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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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van der Burg FA, Baltes TP, Kloen P. Large segmental defects in midshaft clavicle nonunion treated with autologous tricortical iliac crest bone graft. Shoulder Elbow 2023; 15:45-53. [PMID: 36895606 PMCID: PMC9990112 DOI: 10.1177/17585732211064815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 11/05/2021] [Accepted: 11/07/2021] [Indexed: 11/16/2022]
Abstract
Background To evaluate the use of intercalary iliac crest bone graft in the treatment of clavicle nonunion with a large segmental bone defect (3-6 cm). Methods This retrospective study evaluated patients with large segmental bone defects (3-6 cm) after clavicle nonunion, treated with open reposition internal fixation and iliac crest bone graft between February 2003 and March 2021. At follow-up the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was administered. A literature search was performed to provide an overview of commonly used graft types per defect size. Results We included five patients treated with open reposition internal fixation and iliac crest bone graft for clavicle nonunion with a median defect size of 3.3 cm (range 3-6 cm). Union was achieved in all five, and all pre-operative symptoms resolved. The median DASH score was 23 out of 100 (IQR 8-24). An extensive literature search revealed that there are no studies describing the use of an used iliac crest graft for defects larger than 3 cm. Instead, a vascularized graft was typically used to treat defects sizes between 2.5 and 8 cm. Discussion An autologous non-vascularized iliac crest bone graft can be safely used and is reproducible to treat a midshaft clavicle non-union with a bone defect between 3 and 6 cm.
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Affiliation(s)
- Fleur Ae van der Burg
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, The Netherlands
| | - Thomas Pa Baltes
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, The Netherlands
| | - Peter Kloen
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, The Netherlands
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Yetter T, Harper J, Weatherby PJ, Somerson JS. Complications and Outcomes After Surgical Intervention in Clavicular Nonunion: A Systematic Review. JBJS Rev 2023; 11:01874474-202301000-00012. [PMID: 36722838 DOI: 10.2106/jbjs.rvw.22.00171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Surgical repair of clavicle fractures is being employed more frequently, although most fractures are still treated conservatively. Both can result in nonunion. Current treatments for clavicle nonunion include open reduction with internal fixation (ORIF) plating without bone graft, ORIF plating with bone graft, and intramedullary pin fixation. METHODS We performed a systematic review and meta-analysis of studies reporting outcome, complication, and reoperation rates following surgical treatment for clavicle nonunion. Subgroup analysis was undertaken for outcome and complication rates between single plating and intramedullary pin fixation, bone graft use, and nonunion time length definition. RESULTS Fifty-three studies met inclusion criteria (1,258 clavicle nonunions). Mean clinical follow-up was 2.6 years. Seventy-two percent of nonunions were of the middle third, 1% were proximal third, 12% were distal third, and 15% were not reported. Forty-eight percent of nonunions were atrophic or oligotrophic and 17% were hypertrophic (35% not reported). Mean time to union was 13.6 weeks. Ninety-five percent of patients achieved union after the primary nonunion surgery. Overall complication rate was 17%. Single-plating fixation had significantly faster union time (15.2 vs. 19.8 weeks), lower reoperation rate (23% vs. 37%), and hardware removal rate (20% vs. 34%) than intramedullary pin fixation. Bone graft had significantly lower rates of delayed union (0.6% vs. 3.6%) but higher complication (15% vs. 8%) and reoperation rates (29% vs. 14%) than the other groups. Studies that defined nonunion after 3 months had significantly faster union times than the 6-month studies (13 vs. 16 weeks). The 3-month group had a significantly lower overall complication rate (12% vs. 25%) and hardware/fixation failure rate (3% vs. 5.5%) than the 6-month group. CONCLUSIONS This systematic review is the largest report of complications, reoperations, and patient outcomes of clavicle nonunions after surgical intervention in the current literature. Plating showed faster time to union and lower reoperation rates than intramedullary pin fixation. Bone graft use showed lower rates of delayed union but substantially higher rates of complications and reoperations. Reports with a definition of nonunion at 3 months showed faster union times and lower complication rates compared to reports with a definition of nonunion that was 6 months or greater. Surgery could be considered at 3 months post-injury in cases of symptomatic non-united clavicle fracture, and plating results in reliable outcomes. Adjuvant bone grafting requires further study to determine its value and risk/benefit ratio. LEVEL OF EVIDENCE Level IV, Systematic Review. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Thomas Yetter
