other document types. Both reviewers independently reviewed all abstracts until 50 studies pertaining to MCF were included. Theory We hypothesized that most articles would be published between 2000 and 2019, pertain to outcomes, and those with a greater (lower numeric) level of evidence would correlate with number of citations. Results The most prolific decade was from 2010 to 2019, with 50% (25/50) of articles published. Average citation density was 6.3 ± 5.5 (range, 1.3-33.1), defined as the average number of citations per year since publication. The median level of evidence (LOE) was 3.5 (IQR: 3). One-way ANOVA tests were used to compare the effects of LOE on total citations and citation density. There were statistically significant differences in total citations (F value = 12.07, p = 0.001) and citation density (F value = 21.14, p < 0.001) between LOE groups. The median number of total citations, grouped by LOE of 1 through 5, were as follows: 110, 66, 66, 51, 52. Conclusions This review provides an overview of the 50 most cited papers regarding MCF. This should be used as a reference for physicians and other providers who treat patients with MCF for treatment guidance and for those in teaching roles as a student and resident/fellow educational resource.
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Affiliation(s)
- Marissa Tandron
- University of Miami, Department of Orthopaedic Surgery, Miami, FL, 33136, USA
| | - Lara Cohen
- Harvard Combined Orthopaedic Residency Program, Boston, MA, 02114, USA
| | - Jacob Cohen
- University of Miami, Department of Orthopaedic Surgery, Miami, FL, 33136, USA
| | - Paul Allegra
- Lenox Hill Hospital, Department of Orthopaedic Surgery, New York, NY, 10075, USA
| | - Julianne Munoz
- University of Miami, Department of Orthopaedic Surgery, Miami, FL, 33136, USA
| | - Lee Kaplan
- University of Miami, Department of Orthopaedic Surgery, Miami, FL, 33136, USA
| | - Michael Baraga
- University of Miami, Department of Orthopaedic Surgery, Miami, FL, 33136, USA
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10
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Ma C, Miao F, Wu H, Li L, Yang Z, Han X. Comparison of the clinical efficacy of three internal fixation methods in the treatment of Edinburgh type IB fractures of the proximal clavicle. Biotechnol Genet Eng Rev 2023:1-15. [PMID: 37092813 DOI: 10.1080/02648725.2023.2202990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Clavicle fractures are one of the most common fractures and usually occur in the medial third of the clavicle. The study explored the efficacy of three internal fixation methods to treat Edinburgh IB fractures of the proximal clavicle. 68 patients with Edinburgh IB fractures of the proximal clavicle were divided into T-shaped plate group, double-miniature steel plate group and memory alloy embracing device group. Postoperative complications, return time to work, and fracture healing time were recorded. The clinical efficacy was evaluated by Constant-Murley score of shoulder joint, Visual Analogue Scale (VAS) score of pain, and arm-shoulder-hand dysfunction score. The operative time of the memory alloy embracing device group was significantly better than T-shaped plate group and double-miniature steel plate group. The length of surgical incision in the double-miniature steel plate group was significantly shorter than that in the T-shaped plate group and the memory alloy embracing device group. The hospitalization cost and recovery time of the double-plate and memory alloy hug groups were lower than those of the T-plate group. The double-miniature steel plate group and the memory alloy embracing device group were significantly better than the T-shaped plate group at two weeks after operation. Satisfactory clinical results can be obtained by using T-shaped plate, double-miniature steel plate and memory alloy embracing device in the treatment of Edinburgh IB fracture of proximal clavicle. However, the double-miniature steel plate group has the advantages of small incision, low cost, and quick postoperative recovery, and has more early advantages.
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Affiliation(s)
- Chengzhi Ma
- Department of Emergency Surgery, Dongying People's Hospital, Dongying Hospital Affiliated to Shandong Provincial Hospital Group, Dongying, China
| | - Fengxia Miao
- Department of Emergency Surgery, Dongying People's Hospital, Dongying Hospital Affiliated to Shandong Provincial Hospital Group, Dongying, China
| | - Hongxiao Wu
- Department of Emergency Surgery, Dongying People's Hospital, Dongying Hospital Affiliated to Shandong Provincial Hospital Group, Dongying, China
| | - Liang Li
- Department of Emergency Surgery, Dongying People's Hospital, Dongying Hospital Affiliated to Shandong Provincial Hospital Group, Dongying, China
| | - Zhan Yang
- Department of Emergency Surgery, Dongying People's Hospital, Dongying Hospital Affiliated to Shandong Provincial Hospital Group, Dongying, China
| | - Xiaochuan Han
- Department of Emergency Surgery, Dongying People's Hospital, Dongying Hospital Affiliated to Shandong Provincial Hospital Group, Dongying, China
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11
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Sepehri A, Guy P, Roffey DM, O’Brien PJ, Broekhuyse HM, Lefaivre KA. Assessing the Change in Operative Treatment Rates for Acute Midshaft Clavicle Fractures: Incorporation of Evidence-Based Surgery Results in Orthopaedic Practice. JB JS Open Access 2023; 8:JBJSOA-D-22-00096. [PMID: 37123504 PMCID: PMC10132723 DOI: 10.2106/jbjs.oa.22.00096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
