Hook Plate Versus Distal Locking Plate for the Fixation of Unstable Distal Clavicle Injuries, Outcomes and Complications: A Meta-Analysis.

Numerous interventions are advised for the surgical management of distal clavicle fractures. Hook plate (HP) and distal locking plate (DLP) are among the commonly used techniques; nonetheless, no single procedure is deemed to be the benchmark treatment. Thus, the aim of the study is to conduct a comparative analysis, hopefully, to recommend the superior method between the two operations. PubMed, Embase via Ovid and Web of science were electronically searched between January 2000 and to date for studies directly comparing HP to DLP. Comparative retrospective/prospective and randomized studies were incorporated. Constant-Murley score "CMS" at a minimum of 12 months, pain visual analogue scale "VAS", coracoclavicular distance "CCD" and reported complications were analysed. Review manager software was used for the statistical analyses. The total number of patients was 523; 274 (52.3%) with HP and 249 (47.6%) with DLP, 81 of which were associated with CC reconstruction. The mean follow up was 38.7 and 37.03 months for HP and DLP, respectively. CMS leaned towards the DLP group with no statistically significant difference (P=0.06). VAS was in favour of the DLP with again no statistically significant difference (P=0.12). In terms of CCD, the comparison favoured the HP with a lesser CCD postoperatively and a statistically significant difference (P<0.05). Complications were significantly higher in the HP group (P<0.0001). Contrary to our hypothesis, though HP did show a better radiological outcome; nonetheless, DLP did demonstrate a better functional result with a lesser rate of complications and the ability to retain the implant avoiding a second surgery.

Complications of clavicle fracture surgery in patients with concomitant chest wall injury: a retrospective study.

BACKGROUND: The impact of associated chest wall injuries (CWI) on the complications of clavicle fracture repair is unclear to date. This study aimed to investigate the complications after surgical clavicle fracture fixation in patients with and without different degrees of associated CWI. METHODS: A retrospective review over a four-year period of patients who underwent clavicle fracture repair was conducted. A CWI and no-CWI group were distinguished, and the CWI group was subdivided into the minor-CWI (three or fewer rib fractures without flail chest) and complex-CWI (flail chest, four or more rib fractures) subgroup. Demographic data, classification of the clavicle fracture, number of rib fractures, and associated injuries were recorded. Overall complications included surgery-related complications and unplanned hospital readmissions. Univariate analysis and stepwise backward multivariate logistic regression were used to identify potential risk factors for complications. RESULTS: A total of 314 patients undergoing 316 clavicle fracture operations were studied; 28.7% of patients (90/314) occurred with associated CWI. Patients with associated CWI showed a significantly higher age, body mass index, and number of rib fractures. The overall and surgical-related complication rate were similar between groups. Unplanned 30-day hospital readmission rates were significantly higher in the complex-CWI group (p = 0.02). Complex CWI and number of rib fractures were both independent factor for 30-day unplanned hospital readmission (OR 1.59, 95% CI: 1.00-2.54 and OR 1.33, 95% CI: 1.06-1.68, respectively). CONCLUSION: CWI did not affect surgery-related complications after clavicle fracture repair. However, complex-CWI may increase 30-day unplanned hospital readmission rates.

Comparison of the effect of two internal fixation methods for proximal clavicle fractures

SUMMARY OBJECTIVE To compare the effect of two internal fixation methods in the treatment of proximal clavicle fractures. METHODS Fifty patients with proximal clavicle fractures received surgical treatment. They were divided into a clavicular T-plate group and a double mini-plates group. The duration of the operation, blood loss during the operation, fracture healing time, and incision infection were evaluated between the two groups. RESULTS Operation time (t=2.063, P=0.058), intraoperative bleeding (t=1.979, P=0.062), and fracture healing time (t=1.082, P=0.066) were not statistically significant in the two groups. The patients were followed up for 12-18 months; one patient in the T-plate group had early removal of nails, but no clinical symptoms. At the 2-month follow-up, the ASES score in the double mini-plates group was significantly better than in the T-plate group (P<0.001); but at the 6-month follow-up, 1-week before removal of internal fixation and the final follow-up, the two groups had no significant differences (P>0.05). CONCLUSIONS Both internal fixations have similar clinical results in the duration of operation, blood loss during the operation, and fracture healing time. The double mini-plates fixation presents advantages by reducing complications and speeding fracture healing; thus it is a more effective method to treat proximal clavicle fractures.

RESUMO OBJETIVO Comparar o efeito de dois métodos de fixação interna no tratamento de fraturas da clavícula proximal. MÉTODOS Cinquenta pacientes com fraturas da clavícula proximal receberam tratamento cirúrgico. Eles foram divididos em um grupo de placa T clavicular e um grupo de miniplacas duplas. A duração da operação, perda de sangue durante a operação, tempo de cura da fratura e infecção na incisão foram avaliados nos dois grupos. RESULTADOS O tempo de operação (t=2,063, P=0,058), perda de sangue durante a operação (t=1,979, P=0,062) e tempo de cura das fraturas (t=1,082, P=0,066) não foram estatisticamente significativos nos dois grupos. Os pacientes foram acompanhados por 12-18 meses; um dos pacientes do grupo da placa T teve retirada antecipada dos parafusos, mas não apresentou sintomas clínicos. Aos dois meses de acompanhamento, a pontuação ASES no grupo de miniplacas duplas foi significativamente melhor do que a do grupo de placas T (P<0,001). Porém, no acompanhamento de seis meses, uma semana antes da remoção da fixação interna e do acompanhamento final, os dois grupos não apresentavem diferenças significativas (P>0,05). CONCLUSÃO Ambas técnicas de fixação interna têm resultados clínicos semelhantes quanto a duração da operação, perda de sangue durante a operação e tempo de cura da fratura. A fixação de miniplacas duplas apresenta vantagens quanto a redução das complicações e cura mais rápida da fratura, sendo, portanto, um método mais eficaz para tratar fraturas da clavícula proximal.