- John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, Texas
| | - Jacob Harper
- John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, Texas
| | - Paul J Weatherby
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, Texas
| | - Jeremy S Somerson
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, Texas
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Zhang C, Ma T, Duan N, Huang Q, Lu Y, Lin H, Zhang K, Xu Y, Wang Q, Xue H, Wang C, Li Z. Clinical and radiographic outcomes of revision with autogenous "structured" bone grafting combined with superior plate for recalcitrant atrophic nonunion of clavicular midshaft: a retrospective study. INTERNATIONAL ORTHOPAEDICS 2022; 46:2585-2592. [PMID: 36048235 DOI: 10.1007/s00264-022-05564-1] [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: 06/07/2022] [Accepted: 08/05/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE To assess the efficacy of autogenous "structured" bone grafting (ASBG), it was combined with superior plate (SP) revision operations for recalcitrant clavicular midshaft aseptic nonunion (CMAN). METHODS This retrospective study included 12 patients who suffered from failure of autologous cancellous bone grafting (ACBG) and SP fixation because of CMAN. Visual analogue scale (VAS) data for pain and disabilities of arm, shoulder, and hand (DASH) scores of patients who underwent these procedures from January 2019 to December 2020, obtained before surgery and at the final follow-up time, were analysed. RESULTS The average time between primitive fracture and this operative treatment was 29 months (15-38 months). The average duration of surgery was 153 minutes (range, 115-230 min), and the average blood loss was 560 ml (range, 350-860 ml). Complications occurred in two cases (16.67%): one was persistent pain at the donor site, and the other was a calf muscle vein thrombosis. No tissue infection was observed during follow-up. The mean follow-up time was 18 months (range, 12-30 months). All fractures progressed to osseous healing at a mean time of 14 weeks (range, 12-16 weeks). The mean pain VAS score significantly improved, from 4.8 ± 1.7 pre-operatively to 1.9 ± 1.1 at the final follow-up (P = 0.01). The mean DASH score improved significantly from 30.1 ± 11.2 pre-operatively to 7.8 ± 4. 2 at the final follow-up (P < 0.01). CONCLUSIONS ASBG combined with SP revision surgery achieved excellent clinical outcomes in patients with recalcitrant CMAN.
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Affiliation(s)
- Congming Zhang
- Department of Orthopaedics and Traumatology, Xi'an, Jiaotong University College of Medicine, Honghui Hospital, 555 Youyi Road, Xi'an City, 710054, China
| | - Teng Ma
- Department of Orthopaedics and Traumatology, Xi'an, Jiaotong University College of Medicine, Honghui Hospital, 555 Youyi Road, Xi'an City, 710054, China
| | - Ning Duan
- Department of Orthopaedics and Traumatology, Xi'an, Jiaotong University College of Medicine, Honghui Hospital, 555 Youyi Road, Xi'an City, 710054, China
| | - Qiang Huang
- Department of Orthopaedics and Traumatology, Xi'an, Jiaotong University College of Medicine, Honghui Hospital, 555 Youyi Road, Xi'an City, 710054, China
| | - Yao Lu
- Department of Orthopaedics and Traumatology, Xi'an, Jiaotong University College of Medicine, Honghui Hospital, 555 Youyi Road, Xi'an City, 710054, China
| | - Hua Lin
- Department of Orthopaedics and Traumatology, Xi'an, Jiaotong University College of Medicine, Honghui Hospital, 555 Youyi Road, Xi'an City, 710054, China
| | - Kun Zhang
- Department of Orthopaedics and Traumatology, Xi'an, Jiaotong University College of Medicine, Honghui Hospital, 555 Youyi Road, Xi'an City, 710054, China
| | - Yibo Xu
- Department of Orthopaedics and Traumatology, Xi'an, Jiaotong University College of Medicine, Honghui Hospital, 555 Youyi Road, Xi'an City, 710054, China
| | - Qian Wang
- Department of Orthopaedics and Traumatology, Xi'an, Jiaotong University College of Medicine, Honghui Hospital, 555 Youyi Road, Xi'an City, 710054, China
| | - Hanzhong Xue
- Department of Orthopaedics and Traumatology, Xi'an, Jiaotong University College of Medicine, Honghui Hospital, 555 Youyi Road, Xi'an City, 710054, China
| | - Chaofeng Wang
- Department of Orthopaedics and Traumatology, Xi'an, Jiaotong University College of Medicine, Honghui Hospital, 555 Youyi Road, Xi'an City, 710054, China.