In 2007, a randomized controlled trial (RCT) by the Canadian Orthopaedic Trauma Society (COTS) demonstrated better functional outcomes and a lower proportion of patients who developed malunion or nonunion following operative, compared with nonoperative, treatment of midshaft clavicle fractures. The primary aim of the present study was to compare the proportion of midshaft clavicle fractures treated operatively prior to and following the publication of the COTS RCT. An additional exploratory aim was to assess whether the proportion of midshaft clavicle fractures that were treated with surgery for malunion or nonunion decreased. Methods This retrospective cohort analysis used population-level administrative health data on the residents of British Columbia, Canada. Cases were identified by International Classification of Diseases, Ninth Revision (ICD-9) diagnostic codes and procedure fee codes. Adult patients (≥18 years) with closed middle-third clavicle fractures between 1997 and 2018 were included. Multivariable logistic regression modeling compared the proportion of clavicle fractures treated operatively before and after January 1, 2007, controlling for patient factors. The Pearson chi-square test compared the proportion of fractures treated operatively for malunion or nonunion in the cohorts. Results A total of 52,916 patients were included (mean age, 47.5 years; 65.6% male). More clavicle fractures were treated operatively from 2007 onward: 6.9% compared with 2.2% prior to 2007 (odds ratio [OR] = 3.35, 95% confidence interval [CI] = 3.03 to 3.70, p < 0.001). Male sex, moderate-to-high income, and younger age were associated with a greater proportion of operative fixation. The rate of surgery for clavicle malunion or nonunion also increased over this time period (to 4.1% from 3.4%, OR = 1.26, 95% CI = 1.15 to 1.38, p < 0.001). Conclusions We found a significant change in surgeon practice regarding operative management of clavicle fractures following the publication of a Level-I RCT. With limited high-quality trials comparing operative and nonoperative management, it is important that clinicians, health-care institutions, and health-authority administrations determine what steps can be taken to increase responsiveness to new clinical studies and evidence-based guidelines. Level of Evidence Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Aresh Sepehri
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Pierre Guy
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Darren M. Roffey
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Peter J. O’Brien
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Henry M. Broekhuyse
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Kelly A. Lefaivre
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, British Columbia, Canada
- Email for corresponding author:
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Markes AR, Garcia-Lopez E, Halvorson RT, Swarup I. Management of Displaced Midshaft Clavicle Fractures in Pediatrics and Adolescents: Operative vs Nonoperative Treatment. Orthop Res Rev 2022; 14:373-381. [PMID: 36345395 PMCID: PMC9636878 DOI: 10.2147/orr.s340538] [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: 08/16/2022] [Accepted: 10/17/2022] [Indexed: 01/24/2023] Open
Abstract
The purpose of the current review is to describe the management of displaced midshaft clavicle fractures in pediatric and adolescent patients. Midshaft clavicle fractures are relatively common in pediatric and adolescent patients. They most commonly occur from direct trauma and are often related to sports participation in adolescents. Recent literature in the management of adult midshaft clavicle fractures has supported operative management due to improved functional outcomes, decreased time to union, leading to early return to activity. A similar trend of increasing frequency in operative management has been seen in pediatric and adolescent patients with no consensus in the literature on optimal management. Nonoperative treatment consists of with a brief period of sling immobilization followed by range of motion. Operative management may be considered for open fractures, fractures with significant neurovascular compromise and soft tissue complications. Studies have shown comparable mid- to long-term functional and patient-reported outcomes after operative and nonoperative management of midshaft clavicle fractures in pediatric patients.
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Affiliation(s)
- Alexander R Markes
- Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, CA, USA
| | - Edgar Garcia-Lopez
- Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, CA, USA
| | - Ryan T Halvorson
- Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, CA, USA
| | - Ishaan Swarup
- Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, CA, USA,Correspondence: Ishaan Swarup, Email
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13
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Chen W, Wang B, Liu Z. A fluoroscopic view for midshaft clavicular fracture reduction and internal fixation: posteroanterior 25° skyline projection. BMC Surg 2022; 22:371. [PMID: 36309726 PMCID: PMC9618203 DOI: 10.1186/s12893-022-01813-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 09/23/2022] [Indexed: 11/10/2022] Open
Abstract
Background Open reduction and internal fixation have been frequently applied for displaced midshaft clavicular fracture. Plate and screw fixation of clavicular fractures could provide rigid fixation and rotational control. Proper implant positioning in surgical fixation is critical to prevent iatrogenic complications. Fluoroscopy plays an important role in the intraoperative evaluation of implants. This study aimed to introduce a new fluoroscopic projection to evaluate the positioning of plates and screws. Methods Adult patients with a diagnosis of acute displaced midshaft clavicular fracture were included in this study. The slope angle of the midshaft clavicle was measured on sagittal reconstructions of preoperative computed tomography (CT) scans. The incidence of screw revision based on intraoperative standard posteroanterior (PA) and PA 25° cephalic skyline projections was compared. The interobserver agreement for the two projections was calculated. Results Twenty-nine patients with midshaft clavicular fractures were enrolled from January 2020 to June 2021. The PA 25° skyline projection could clearly display the tangential line of the plate and inferior border of the clavicle. The slope angle on the superior surface of the midshaft clavicle was 26.0 ± 5.8° (range: 18.5–38.3°). The incidence of screw revision using the PA projection (72.4%) was significantly different from that using the PA 25° skyline projection (34.5%) (P < 0.05). The concordance of the screw revision rate based on the standard PA and PA 25° skyline projections was strong, with kappa coefficients of 0.680 (95% CI: 0.394–0.968) and 0.776 (95% CI: 0.537–0.998). Conclusion The PA 25° skyline projection corresponds to the slope angle of the midshaft clavicle. It can provide more accurate information regarding the proper screw length and be applied as a routine method for intraoperative evaluation.
