Middle third clavicle fracture osteosynthesis. Functional mid-term results
DOI:
https://doi.org/10.1016/j.rccot.2015.10.006Keywords:
clavicle fractures, open reduction and internal fixation (ORIF)Abstract
Introduction: Clavicle fractures have been treated historically by different types of immobilization. Recently, the therapeutic approach has gradually shifted to the surgical management. The aim of the study is to determine the results of a cohort of patients who underwent surgery for treatment of clavicular fractures.
Materials and methods: A prospective longitudinal cohort, including 66 patients who underwent surgery for middle third clavicle fractures from April 2009 until September 2010, who underwent to open reduction and internal fixation with locked anatomical plate (LCP) osteosynthesis was performed. The 66 patients were followed using visual analogue scale (VAS) and functional Constant score at six weeks, three months, six months and one year after surgery.
Results: Statistically significant changes were introduced in progressive improvement in pain and function in each monitoring period (p < 0.001), with no change in pain score between the sixth month follow up evaluation and year follow-up evaluation (p = 0.083). Similarly, high levels of satisfaction was evaluated in both, EVA and Constant scale thorough follow up time.
Discussion: It was concluded that open reduction and internal fixation of fractures of the middle third of the clavicle represent an excellent alternative of treatment for such injuries, with a promptly and fully functional recovery and low probability of complications.
Evidence level: III.
Downloads
References
Postacchini F, Gumina S, De Santis P, Albo F. Epidemiology of clavicle fracture. J Shoulder Elbow Surg. 2002;11:452-6. https://doi.org/10.1067/mse.2002.126613
Hill JM, McGuire MH, Crosby LA. Closed treatment of displaced middle third fracture of the clavicle gives poor results. J Bone Joint Surg Br. 2005;87-B:568-70.
Zlowodzki M, Zelle BA, Cole PA, Jeray K, McKee MD. EvidenceBased Orthopaedic Trauma Working Group. Treatment of midshaft clavicle fractures: systemic review of 2144 fractures: on behalf of the Evidence-Based Orthopaedic Trauma Working Group. J Orthop Trauma. 2005;19:504-7. https://doi.org/10.1097/01.bot.0000172287.44278.ef
Sharr JR1, Mohammed KD. Optimizing the radiographic technique in clavicular fractures. J Shoulder Elbow Surg. 2003;12:170-2. https://doi.org/10.1067/mse.2003.25
Nordqvist A, Petersson CJ, Redlund-Johnell I. Mid-clavicle fractures in adults: end result study after conservative treatment. J Orthop Trauma. 1998;12:572-6. https://doi.org/10.1097/00005131-199811000-00008
Hill JM, McGuire MH, Crosby LA. Closed treatment of displaced middle-third fractures of the clavicle gives poor results. J Bone Joint Surg Br. 1997;79:537-9. https://doi.org/10.1302/0301-620X.79B4.0790537
Lazarides S, Zafiropoulous G. Conservative treatment of fractures at the middle third of the clavicle: the relevance of shortening and clinical outcome. J Shoulder Elbow Surg. 2006;15:191-4. https://doi.org/10.1016/j.jse.2005.08.007
McKee MD, Wild LM, Schemitsch EH. Midshaft malunions of the clavicle. J Bone Joint Surg Am. 2003;85:790-7. https://doi.org/10.2106/00004623-200305000-00003
McKee MD, Wild LM, Schemitsch EH. Midshaft malunions of the clavicle. Surgical technique. J Bone Joint Surg Am. 2004;86 Suppl 1:37-43. https://doi.org/10.2106/00004623-200403001-00006
McKee MD, Pedersen EM, Jones C, Stephen DJ, Kreder HJ, Schemitsch EH, et al. Deficits following non-operative treatment of displaced midshaft clavicular fractures. J Bone Joint Surg Am. 2006;88:35-40. https://doi.org/10.2106/00004623-200601000-00005
Brinker MR, Edwards TB, O'Connor DP. Letter regarding estimating the risk of nonunion following nonoperative treatment of a clavicular fracture. J Bone Joint Surg Am. 2005;87:676-7. https://doi.org/10.2106/00004623-200503000-00034
Robinson CM, Court-Brown CM, McQueen MM, Wakefield AE. Estimating the risk of non-union following nonoperative treatment of a clavicular fracture. J Bone Joint Surg Am. 2004;86: 1359-65. https://doi.org/10.2106/00004623-200407000-00002
Wick M, Muller EJ, Kollig E, et al. Midshaft fractures of the clavicle with a shortening of more than 2 cm predispose to nonunion. Arch OrthopTrauma Surg. 2001;121:207-11. https://doi.org/10.1007/s004020000202
Jhonston RM. Clavicle fractures: non union. Orthopedic hiperguide. http://www.ortho.hyperguides.com/Jun 2005.