| | - Zhong Li
- Department of Orthopaedics and Traumatology, Xi'an, Jiaotong University College of Medicine, Honghui Hospital, 555 Youyi Road, Xi'an City, 710054, China.
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Wu S, Quan K, Mei J, Dai M, Song S. Cortical allograft strut augmented with platelet-rich plasma for the treatment of long bone non-union in lower limb- a pilot study. BMC Musculoskelet Disord 2022; 23:512. [PMID: 35637466 PMCID: PMC9150336 DOI: 10.1186/s12891-022-05375-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 04/25/2022] [Indexed: 11/18/2022] Open
Abstract
Background The autogenous iliac bone graft is the first choice of surgical treatment for long bone non-union. However, many factors limit the use of autogenous bone, such as insufficient bone harvest and complications in the donor site. This study aimed to pilot-test the effectiveness of the cortical allograft strut augmented with Platelet-rich plasma (PRP) on long bone non-union in the lower limb. Method This study was a one-armed pilot trial, with thirteen men and four women patients scheduled for surgery. Revision surgery for managing long bone non-union included debridement, internal fixation of the cortical allograft strut, and adding PRP in the fracture site. After surgery, outcome measurements of healing rate, healing time, the incidence of revision, and complications, were assessed at least one-year follow-up. Results Fourteen of seventeen participants completed all follow-ups. The mean age of 14 patients was 35.9 years (range, 18–56 years), and the mean BMI was 22.44 ± 1.53 kg/m2. All nonunions united after the operation. The mean healing time was 4.6 ± 0.7 months. There was no revision or complication. Conclusion Cortical allograft strut augmented with PRP led to healing long bone non-union in the lower limb. More clinical research is required before widespread use.
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Affiliation(s)
- Shenghui Wu
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 YiShan Road, Shanghai, 200233, China
| | - Kun Quan
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jiong Mei
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 YiShan Road, Shanghai, 200233, China
| | - Min Dai
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Sa Song
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 YiShan Road, Shanghai, 200233, China.
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Abstract
Background Plate fixation is the treatment of choice for a midshaft clavicle non-union. Those non-unions that require >1 surgical procedure to heal are termed recalcitrant non-union. Regardless of the number of previously failed procedures, our surgical strategy is aimed at achieving an optimal mechanical and biological environment to facilitate healing. Materials and methods We performed a retrospective analysis of 14 patients with a recalcitrant clavicle non-union treated with open reduction and plate fixation combined with graft augmentation when indicated. Healing rates after index surgery were analysed. All patients were observed for at least 12 months. Results All patients healed at a mean time of 193.2 days (range 90–390). Five of the 14 patients had at least one positive surprise culture, for which they received antibiotic treatment. At the latest follow-up, no patient reported pain or discomfort. Mean disability of the arm, shoulder and hand (DASH) score was 16.3 points (range 0–40), indicating only mild residual impairment. A possible link was found between the time between injury and definitive surgery and the time to healing [Pearson correlation 0.527, sig. (two-tailed) 0.000]. Conclusion This study shows 100% bone healing and good functional outcomes after surgical revision for a recalcitrant clavicle non-union. How to cite this article Grewal S, Baltes TPA, Wiegerinck E, et al. Treatment of a Recalcitrant Non-union of the Clavicle. Strategies Trauma Limb Reconstr 2022;17(1):1–6.