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14
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Kim C. DIY Postoperative t-shirts for arm or shoulder injuries. Arch Phys Med Rehabil 2022; 103:2273-2275. [DOI: 10.1016/j.apmr.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/18/2022] [Accepted: 07/20/2022] [Indexed: 11/02/2022]
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15
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Ferguson DP, Baker HP, Dillman D, Theriault P, Trask K, MacDonald S, Trenholm A. Dual mini-fragment plate fixation of midshaft clavicle fractures is biomechanically equivalent to anatomic pre-contoured plating. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2022; 33:1109-1116. [PMID: 35412150 DOI: 10.1007/s00590-022-03268-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 04/05/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To biomechanically compare the stiffness of midshaft synthetic clavicle osteotomies fixed with either superior anatomic pre-contoured locking plates, anterior anatomic pre-contoured locking plates, or short-segment dual orthogonal mini-plate fixation. DESIGN AND SETTING Controlled laboratory study. Specimens Twenty-one synthetic pre-osteotomized clavicles were separated into three groups: superior plating, anterior plating, or dual-plating. Each clavicle was sequentially tested in non-destructive cycles of axial compression, three-point bending, and torsion. Load and displacement were recorded. Stiffness was calculated. RESULTS No statistically significant differences were found between construct stiffness during axial compression, three-point bending, or torsional testing. One superior plated clavicle suffered catastrophic failure during axial compression. One dual mini-fragment plated clavicle suffered catastrophic failure during torsion. CONCLUSIONS Orthogonal dual mini-fragment fixation of transverse clavicle fractures is biomechanically similar to superior and anterior pre-contoured anatomic locking plate fixation. No statistically significant differences in construct stiffness were found in axial compression, three-point bending, or torsion testing. Further clinical research is required to determine the long-term stability of dual mini-fragment plate fixation. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Devin P Ferguson
- Division of Orthopaedic Surgery, Dalhousie University, Halifax, NS, Canada
| | - Hayden P Baker
- Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago, 5841 South Maryland Avenue, Chicago, IL, 60637, USA.
| | - Daryl Dillman
- Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago, 5841 South Maryland Avenue, Chicago, IL, 60637, USA
| | - Patrick Theriault
- Division of Orthopaedic Surgery, Dalhousie University, Halifax, NS, Canada
| | - Kelly Trask
- Nova Scotia Health Authority, Halifax, NS, Canada
| | | | - Andrew Trenholm
- Division of Orthopaedic Surgery, Dalhousie University, Halifax, NS, Canada
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Dedeoglu SS, Imren Y, Karslioglu B, Keskin A, Atar S, Bilsel K. Kinesiotaping therapy for midshaft clavicular fractures: a randomised trial study. Acta Orthop Belg 2022; 88:143-150. [PMID: 35512165 DOI: 10.52628/88.1.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Midshaft clavicle fractures with shortening by less than 2 cm or minimal displacement without neurovascular injury can be treated conservatively. We hypothesized that kinesiotaping reduces the disadvantages of conservative treatment, such as early-phase pain, high nonunion rates, and a prolonged time to return to work, and yields better clinical and functional outcomes. Forty patients were randomly divided into the arm slings only (group S) or arm sling with kinesiotaping therapy group (group K). The outcome measures included the visual analog scale (VAS) score, Constant score, American Shoulder and Elbow Surgeons (ASES) score, union time, magnitude of shortening, and time to return to work. The mean follow-up period of the study was 8.5 (6- 10) months. The ASES and Constant scores were significantly better in group K than in group S in the 3rd month. The mean union time was 8.60 (8-12) weeks in group S and 8.25 (6-12) weeks in group K. The mean time to return to work was 7.23 (4-12) weeks in group S and 5.37 (2-10) weeks in group K, and the difference was statistically significant (p <0.05). There was no significant difference in terms of shortening between the two groups. Compared with an arm sling only, an arm sling with kinesiotaping can yield better clinical functional results, higher union rates, and a shorter the time to return to work due to the early control of pain and edema.