Preferences of orthopedic surgeons for treating midshaft clavicle fracture in adults / Preferências dos cirurgiões ortopédicos para o tratamento da fratura do terço médio da clavícula em adultos

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.

RESUMO Objetivo Determinar a prática clínica atual na América Latina para o tratamento das fraturas do terço médio da clavícula, incluindo abordagens cirúrgicas e não cirúrgicas. Métodos Estudo transversal com aplicação de questionário descritivo. Cirurgiões de ombro e cotovelo da Sociedade Brasileira de Cirurgia do Ombro e Cotovelo e da Sociedade Latino-Americana de Ombro e Cotovelo foram contatados e convidados a completar um breve questionário (SurveyMonkey®) sobre o manejo das fraturas do terço médio da clavícula. Foram excluídas as respostas incompletas ou inconsistentes. Resultados O tipo de classificação radiográfica utilizada de preferência esteve de acordo com a descrição da morfologia da fratura, representando 41% do total dos participantes. Em segundo lugar, apareceu a classificação de Allman, que foi utilizada por 24,1% dos participantes. Nas indicações de tratamento cirúrgico, as indicações com encurtamento e iminência de exposição da pele foram estatisticamente significativas. Tratamento conservador foi prescrito em caso de contato entre as corticais. Como método de imobilização, a tipoia simples foi a preferência, e o tempo de tratamento foi de 4 a 6 semanas. Apesar do resultado sem significância estatística, a placa bloqueada foi a opção preferencial nos casos cirúrgicos. Conclusão A metodologia de tratamento das fraturas do terço médio da clavícula nos países da América Latina é semelhante, assim como com a literatura atual.

Results of minimal invasive coracoclavicular fixation by double button lift-up system in Neer type II distal clavicle fractures.

AIM: We aimed to evaluate clinical and functional outcomes of indirect fracture reduction performed by coracoclavicular fixation with minimal invasive double button lift-up system in Neer type IIa unstable fractures of distal clavicle. MATERIAL AND METHODS: 22 patients with Neer type 2 distal clavicle fracture were enrolled in that prospective study. All patients underwent indirect reduction and osteosynthesis performed by coracoclavicular fixation with minimal invasive double button lift-up system. Postoperative follow-up was carried out clinically and radiologically with plain X-rays and utilization of Constant and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment (ASES) shoulder scores. Mean follow-up time was 15 months. A standard sling was applied for 2 weeks, postoperatively. Rehabilitation program was started on postoperative day 1. RESULTS: Mean age was 39 (range: 21-60), 18 of the patients were male. Right dominant extremity was affected in 14 patients. Mean duration of the surgical intervention was 40 min (range: 30-55 min). Mean union time was found to be 14 weeks (range: 7-21 weeks). Mean postoperative ASES and Constant scores were 79.9 (66.9-88.3) and 82.2 (71-100), respectively. The duration of return to normal daily activities were found to be 4.5 months. Any loss of reduction, AC joint arthrosis, and clavicular shortening were not detected in X-rays. CONCLUSION: This study has demonstrated that indirect osteosynthesis performed by coracoclavicular fixation with double button lift-up system in the treatment of unstable Neer type IIa fractures of the distal clavicle had successful clinical, radiological, and functional outcomes.

Acromioclavicular dislocation type VI associated with diaphyseal fracture of the clavicle / Luxação acromioclavicular tipo VI associada à fratura diafisária da clavícula

The purpose is to present a very unusual case of the acromioclavicular joint inferior dislocation associated with the clavicle fracture. It concerns to a young patient who had a bike fall and had this type of pathology, had been operated and obtained excellent clinic result. The literature mentions many cases of subcoracoide dislocation, but there are only two subacromial similar to ours. The case is described, a literary revision is done and discussed and the treatment is discussed.

O objetivo é apresentar um caso muito raro de luxação inferior da articulação acromioclavicular (AAC) associada à fratura da clavícula. Trata-se de um paciente jovem que sofreu queda de bicicleta e evoluiu com esse tipo de patologia. Foi operado e obtido ótimo resultado clínico. A literatura cita vários casos de luxação subcoracoide, mas existem somente dois casos subacromiais semelhantes ao nosso. É descrito o caso, feita uma revisão literária e discutido o tratamento.

Acromioclavicular dislocation type VI associated with diaphyseal fracture of the clavicle.

The purpose is to present a very unusual case of the acromioclavicular joint inferior dislocation associated with the clavicle fracture. It concerns to a young patient who had a bike fall and had this type of pathology, had been operated and obtained excellent clinic result. The literature mentions many cases of subcoracoide dislocation, but there are only two subacromial similar to ours. The case is described, a literary revision is done and discussed and the treatment is discussed.