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Affiliation(s)
- Simran Grewal
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Simran Grewal, Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands, e-mail:
| | - Thomas PA Baltes
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Esther Wiegerinck
- Department of Orthopaedic and Trauma Surgery, Tergooi Hospital, Hilversum, The Netherlands
| | - Peter Kloen
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
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Addition of Bone Marrow Aspirate Concentrate Resulted in High Rate of Healing and Good Functional Outcomes in the Treatment of Clavicle Fracture Nonunion: A Retrospective Case Series. J Clin Med 2021; 10:jcm10204749. [PMID: 34682872 PMCID: PMC8541197 DOI: 10.3390/jcm10204749] [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: 09/09/2021] [Revised: 10/04/2021] [Accepted: 10/14/2021] [Indexed: 12/19/2022] Open
Abstract
Bone marrow aspirate concentrate (BMAC) is an autologous cell composition that is obtained through a needle aspiration from the iliac crest. The purpose of this study was to evaluate the outcomes of patients treated with open reduction and internal fixation with BMAC supplementation for clavicle fracture nonunion. This was a retrospective case series of 21 consecutive patients with clavicle fracture nonunion that were treated with ORIF and BMAC supplementation between 2013 and 2020. Patients were evaluated for fracture union, time to union, complications related to surgical and donor site, and functional outcome using the Quick Disability of the Arm Shoulder and Hand (QDASH), subjective shoulder value (SSV), and pain. The mean age was 41.8 years. The mean follow-up was 36 months. Twenty (95.2%) patients demonstrated fracture union, with a mean time to union of 4.5 months. Good functional scores were achieved: SSV, 74.3; QDASH, 23.3; pain level, 3.1. There were no complications or pain related to the iliac crest donor site. Supplementary BMAC to ORIF in the treatment of clavicle fracture nonunion is a safe method, resulting in high rates of fracture union and good functional outcomes with minimal complications and pain.
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Gkotsi A, Schuind F. Treatment of diaphyseal clavicular nonunion with special emphasis on microsurgery. Injury 2020; 51 Suppl 4:S54-S58. [PMID: 32178847 DOI: 10.1016/j.injury.2020.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 02/21/2020] [Accepted: 03/07/2020] [Indexed: 02/02/2023]
Abstract
Diaphyseal fractures of the clavicle had until recently the reputation to always heal with abundant callus formation, except if operated, due to a reported high rate of nonunion after plate fixation by older series. The reason would be that the bone has only periosteal vascularization, easily destroyed by periosteal stripping for implant apposition. Bone autograft and external fixation has been reported as the best technique to heal a nonunited clavicle nonunion. Are these classical considerations still valid nowadays? The purposes of this article focusing only on diaphyseal clavicular fractures are to review the vascularization of the bone, the rate of nonunion after nonoperative treatment, the indications and techniques of osteosynthesis, and the treatment possibilities of an established nonunion. This article will not deal with the specific problems of the lateral clavicular fractures, which are equivalent to acromio-clavicular fracture-dislocations, nor of medial fractures, close to the sterno-clavicular joint.