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17
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Kunkle BF, DesJardins JD, Campbell JR, Eichinger JK, Kissenberth MJ, Shaw KA, Tokish JM, Parada SA. Biomechanical evaluation of an intramedullary clavicle screw in simple oblique and butterfly wedge fractures. Proc Inst Mech Eng H 2021; 235:1257-1264. [PMID: 34289763 DOI: 10.1177/09544119211031052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This biomechanical study evaluates the performance of a solid titanium-alloy intra-medullary (IM) clavicular screw in torsion and cantilever bending in cadaveric clavicle specimens with simulated simple oblique and butterfly wedge midshaft fractures. Thirty-two fresh-frozen male clavicles were sorted into six experimental groups: Torsion Control, Torsion Simple Oblique Fracture, Torsion Butterfly Wedge Fracture, Bending Control, Bending Simple Oblique Fracture, and Bending Butterfly Wedge Fracture. The experimental groups were controlled for density, length, diameter, and laterality. All other samples were osteotomy-induced and implanted with a single 90 mm × 3 mm clavicle screw. All groups were tested to physiologically relevant cutoff points in torsion or bending. There were no statistically significant differences in the performance of the oblique and butterfly wedge fracture models for any torsion or bend testing measures, including maximum torsional resistance (p = 0.66), torsional stiffness (p = 0.51), maximum bending moment (p = 0.43), or bending stiffness (p = 0.73). Torsional testing of samples in the direction of thread tightening tended to be stronger than samples tested in loosening, with all groups either approaching or achieving statistical significance. There were no significant differences between the simple oblique or the butterfly-wedge fracture groups for any of the tested parameters, suggesting that there is no difference in the gross biomechanical properties of the bone-implant construct when the IM clavicle screw is used in either a simple midshaft fracture pattern or a more complex butterfly wedge fracture pattern.
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Affiliation(s)
- Bryce F Kunkle
- Department of Bioengineering, Clemson University, Clemson, SC, USA
| | | | - Joel R Campbell
- Steadman Hawkins Clinic of the Carolinas, Greenville, SC, USA
| | | | | | | | | | - Stephen A Parada
- Medical College of Georgia at Augusta University, Augusta, GA, USA
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Lin CY, Chang HW, Chang YH, Lin IH, Huang HY, Chang CH, Chen HT, Chen YW, Lin TL, Hsu CJ. Isolated Middle-Third Clavicle Fracture Causing Horner's Syndrome: A Case Report and Literature Review. Front Surg 2021; 8:640900. [PMID: 34124133 PMCID: PMC8195325 DOI: 10.3389/fsurg.2021.640900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/27/2021] [Indexed: 11/13/2022] Open
Abstract
The pathophysiology of Horner's syndrome arises due to compression or destruction of the oculosympathetic nerve pathway. Traumatic Horner's syndrome may indicate lethal neurovascular injury, such as brain stem lesion, cervical spine injury, or carotid artery dissection. The middle-third is the most common type of clavicle fracture. However, the association of the isolated middle-third clavicle fracture and Horner's syndrome is rare. We report the case of a 47 year-old woman who presented to our emergency department with acute trauma. Severe tenderness and limited mobility were observed in her left shoulder. On radiographic examination, a middle-third clavicle fracture was diagnosed. Ptosis and myosis were also noticed on further examination, and she was subsequently diagnosed with Horner's syndrome. A survey of the brain, cervical spine, carotid artery, and lung revealed no pathological findings. Surgery for the clavicle fracture was performed 2 days after the accident. The patient recovered from Horner's syndrome gradually over the 2 months following the surgery, and the syndrome completely resolved by the third month. To the best of our knowledge, this is the first report of traumatic Horner's syndrome caused by an isolated middle-third clavicle fracture. The improved outcome may be attributed to the surgical intervention for middle-third clavicle fracture, which may help release ganglion or neuronal compression.
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Affiliation(s)
- Chia-Yu Lin
- Department of Orthopedics, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Hao-Wei Chang
- Department of Orthopedics, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Yu-Hsuan Chang
- Department of Medical Image, National Taiwan University Hospital, Taipei, Taiwan
| | - I-Hao Lin
- Department of Orthopedics, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Hung-Yu Huang
- Department of Neurology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Cheng-Hsien Chang
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan.,Department of Optometry, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Hsien-Te Chen
- Department of Orthopedics, China Medical University Hospital, China Medical University, Taichung, Taiwan.,Spine Center, China Medical University Hospital, China Medical University, Taichung, Taiwan.,Department of Sport Medicine, College of Health Care, China Medical University, Taichung, Taiwan
| | - Yi-Wen Chen
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan.,3D Printing Medical Research Institute, Asia University, Taichung, Taiwan
| | - Tsung-Li Lin
- Department of Orthopedics, China Medical University Hospital, China Medical University, Taichung, Taiwan.,Department of Sport Medicine, College of Health Care, China Medical University, Taichung, Taiwan.,Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| | - Chin-Jung Hsu
- Department of Orthopedics, China Medical University Hospital, China Medical University, Taichung, Taiwan.,School of Chinese Medicine, China Medical University, Taichung, Taiwan