Hill JM, McGuire MH, Crosby LA. Closed treatment of displaced middle - third fractures of the clavicle gives poor results. J Bone Joint Surg Br. 2005;79-B:537-40. https://doi.org/10.1302/0301-620X.79B4.0790537
Muller SD, Maiyah MA, Hui AC, Adedapo AO. Thoracic penetration following mid-shaft clavicular fracture. J Bone Joint Surg Br. 2005;87-B:568-70. https://doi.org/10.1302/0301-620X.87B4.15861
Schwarz N, Hocker K. Osteosynthesis of irreducible fractures of the clavicle with 2.7 - MM ASIF plates. J Trauma. 1992;33:179-83. https://doi.org/10.1097/00005373-199208000-00003
Doro C, Hayden RJ, Louis DS. Complex regional pain syndrome type I in the upper extremity. Clin Occup Environ Med. 2006;5:445-54.
McKee MD, Seiler JG, Jupiter JB. The application of the limited contact dynamic compression plate in the upper extremity: an analysis of 114 consecutive cases. Injury. 1995;26:661-6. https://doi.org/10.1016/0020-1383(95)00148-4
Marti RK, Nolte PA, Kerkhoffs GM, et al. Operative treatment of mid-shaft clavicular non-union. Int Orthop. 2003;27:131-5. https://doi.org/10.1007/s00264-002-0424-7
Zlowdzki M, Zelle BA, Cole PA, et al. Treatment of acute midshaft clavicle fractures: systematic review of 2144 fractures: on behalf of the evidence-based orthopaedic trauma working group. J Orthop Trauma. 2005;19:504-7. https://doi.org/10.1097/01.bot.0000172287.44278.ef
Gordon J. The bony anatomy of clavicular malunions. J Shoulder Elbow Surg. 2003;12:173-8. https://doi.org/10.1067/mse.2003.2
Jubel A, Andermahr J, Schiffer G, Tsironis K, Rehm KE. Elastic stable intramedullary nailing of midclavicular fractures with a titanium nail. Clin Orthop Relat Res. 2003;408:279-85. https://doi.org/10.1097/00003086-200303000-00037
Yian EH, Ramappa AJ, Arneberg O, Gerber C. The Constant score in normal shoulders. J Shoulder Elbow Surg. 2005;14:128-33. https://doi.org/10.1016/j.jse.2004.07.003
Marsh JL, Slongo TF, Agel J, Scott Broderick J, Creevey W, DeCoster TA, et al. Fracture and dislocation classification compendium - 2007: Orthopaedic Trauma Classification, Database and Outcomes Committee. J Orthopaed Trauma. 2007;21:S72-4. https://doi.org/10.1097/00005131-200711101-00001
Fabre T, Piton C, Leclourec G, Gervais-Delion F, Durandeau A. Entrapment of the subescapular nerve. J Bone Joint Sur Br. 1999;B1:4414-8.
Nowak J, Holgersson M, Larsson S. Can we predict long-term sequelae after fractures of the clavicle based on initial findings? A prospective study with nine to ten years of follow-up. J Shoulder Elbow Surg. 2004;13:479-86. https://doi.org/10.1016/j.jse.2004.01.026
Boehme D, Curtis RJ Jr, DeHaan JT, Kay SP, Young DC, Rockwood CA Jr. Nonunion of fractures of the mid-shaft of the clavicle. Treatment with a modified Hagie intramedullary pin and autogenous bone-grafting. J Bone Joint Surg Am. 1991;73:1219-26. https://doi.org/10.2106/00004623-199173080-00012
Kabak S, Halici M, Tuncel M, et al. Treatment of midclavicular nonunion: comparison of dynamic compression plating and contact dynamic compression plating techniques. J Shoulder Elbow Surg. 2004;13:396-404. https://doi.org/10.1016/j.jse.2004.01.033
Drosdowech S, Stuart E, Manwell E, Ferreira L, BS Da Goel D, Faber K, et al. Biomechanical analysis of fixation of middle third fractures of the clavicle. J Orthop Trauma. 2011;25:39-43. https://doi.org/10.1097/BOT.0b013e3181d8893a
Del Gordo RJ, Habeych A, Castillo FG, Trout GO. Fracturas de clavícula. Tratamiento quirúrgico con clavos intramedulares flexibles. Rev Duazary. 2006;2:115-20.
Ring D, Holovacs T. Brachial plexus palsy after intramedullary fixation of a clavicular fracture. A report of three cases. J Bone Joint Surg Am. 2005;87:1834-7. https://doi.org/10.2106/00004623-200508000-00025
Canadian Orthopaedic Trauma Society. Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter randomized clinical trial. J Bone Joint Surg Am. 2007;89:1-10. https://doi.org/10.2106/JBJS.F.00020
Heritier SR, Gebski VJ, Keech AC. Inclusion of patients in clinical trial analysis: the intention-to-treat principle. Med J Aust. 2003;179:438-40. https://doi.org/10.5694/j.1326-5377.2003.tb05627.x
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Revista Colombiana de ortopedia y traumatología
This work is licensed under a Creative Commons Attribution 3.0 Unported License.