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Affiliation(s)
- Antonia Gkotsi
- Department of Orthopaedics and Traumatology, Cliniques Universitaires de Bruxelles, Hôpital Erasme, Université libre de Bruxelles, Route de Lennik 808, 1070 Bruxelles, Brussels, Belgium.
| | - Frédéric Schuind
- Department of Orthopaedics and Traumatology, Cliniques Universitaires de Bruxelles, Hôpital Erasme, Université libre de Bruxelles, Route de Lennik 808, 1070 Bruxelles, Brussels, Belgium
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Bizzoca D, Vicenti G, Caiaffa V, Abate A, De Carolis O, Carrozzo M, Solarino G, Moretti B. Assessment of fracture healing in orthopaedic trauma. Injury 2020; 54 Suppl 1:S46-S52. [PMID: 33234266 DOI: 10.1016/j.injury.2020.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 11/05/2020] [Indexed: 02/02/2023]
Abstract
Fracture healing is a complex physiologic process, relying on the crucial interplay between biological and mechanical factors. It is generally assessed using imaging modalities, including conventional radiology, CT, MRI and ultrasound (US), based on the fracture and patient features. Although these techniques are routinely used in orthopaedic clinical practice, unfortunately, they do not provide any information about the biomechanical status of the fracture site. Therefore, in recent years, several non-invasive techniques have been proposed to assess bone healing using ultrasonic wave propagation, changes in electrical properties of bones and callus stiffness measurement. Moreover, different research groups are currently developing smart orthopaedic implants (plates, intramedullary nails and external fixators), able to provide information about the fracture healing process. These devices could significantly improve orthopaedic and trauma clinical practice in the future and, at the same time, reduce patients' exposure to X-rays. This study aims to define the role of traditional imaging techniques and emerging technologies in the assessment of the fracture healing process.
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Affiliation(s)
- Davide Bizzoca
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Giovanni Vicenti
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy.
| | - Vincenzo Caiaffa
- Orthopaedic and Traumatology Unit, "Di Venere" Hospital, Bari, Italy
| | - Antonella Abate
- Orthopaedic and Traumatology Unit, "Di Venere" Hospital, Bari, Italy
| | - Oronzo De Carolis
- Orthopaedic and Traumatology Unit, "Di Venere" Hospital, Bari, Italy
| | - Massimiliano Carrozzo
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Giuseppe Solarino
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Biagio Moretti
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
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Annicchiarico N, Latta A, Santolini E. Plate osteosynthesis for mid-shaft clavicle fractures: An update. Injury 2020; 54 Suppl 1:S53-S57. [PMID: 33190853 DOI: 10.1016/j.injury.2020.10.085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 10/11/2020] [Accepted: 10/17/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Over the last few years, treatment of mid-shaft clavicle fractures seems to have shifted from conservative to surgical. Our study reports the results of plate osteosynthesis of mid-shaft clavicle fractures and compares them with literature. MATERIALS AND METHODS A retrospective cohort study was conducted on 32 patients with mid-shaft clavicle fractures treated with plate and screws between January 2009 and December 2014. All the patients followed the same post-operative rehabilitation program with radiographic and clinical evaluation (DASH score and Constant score) at a minimum follow-up of 24 months. RESULTS All the patients healed clinically and radiographically, without deformities or non-unions, with complete and early functional recovery and return to their pre-injury sport activities. At one year follow-up the mean Constant Score was 93.8 (SD 4.8) and the mean DASH score was 42 (SD 5.0). CONCLUSIONS Osteosynthesis with plate and screws of mid-shaft clavicle fractures allows not only restoration of the anatomy, but also early recovery of shoulder function. For this reason, such surgical treatment should always be considered when facing this particular fracture group, also in accordance with recent literature.
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Affiliation(s)
- Nicola Annicchiarico
- Orthopedics and Trauma Unit, Ospedale Moriggia-Pelascini, Via Moriggia Pelascini, 3, 22015 Gravedona - CO, Italy
| | - Arturo Latta
- Orthopedics and Trauma Unit, Ospedale Moriggia-Pelascini, Via Moriggia Pelascini, 3, 22015 Gravedona - CO, Italy
| | - Emmanuele Santolini
- Academic Unit of Trauma and Orthopaedics, University of Genoa, Ospedale Policlinico San Martino, Largo R. Benzi 10 - 16132, Genoa, Italy.