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White-Light Body Scanning Captures Three-Dimensional Shoulder Deformity After Displaced Diaphyseal Clavicle Fracture. J Orthop Trauma 2021; 35:e142-e147. [PMID: 32910627 DOI: 10.1097/bot.0000000000001957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/28/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We sought to determine if white-light three-dimensional (3D) body scanning can identify clinically relevant shoulder girdle deformity after displaced diaphyseal clavicle fracture (DCF). METHODS Adult patients with DCF (OTA/AO 15A) were prospectively enrolled. Four subcutaneous osseous landmarks were used to measure shoulder girdle morphology of the injured and uninjured shoulder. Measurements were made both manually with a tape measure and digitally with a white-light 3D scanner. Bilateral radiographs were obtained, and clavicle length was recorded. Quick-Disabilities of the Arm, Shoulder, and Hand surveys were administered at injury and at 6 and 12 weeks. RESULTS Twenty-two patients were included in the study. At the initial visit, all patients had significant differences in deformity measurements between injured and uninjured shoulders as measured by 3D scanning. There was no difference between shoulders measured using manual measurements. At 6 and 12 weeks, shoulder asymmetry was significantly less in patients treated with surgery compared with nonoperative patients as measured by the 3D scanner alone. Clavicle shortening measured on 3D scanning had weak and moderate positive correlations to radiographs (R = 0.27) and manual measurements (R = 0.53), respectively. Patients treated with surgery had significant functional improvements by 6 weeks, and a similar improvement was not seen until 12 weeks in nonsurgical patients. CONCLUSION White-light 3D scanning was able to identify and monitor clinically relevant shoulder girdle deformity after DCF. This tool may become a useful adjunct to clinical examination and radiographic assessment, when determining clinically relevant deformity thresholds. In the future, quantifying and understanding shoulder deformity may inform clinical decision making in these patients. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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20
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Vellingiri K, Seenappa H. Bilateral Clavicle Fractures - A Rare Injury. Cureus 2020; 12:e11449. [PMID: 33329948 PMCID: PMC7733778 DOI: 10.7759/cureus.11449] [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: 12/02/2022] Open
Abstract
Both surgical or nonsurgical management of bilateral clavicle fractures have advantages and disadvantages. Hence a patient must be advised for shared decision making. Our patient was a painter by occupation with a left-sided dominant hand. Considering his job and financial constraints, we fixed his left clavicle fracture surgically and treated his right-sided clavicle fracture conservatively. We suggest based on our report concerning this rare injury, is that not all fractures need to be fixed surgically. Patient needs and other factors should be taken into consideration before taking the patient for surgical management.
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Affiliation(s)
- Kishore Vellingiri
- Department of Orthopaedics, Sri Devaraj Urs Medical College, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
| | - Hariprasad Seenappa
- Department of Orthopaedics, Sri Devaraj Urs Medical College, Sri Devaraj Urs Academy of Higher Eduacation and Research, Kolar, IND
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21
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Pilotstudie zur Versorgung von Claviculafrakturen bei Kindern. Monatsschr Kinderheilkd 2020. [DOI: 10.1007/s00112-020-00937-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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22
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Ma X, Wang K, Ma J, Chen X, Han S. Operative treatments compared with nonoperative treatment of displaced midshaft clavicular fractures. J Orthop Sci 2020; 25:310-314. [PMID: 31031110 DOI: 10.1016/j.jos.2019.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 04/05/2019] [Accepted: 04/08/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Few reports on external fixation to treat displaced midshaft clavicular fractures exist. We sought to compare the clinical effects of external fixation, plate fixation, and nonoperative treatment for treating displaced midshaft clavicular fractures in adults. MATERIAL AND METHODS Eighty-nine patients with a displaced midshaft fracture of the clavicle were selected (according to inclusion criteria) for a retrospective analysis and assigned to either operative treatment with external fixation (29 patients), plate fixation (30 patients) or nonoperative treatment with a sling (30 patients). The average follow-up period is 32 months. Outcome analysis included: Constant shoulder score (CSS); disabilities of the arm, shoulder and hand score (DASH); nonunion rate; satisfaction of shoulder appearance. RESULTS Eighty-five cases were successfully followed up. No significant difference was observed between external fixation and plate fixation (p > 0.05 and p = 0.132, respectively). The operative groups achieved better effects (p < 0.001) compared to the nonoperative treatment. The healing time of the three groups were: 10.4 ± 2.3 weeks for external fixation; 12.1 ± 2.5 weeks for plate fixation; and 15.7 ± 2.2 weeks for nonoperative treatment. In the follow-up, patients in the external fixation group (96%) and plate fixation group (93%) were more likely to be satisfied with the appearance of the shoulder than were those in the nonoperative group (77%). CONCLUSION The external fixation and plate fixation are overall better than the nonoperative treatment. As to choose between the two, it depends on the local soft tissue condition, surgeon's techniques, communication between doctor and patients and so on.
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Affiliation(s)
- Xianzhi Ma
- Trauma Orthopedic Department, Qinghai Provincial People's Hospital, Xining, Qinghai Province, China.
| | - Kai Wang
- Trauma Orthopedic Department, Qinghai Provincial People's Hospital, Xining, Qinghai Province, China.
| | - Jun Ma
- Trauma Orthopedic Department, Qinghai Provincial People's Hospital, Xining, Qinghai Province, China
| | - Xiaotao Chen
- Trauma Orthopedic Department, Qinghai Provincial People's Hospital, Xining, Qinghai Province, China
| | - Shengshou Han
- Trauma Orthopedic Department, Qinghai Provincial People's Hospital, Xining, Qinghai Province, China.
