Treatment with precontoured blocked plate of the middle third of the clavicle displaced fractures.
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Published:
Nov 8, 2016
Keywords:
midshaft clavicle fracture. Functional results. Precontoured clavicle locking plate.
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Abstract
BackgroundThe aim of this paper is to analyze the results of a group of patients with displaced diaphyseal fractures treated with precontoured clavicle locking plate. The rate of bone healing, functional outcome and complications were analyzed.MethodsForty-six displaced clavicle fractures type 2-B of Edinburgh were treated with precontoured locking plate. Thirty-six were men (one with bilateral fracture) and 9 women. The average age was 33 years (range 17-56 years). Patients were assessed with radiology and the Constant score, the Quick-Dash, and the visual analog scale (VAS) for pain. ResultsThe average follow-up was 30 months (range 12-46). Forty five fractures healed and one did not. The Constant average was 96 points (range 56-100) and the Quick-Dash 2 point average (range 0-32). Pain was 0.3 points (range 0-6).There were 10 complications in 9 patients (21%), but only three (6.5%) were considered major. In 7 patients (15%) we had to remove the plate by intolerance (one of them was a patient with malunion, registering as a second complication in the same patient). ConclusionsThe reduction and stabilization of midshaft displaced fractures of the clavicle with precontoured clavicle locking plate is an effective treatment with a low rate of major complications related to technical errors sometimes.
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Paoletta, R. E., Mecozzi, G. E., Bongiovanni, S. L., Ranalletta, M., & Maignón, G. D. (2016). Treatment with precontoured blocked plate of the middle third of the clavicle displaced fractures. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 81(4), 302-309. https://doi.org/10.15417/401
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Clinical Research
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References
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2. Postacchini F, Gumina S, De Santis P, et al. Epidemiology of clavicle fractures. J Shoulder Elbow Surg. 2002;11:452–456.
3. Neer CS 2nd. Nonunion of the clavicle. J Am Med Assoc. 1960;172(10):1006-11.
4. Rowe CR. An atlas of anatomy and treatment of midclavicular fractures. Clin Orthop Relat Res. 1968;(58):29-42.
5. Nowak J, Holgersson M, Larsson S. Sequelae from clavicular fractures are common: a prospective study of 222 patients. Acta Orthop. 2005;76:496-502
6. McKee MD, Pedersen EM, Jones C, Stephen DJ, Kreder HJ, Schemitsch EH, Wild LM, Potter J. Deficits following nonoperative treatment of displaced midshaft clavicular fractures. J Bone Joint Surg Am. 2006;88:35-40.
7. 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(4):537-9.
8. Wijdicks FJ, Houwert M, Dijkgraaf M, De Lange D, Oosterhuis K, Clevers G, Verleisdon EJ. Complications after plate fixation and elastic stable intramedullary nailing of dislocated midshaft clavicle fractures: a retrospective comparison. International Orthopaedics (SICOT) 2012 36:2139–2145
9. Celestre P, Roberston C, Mahar A, et al. Biomechanical evaluation of clavicle fracture 205 plating technique: dose a locking plate provide improved stability? J Orthop Trauma. 206 2008;22:241-247.
10. Demirhan M, Bilsel K, Atalar A, Bozdag E, Sunbuloglu E and Kale A. Biomechanical Comparison of Fixation Techniques in Midshaft Clavicular Fractures. J Orthop Trauma 2011 25(5):272-8.
11. Goswami T., DSc, Markert R., PhD, Anderson C. MD, Sundaram S, MS,and Crosby L, MD, Dayton, OH Biomechanical evaluation of a pre-contoured clavicle plate. J Shoulder Elbow Surg 2008;17:815-818.
12. Huang J., Toogood P., BS, Chen M., Wilber J., and Cooperman D, Clavicular Anatomy and the Applicability of Precontoured Plates J Bone Joint Surg Am. 2007;89:2260-5.
13. Iannotti MR, Crosby LA, Stafford P, Grayson G, Goulet R. Effects of plate location and selection on the stability of midshaft clavicle osteotomies: a biomechanical study. J Shoulder Elbow Surg. 2002; 11:457-62.
14. Beaton DE, Katz JN, Fossel AH, et al. Measuring the whole or the parts? Validity, reliability, and responsiveness of the Disabilities of the Arm, Shoulder and Hand outcome measure in different regions of the upper extremity. J Hand Ther 2001;14:128-146.