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Medial Femoral Condyle Vascularized Bone Graft for Treatment of Midshaft Clavicle Recalcitrant Nonunion With Use of the Transverse Cervical Artery as an Anastomosis. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2020; 4:JAAOSGlobal-D-19-00049. [PMID: 32656481 PMCID: PMC7322782 DOI: 10.5435/jaaosglobal-d-19-00049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 10/24/2019] [Indexed: 12/01/2022]
Abstract
Vascularized medial femoral condyle bone grafts have been reported to be a reliable treatment for recalcitrant bony nonunions of the extremities. Although clavicle fracture nonunions are rare after treatment with open reduction internal fixation, symptomatic nonunions can be a challenge. The medial femoral condyle vascularized bone graft has been described as a treatment option for clavicle nonunions with the thoracoacromial trunk as the recipient anastomosis site. This case illustrates how the transverse cervical artery and accompanying veins can be used as an anastomosis when the thoracoacromial trunk is inaccessible because of previous surgical- and infection-related scaring. At the final follow-up, the patient had returned to full duty and resumed competitive triathlons. Radiographs demonstrated complete healing of clavicle fracture.
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Ullah K, Khan S, Wang YQ, Zhao ZH, Cheng P, Sapkota B, Ren L, Khan S, Rehman MU, Xue Y. Bilaterally Threaded, Minimal Invasive, Elastic Locking Intramedullary Nailing (ELIN) for the Treatment of Clavicle Fractures. Orthop Surg 2020; 12:321-332. [PMID: 32077261 PMCID: PMC7031594 DOI: 10.1111/os.12612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 12/16/2019] [Accepted: 12/20/2019] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate and present the effectiveness of this innovatively designed, elastic locking intramedullary nail (ELIN) in fixation of clavicle fractures. Methods The study included 38 patients from July 2014 to July 2017. All of them received intramedullary fixation treated with ELIN, 22 were males and 16 females. The mean age of the patients was 54 years. There were twenty right‐side and 18 left‐side clavicular fractures. Radiographs were taken to assess the fracture type: 21 were type A, 16 type B, and one type C. General anesthesia or cervical block was given to all patients. A small incision of 3–5 cm was given only to those who needed mini‐open reduction. The administration of ELIN and reduction of the fracture was made sure with a C arm machine. After a follow‐up of 8 to 33 months, the clinical outcomes were assessed and evaluated. The constant scores and disabilities of the arm, shoulder and hand questionnaire (DASH) were used to determine the outcomes and functional status of the patients. The study was done accordingly to the guidelines provided by the ethics committee. Results Mean operation time was 25.63 min. Mean follow‐up time was 16.5 months. The rate of closed reduction and open reduction was 84% and 16% respectively. There was no shortening of the clavicle. There was no breakage of the nail, though bending of the nail occurred in one patient. Superficial skin infection occurred in three patients at insertion points or the nail tip which was embedded subcutaneously. Skin erosion with nail exposure occurred in a patient with no significant infection. All the other patients had excellent shoulder function. A mini scar was observed in seven patients all the other patients had no scar. Asymmetry was observed in three patients. The mean Constant score was 98.47 and the mean DASH score was 1.55 at the last follow‐up. The implant was removed in all the patients. Conclusion Clavicular fractures treated with ELIN is minimally invasive, which presents a safe and novel surgical technique with less complications and a high success rate, excellent aesthetic and quick recovery after surgery. ELIN restores the micro‐dynamic stress at the fracture ends and promotes fracture healing, keeps intact the fracture hematoma and maintains the blood supply, accelerates healing and thus leads to faster osseous healing and better restoration of clavicle length.