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23
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Hehn FH, Bonavides PS, Oliveira Júnior AN, Silva HC, Back Neto M, Stipp WN. Clinical Evaluation of the Surgical Treatment of Midshaft Clavicle Fractures at a Hospital in the South of Santa Catarina. Rev Bras Ortop 2020; 55:100-105. [PMID: 32123453 PMCID: PMC7048566 DOI: 10.1055/s-0039-1697013] [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] [Received: 03/27/2018] [Accepted: 08/08/2018] [Indexed: 11/03/2022] Open
Abstract
Objective To evaluate the results of the surgical treatment of fractures of the middle third of the clavicle. Methods A retrospective cross-sectional study, in which 36 patients who suffered fractures of the middle third of the clavicle and who were surgically treated from January 2012 to February 2017 were evaluated. They were evaluated for types of fracture, age, smoking, osteosynthesis material, and Constant-Murley and Modified-University of California at Los Angeles Shoulder Rating Scale (UCLA-M) scores. Results The mean Constant-Murley and UCLA-M scores were 91.59 and 31.29 respectively. The mean age was 37.62 years, and it was statistically related to the type of osteosynthesis ( p < 0.05), but the osteosynthesis material did not show significance with the improvement in the rates of the functional scores. Conclusion The surgical treatment provides good functional results after diaphyseal fractures of the clavicle, regardless of the line of the fracture, with a low rate of pseudarthrosis.
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Affiliation(s)
- Fernando H.S. Hehn
- Faculdade de Medicina, Universidade do Sul de Santa Catarina (Unisul), Tubarão, SC, Brasil
| | - Paola S.G. Bonavides
- Faculdade de Medicina, Universidade do Sul de Santa Catarina (Unisul), Tubarão, SC, Brasil
| | | | - Helena C.G. Silva
- Faculdade de Medicina, Universidade do Sul de Santa Catarina (Unisul), Tubarão, SC, Brasil
- Departamento de Ortopedia e Traumatologia, Hospital Nossa Senhora da Conceição, Tubarão, SC, Brasil
| | - Martins Back Neto
- Departamento de Ortopedia e Traumatologia, Hospital Nossa Senhora da Conceição, Tubarão, SC, Brasil
| | - Willian N. Stipp
- Departamento de Ortopedia e Traumatologia, Hospital Nossa Senhora da Conceição, Tubarão, SC, Brasil
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Kang Y, Ma Y, Rui Y, Li F, Liu J, Gu J, Xu P, Wu Y. [Effectiveness of Nice knot combined with elastic intramedullary nailing fixation in treatment of Robinson type 2B midshaft clavicular fracture in adults]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:1394-1398. [PMID: 31650755 PMCID: PMC8337455 DOI: 10.7507/1002-1892.201901027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 09/09/2019] [Indexed: 11/03/2022]
Abstract
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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Affiliation(s)
- Yongqiang Kang
- Department of Orthopaedics, the 9th People's Hospital of Wuxi (Wuxi Orthopedic Hospital), Wuxi Jiangsu, 214062, P.R.China
| | - Yunhong Ma
- Department of Orthopaedics, the 9th People's Hospital of Wuxi (Wuxi Orthopedic Hospital), Wuxi Jiangsu, 214062, P.R.China
| | - Yongjun Rui
- Department of Orthopaedics, the 9th People's Hospital of Wuxi (Wuxi Orthopedic Hospital), Wuxi Jiangsu, 214062, P.R.China
| | - Fengfeng Li
- Department of Orthopaedics, the 9th People's Hospital of Wuxi (Wuxi Orthopedic Hospital), Wuxi Jiangsu, 214062, P.R.China
| | - Jun Liu
- Department of Orthopaedics, the 9th People's Hospital of Wuxi (Wuxi Orthopedic Hospital), Wuxi Jiangsu, 214062, P.R.China
| | - Jun Gu
- Department of Orthopaedics, the 9th People's Hospital of Wuxi (Wuxi Orthopedic Hospital), Wuxi Jiangsu, 214062, P.R.China
| | - Peng Xu
- Department of Orthopaedics, the 9th People's Hospital of Wuxi (Wuxi Orthopedic Hospital), Wuxi Jiangsu, 214062, P.R.China
| | - Yongwei Wu
- Department of Orthopaedics, the 9th People's Hospital of Wuxi (Wuxi Orthopedic Hospital), Wuxi Jiangsu, 214062,
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Comparison of the effectiveness of oblique and transverse incisions in the treatment of fractures of the middle and outer third of the clavicle. J Shoulder Elbow Surg 2019; 28:1308-1315. [PMID: 31230782 DOI: 10.1016/j.jse.2019.03.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 03/22/2019] [Accepted: 03/27/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Iatrogenic supraclavicular nerve injury is frequent during surgical repair of clavicle fractures through a transverse incision. The use of an oblique incision may be a potential approach to avoiding this complication. This study compared the clinical effectiveness of oblique and transverse incisions in the treatment of fractures in the middle and outer thirds of the clavicle. METHODS This prospective observational study included patients with fracture of the mid-to-outer third of the clavicle between August 2011 and August 2016. We allocated the patients into 2 groups based on their choice of treatment: oblique incision (n = 62) and transverse incision (n = 64). We compared the following parameters between the 2 groups: operative time, intraoperative blood loss, postoperative fracture healing time, incision size, clinical complications, postoperative subjective satisfaction, and shoulder function. RESULTS Operative time, postoperative fracture healing time, postoperative shoulder function (Constant-Murley and disabilities of the arm, shoulder and hand [DASH] scores), and clinical complications did not differ significantly between groups (all P > .05). The oblique incision group had less intraoperative blood loss (41.4 ± 16.4 vs. 65.3 ± 10.4 mL, P < .001) and smaller surgical incisions (3.6 ± 1.6 vs. 10.3 ± 2.6 cm, P < .001). The oblique incision group showed better outcomes for postoperative satisfaction (85.5% vs. 64.1%, P = .015), absence of shoulder numbness at the last follow-up (89.3% vs. 70.3%, P = .010), and satisfaction with the scar (90.3% vs. 3.1%, P < .001). CONCLUSION Oblique incisions have several advantages over transverse incisions: less bleeding, smaller incisions, less iatrogenic injury to supraclavicular nerves, and higher patient satisfaction. These 2 approaches have equivalent effects on recovery of shoulder joint function.