15. Verborgt O, Pittoors K, Van Glabbeek F, et al. Plate fixation of middlethird fractures of the clavicle in the semi-professional athlete. Acta Orthop Belg 2005;71:17-21.
16. Witzel K. Intramedullary osteosynthesis in fractures of the mid-third of the clavicle in sports traumatology. Z Orthop Unfall. 2007;145:639-42.
17. Zlowodzki 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.
18. 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.
19. Virtanen KJ, Remes V, Pajarinen J,et al Sling Compared with Plate Osteosynthesis for Treatment of Displaced Midshaft Clavicular Fractures. A Randomized Clinical Trial J Bone Joint Surg Am. 2012; 94:1546-53.
20. McKee RC, Whelan DB, Schemitsch EH and McKee M. Operative Versus Nonoperative Care of Displaced Midshaft Clavicular Fractures: A Meta-Analysis of Randomized Clinical Trials. J Bone Joint Surg Am. 2012;94:675-84.
21. Yun-feng C, Bing-fang Z, Yu-jie C, MS Hai-ming W, MS Jian-feng X, MS Yi-min C, PhD Xue-tao X, MS Chi Z, et al Clinical outcomes of midclavicular fractures treated with titanium elastic nails. J Can Chir 2010;53:369-384
22. Smekal V, Irenberger A, Struve P, Wambacher M, Krappinger D, Kralinger FS. Elastic stable intramedullary nailing versus nonoperative treatment of displaced midshaft clavicular fractures-a randomized, controlled, clinical trial. J Orthop Trauma. 2009;23:106-12.
23. Judd DB, Pallis MP, Smith E, Bottoni CR. Acute operative stabilization versus nonoperative management of clavicle fractures. Am J Orthop (Belle Mead NJ). 2009;38:341-5.
24. Ferran NA, Hodgson P, Vannet N, Williams R, Evans RO. Locked intramedullary fixation vs plating for displaced and shortened mid-shaft clavicle fractures: a randomized clinical trial. J Shoulder Elbow Surg. 2010;19: 783-9.
25. Jubel A, Andemahr J, Bergmann H, et al. Elastic stable intramedullary nailing of midclavicular fractures in athletes. Br J Sports Med 2003;37:480-3.
26. Mueller M, Burger C, Florczyk A, Striepens N, Rangger C. Elastic stable intramedullary nailing of midclavicular fractures in adults: 32 patients followed for 1-5 years. Acta Orthop. 2007;78:421-3.
27. Strauss EJ, Egol KA, France MA, et al. Complications of intramedullary Hagie pin fixation for acute midshaft clavicle fractures. J Shoulder Elbow Surg. 2007;16:280–284.
28. Cho Ch, Song K, Min B, Bae K, Lee K. Reconstruction Plate versus Reconstruction Locking Compression Plate for Clavicle Fractures. Clinics in Orthopedic Surgery 2010; 2 (3): 154–159.
2. Postacchini F, Gumina S, De Santis P, et al. Epidemiology of clavicle fractures. J Shoulder Elbow Surg. 2002;11:452–456.
3. Neer CS 2nd. Nonunion of the clavicle. J Am Med Assoc. 1960;172(10):1006-11.
4. Rowe CR. An atlas of anatomy and treatment of midclavicular fractures. Clin Orthop Relat Res. 1968;(58):29-42.
5. Nowak J, Holgersson M, Larsson S. Sequelae from clavicular fractures are common: a prospective study of 222 patients. Acta Orthop. 2005;76:496-502
6. McKee MD, Pedersen EM, Jones C, Stephen DJ, Kreder HJ, Schemitsch EH, Wild LM, Potter J. Deficits following nonoperative treatment of displaced midshaft clavicular fractures. J Bone Joint Surg Am. 2006;88:35-40.
7. 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(4):537-9.
8. Wijdicks FJ, Houwert M, Dijkgraaf M, De Lange D, Oosterhuis K, Clevers G, Verleisdon EJ. Complications after plate fixation and elastic stable intramedullary nailing of dislocated midshaft clavicle fractures: a retrospective comparison. International Orthopaedics (SICOT) 2012 36:2139–2145
9. Celestre P, Roberston C, Mahar A, et al. Biomechanical evaluation of clavicle fracture 205 plating technique: dose a locking plate provide improved stability? J Orthop Trauma. 206 2008;22:241-247.