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Affiliation(s)
- Kifayat Ullah
- Department of Orthopedic Surgery, Tianjin Fourth Central Hospital, Tianjin Medical University, Tianjin, China
| | - Saima Khan
- Department of Infertility and Reproductive Endocrinology, Tianjin Medical University Central Hospital of Obstetrics and Gynecology, Tianjin, China
| | - Yong-Qing Wang
- Department of Orthopedic Surgery, Tianjin Fourth Central Hospital, Tianjin Medical University, Tianjin, China
| | - Zhi-Hui Zhao
- Department of Orthopedic Surgery, Tianjin Fourth Central Hospital, Tianjin Medical University, Tianjin, China
| | - Peng Cheng
- Department of Orthopedic Surgery, Tianjin Fourth Central Hospital, Tianjin Medical University, Tianjin, China
| | | | - Liang Ren
- Department of Orthopedic Surgery, Tianjin Fourth Central Hospital, Tianjin Medical University, Tianjin, China
| | - Samiullah Khan
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Mujeeb Ur Rehman
- Department of Cardiovascular and Thoracic Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Yuan Xue
- Department of Orthopedic Surgery, Tianjin Medical University General Hospital, Tianjin, China
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Plate-and-bone-strut fixation of distal third humeral shaft aseptic non-unions: A consecutive case series. J Clin Orthop Trauma 2019; 10:S127-S132. [PMID: 31695271 PMCID: PMC6823753 DOI: 10.1016/j.jcot.2019.05.004] [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: 02/20/2019] [Revised: 04/30/2019] [Accepted: 05/06/2019] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Non-union after humeral shaft fractures are seen frequently in clinical practice. The incidence is 2-10% after conservative management and up to 30% after surgical treatment. The purpose of this study is to evaluate the outcomes of plate-and-bone-strut-allograft technique with bone chip augmentation for aseptic non-unions of the distal third of the humerus. MATERIALS AND METHODS 26 consecutive cases were treated using a trans-triceps approach. The non-union was fixed with a 4.5 mm Locking Compression Plate combined with a strut bone allograft at the anterior part of the humerus and bone chips. All patients underwent the same rehabilitation protocol of 12 weeks. Clinical evaluation took place 12 months after surgery with the Mayo elbow score and Oxford elbow score. RESULTS Complete bone healing without complications was achieved in all 26 patients. The average period of radiographic union was 106 days. The average range of flexion-extension was 108° (94°-180°) and pro-supination was 159° (102°-180°). Twelve months after surgery, average Mayo elbow score was 86 (68-100) and the Oxford elbow score was 83 (52-100). CONCLUSION The plate-and-bone-strut-allograft technique with bone chip augmentation in distal humeral shaft for aseptic non-unions resulted in union of all cases. No adverse events related to the surgery or the materials used were documented.
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Vicenti G, Maruccia M, Carrozzo M, Elia R, Giudice G, Moretti B. Free vascularized osteoseptocutaneous fibular flap for radius shaft nonunion: The final solution when the iliac crest autograft fails. A case report. Injury 2018; 49 Suppl 4:S63-S70. [PMID: 30526951 DOI: 10.1016/j.injury.2018.11.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 11/14/2018] [Accepted: 11/19/2018] [Indexed: 02/02/2023]
Abstract
Treatment of forearm nonunion associated with bone defects can be challenging. Restoring the correct length and rotation are two main principles for the management of these patients. Herein, we describe a patient with isolated radius nonunion already treated with an iliac crest autograft with no success. A free vascularized osteoseptocutaneous fibular autogenous graft was harvested as the final solution to managed long bone defect after previous multiple surgeries. At the 1- year follow-up, the patient gained full range of motion and was functioning well.
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Affiliation(s)
- Giovanni Vicenti
- School of Medicine, University of Bari "Aldo Moro"- AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic and Unit, Bari, Italy
| | - Michele Maruccia
- Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Massimiliano Carrozzo
- School of Medicine, University of Bari "Aldo Moro"- AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic and Unit, Bari, Italy.
| | - Rossella Elia
- Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Giuseppe Giudice
- Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Biagio Moretti
- School of Medicine, University of Bari "Aldo Moro"- AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic and Unit, Bari, Italy
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