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Bhardwaj A, Sharma G, Patil A, Rahate V. Comparison of plate osteosynthesis versus non-operative management for mid-shaft clavicle fractures-A prospective study. Injury 2018; 49:1104-1107. [PMID: 29704955 DOI: 10.1016/j.injury.2018.04.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Revised: 04/07/2018] [Accepted: 04/15/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Treatment for mid-shaft clavicle fractures has recently seen a paradigm shift towards surgical management. The aim of the study was to compare clinical and functional outcome between plate osteosynthesis and conservative line of management in middle-third clavicle fractures. MATERIAL AND METHODS A prospective randomized study was conducted on 69 patients with closed displaced clavicle fractures between May 2014 and May 2016. Patients with medial or lateral third clavicle fractures, polytrauma and compound fractures were excluded from the study. Patients treated with plating were in group A (n = 36) while those treated with arm pouch were in group B (n = 33). RESULTS The mean age of the patient in group A was 32.4 ± 43 and group B was 31.7 ± 26 years. 48 (69.9%) females were involved in the study. History of fall was the most common mechanism of injury affecting 51 (73.9%) patients. All the patients were type 2 B as per the Robinson classification system. The average operative duration was 78.3 ± 12.4 min. Union was seen at 15.6 ± 0.8 in group A and 22.8 ± 0.4 in group B (p < 0.0001). Two (6%) of the patients in group B had non-union. One (2.7%) patient in group A had mal-union. Two (5.5%) patients had plate prominence. One (2.7%) patient had superficial infection. The Constant and Murley scoring at 24 months was 89.42 and 76.24 in group A and group B respectively. CONCLUSION Plating for displaced mid-shaft clavicle fractures is can lead to better functional and radiological outcomes with minimal complications as compared to the conservative modality of treatment.
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Affiliation(s)
| | - Gaurav Sharma
- Department of Orthopaedics, Prakash Institue of Medical Sciences, Islampu-Sangle Road, Tal- Walwa, Sangli, Uran, Islampur, 415409, Maharsahtra, India.
| | - Ashok Patil
- Department of Orthopaedics, Prakash Institue of Medical Sciences, Islampu-Sangle Road, Tal- Walwa, Sangli, Uran, Islampur, 415409, Maharsahtra, India
| | - Vaijnath Rahate
- Department of Orthopaedics, Prakash Institue of Medical Sciences, Islampu-Sangle Road, Tal- Walwa, Sangli, Uran, Islampur, 415409, Maharsahtra, India
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Investigations of cortical and cancellous clavicle bone patterns reveal an explanation for the load transmission and the higher incidence of lateral clavicle fractures in the elderly: a CT-based cadaveric study. Anat Sci Int 2018; 93:479-486. [DOI: 10.1007/s12565-018-0437-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 03/18/2018] [Indexed: 10/17/2022]
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Oliveira ASD, Roberto BB, Lenza M, Pintan GF, Ejnisman B, Schor B, Carrera EDF, Murachovsky J. Preferences of orthopedic surgeons for treating midshaft clavicle fracture in adults. EINSTEIN-SAO PAULO 2017; 15:295-306. [PMID: 29091151 PMCID: PMC5823043 DOI: 10.1590/s1679-45082017ao4043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 05/04/2017] [Indexed: 08/30/2023] Open
Abstract
Objective To determine the current clinical practice in Latin America for treating midshaft clavicle fractures, including surgical and non-surgical approaches. Methods A cross-sectional study using a descriptive questionnaire. Shoulder and elbow surgeons from the Brazilian Society of Shoulder and Elbow Surgery and from the Latin American Society of Shoulder and Elbow were contacted and asked to complete a short questionnaire (SurveyMonkey®) on the management of midshaft fractures of the clavicle. Incomplete or inconsistent answers were excluded. Results The type of radiographic classification preferably used was related to description of fracture morphology, according to 41% of participants. Allman classification ranked second and was used by 24.1% of participants. As to indications for surgical treatment, only the indications with shortening and imminence of skin exposure were statistically significant. Conservative treatment was chosen in cortical contact. Regarding immobilization method, the simple sling was preferred, and treatment lasted from 4 to 6 weeks. Although the result was not statistically significant, the blocked plate was the preferred option in surgical cases. Conclusion The treatment of midshaft clavicle fractures in Latin America is in accordance with the current literature.