10. Demirhan M, Bilsel K, Atalar A, Bozdag E, Sunbuloglu E and Kale A. Biomechanical Comparison of Fixation Techniques in Midshaft Clavicular Fractures. J Orthop Trauma 2011 25(5):272-8.
11. Goswami T., DSc, Markert R., PhD, Anderson C. MD, Sundaram S, MS,and Crosby L, MD, Dayton, OH Biomechanical evaluation of a pre-contoured clavicle plate. J Shoulder Elbow Surg 2008;17:815-818.
12. Huang J., Toogood P., BS, Chen M., Wilber J., and Cooperman D, Clavicular Anatomy and the Applicability of Precontoured Plates J Bone Joint Surg Am. 2007;89:2260-5.
13. Iannotti MR, Crosby LA, Stafford P, Grayson G, Goulet R. Effects of plate location and selection on the stability of midshaft clavicle osteotomies: a biomechanical study. J Shoulder Elbow Surg. 2002; 11:457-62.
14. Beaton DE, Katz JN, Fossel AH, et al. Measuring the whole or the parts? Validity, reliability, and responsiveness of the Disabilities of the Arm, Shoulder and Hand outcome measure in different regions of the upper extremity. J Hand Ther 2001;14:128-146.
15. Verborgt O, Pittoors K, Van Glabbeek F, et al. Plate fixation of middlethird fractures of the clavicle in the semi-professional athlete. Acta Orthop Belg 2005;71:17-21.
16. Witzel K. Intramedullary osteosynthesis in fractures of the mid-third of the clavicle in sports traumatology. Z Orthop Unfall. 2007;145:639-42.
17. Zlowodzki 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.
18. 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.
19. Virtanen KJ, Remes V, Pajarinen J,et al Sling Compared with Plate Osteosynthesis for Treatment of Displaced Midshaft Clavicular Fractures. A Randomized Clinical Trial J Bone Joint Surg Am. 2012; 94:1546-53.
20. McKee RC, Whelan DB, Schemitsch EH and McKee M. Operative Versus Nonoperative Care of Displaced Midshaft Clavicular Fractures: A Meta-Analysis of Randomized Clinical Trials. J Bone Joint Surg Am. 2012;94:675-84.
21. Yun-feng C, Bing-fang Z, Yu-jie C, MS Hai-ming W, MS Jian-feng X, MS Yi-min C, PhD Xue-tao X, MS Chi Z, et al Clinical outcomes of midclavicular fractures treated with titanium elastic nails. J Can Chir 2010;53:369-384
22. Smekal V, Irenberger A, Struve P, Wambacher M, Krappinger D, Kralinger FS. Elastic stable intramedullary nailing versus nonoperative treatment of displaced midshaft clavicular fractures-a randomized, controlled, clinical trial. J Orthop Trauma. 2009;23:106-12.
23. Judd DB, Pallis MP, Smith E, Bottoni CR. Acute operative stabilization versus nonoperative management of clavicle fractures. Am J Orthop (Belle Mead NJ). 2009;38:341-5.
24. Ferran NA, Hodgson P, Vannet N, Williams R, Evans RO. Locked intramedullary fixation vs plating for displaced and shortened mid-shaft clavicle fractures: a randomized clinical trial. J Shoulder Elbow Surg. 2010;19: 783-9.
25. Jubel A, Andemahr J, Bergmann H, et al. Elastic stable intramedullary nailing of midclavicular fractures in athletes. Br J Sports Med 2003;37:480-3.
26. Mueller M, Burger C, Florczyk A, Striepens N, Rangger C. Elastic stable intramedullary nailing of midclavicular fractures in adults: 32 patients followed for 1-5 years. Acta Orthop. 2007;78:421-3.
27. Strauss EJ, Egol KA, France MA, et al. Complications of intramedullary Hagie pin fixation for acute midshaft clavicle fractures. J Shoulder Elbow Surg. 2007;16:280–284.
28. Cho Ch, Song K, Min B, Bae K, Lee K. Reconstruction Plate versus Reconstruction Locking Compression Plate for Clavicle Fractures. Clinics in Orthopedic Surgery 2010; 2 (3): 154–159.