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Affiliation(s)
| | | | - Mario Lenza
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | | | - Benno Ejnisman
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.,Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Breno Schor
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | | | - Joel Murachovsky
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.,Faculdade de Medicina do ABC, Santo André, SP, Brazil
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Bakota B, Chan G, Staresinic M, Rajput V, Phadnis J, Korac Z. Safe intramedullary fixation of displaced midshaft clavicle fractures with 2.5mm Kirschner wires - technique description and a two-part versus multifragmentary fracture fixation outcome comparison. Injury 2017; 48 Suppl 5:S27-S33. [PMID: 29122118 DOI: 10.1016/s0020-1383(17)30735-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The aim of this study was to present a modified Murray and Schwarz 2.5-mm Kirschner wire (K-wire) intramedullary (IM) technique for fixation of displaced midshaft clavicle fractures (DMCF), and to compare the differences in treatment outcome of two-part (Robinson 2B.1) and multifragmentary (Robinson 2B.2) DMCF. METHODS A retrospective analysis of 91 patients who underwent IM fixation with a 2.5-mm K-wire for DMCF and had a 1-year post-operative follow-up between 2000 and 2012 was performed. The patients were allocated into two groups: Robinson 2B.1 (n = 64) and Robinson 2B.2 (n = 27). Assessed outcomes were non-union, reoperation rate, wire migration and infection. RESULTS There was no statistically significant difference in the rate of non-union (2B.1,2B.2; 3.13%, 7.41%; p = 0.365), reoperation (2B.1, 2B.2; 3.13%, 7.41%; p = 0.365), K-wire migration (2B.1, 2B.2; 0.00%, 0.00%; p = 1.00) and clavicle shortening at 12-months (2B.1, 2B.2; 3.13%, 7.41%; p = 0.365). CONCLUSION Intramedullary clavicle fixation with a 2.5-mm K-wire is a safe surgical technique. 2B.1 injuries treated with 2.5-mm IM K-wire fixation have relatively improved outcome compared with displaced 2B.2 fractures for both non-union and reoperation rates. There were no occurrences of implant migration with either 2B.1 or 2B.2 injuries, and a non-significant difference in implant irritation was documented with IM K-fixation. The non-union rate with K-wire IM fixation of 2B.1 injuries concords with the published results of other IM devices and thus this technique should be added to the surgeon's armamentarium when considering surgical treatment of such injuries.
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Affiliation(s)
- Bore Bakota
- Department of Trauma & Orthopaedics, Brighton & Sussex University Hospitals NHS Trust, United Kingdom; Department of Trauma & Orthopaedics, General Hospital Karlovac, Croatia.
| | - Gareth Chan
- Department of Trauma & Orthopaedics, Brighton & Sussex University Hospitals NHS Trust, United Kingdom
| | - Mario Staresinic
- Department of Trauma & Orthopaedics, University Hospital Merkur, Zagreb, Croatia
| | - Vishal Rajput
- Department of Trauma & Orthopaedics, Pilgrim Hospital, United Lincolnshire Hospitals NHS Trust, United Kingdom
| | - Joideep Phadnis
- Department of Trauma & Orthopaedics, Brighton & Sussex University Hospitals NHS Trust, United Kingdom
| | - Zelimir Korac
- Department of Trauma & Orthopaedics, General Hospital Karlovac, Croatia
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McKerrow M, North J. Clavicle fracture management: A comparison of a tertiary hospital and rural telehealth sites. J Telemed Telecare 2017; 23:856-860. [PMID: 28958210 DOI: 10.1177/1357633x17733503] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The clavicle is one of the most commonly fractured bones in the adult population. Management has traditionally been conservative, however more recent research has yielded higher non-union rates associated with non-operative management. This study aims to analyse the proportion of operative and non-operative treatment methods for clavicle fracture in a tertiary hospital facility and rural health sites accessed via telehealth, comparing patient outcome between these two methods of fracture management. Following ethical approval, a retrospective review was conducted of patients presenting with clavicle fractures to the Princess Alexandra Hospital Fracture Clinics and to Orthopaedic Fracture Clinics run via teleconference with rural health sites. Only 2% of patients received operative fracture management in the telehealth group, versus 33% in the tertiary hospital sample. Patient outcome was measured in the larger tertiary hospital sample, with clinical notes reflecting good patient outcome in 70% of operatively managed patients and 85% of patients with conservatively managed clavicle fractures. For the patients in the telehealth sample that returned for follow-up appointments, 93% reported a good outcome with one of these individuals undergoing operative treatment and the rest managed conservatively.
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Affiliation(s)
- Megan McKerrow
- Department of Orthopaedics, 1966 Princess Alexandra Hospital , Australia
| | - John North
- Department of Orthopaedics, 1966 Princess Alexandra Hospital , Australia
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