The application of inverted lateral clavicle locking compression plate for medial clavicle fractures: biomechanical study and clinical implementation.

BACKGROUND: There has been no absolute consensus on the optimal implant for fixation of medial clavicle fracture. The purpose of the present study was to test the biomechanical efficacy of inverted lateral clavicle locking compression plate (LCP-LC) in fixation of this specific fracture location by finite element analysis. METHODS: Transverse and comminuted medial clavicle fracture simulated models stabilized by three different devices including inverted LCP-LC, superior clavicle LCP (LCP-SC), and dual reconstruction (LCP-RP) with LCP-SC were investigated biomechanical performance under three loading conditions, i.e., axial compression, inferior bending, and axial torsion. RESULTS: EQV stress exhibited on implant and elastic strain at fracture site under inferior bending was greater than other loading cases. LCP-SC construct represented the greatest EQV stress and elastic strain. The inverted LCP-LC construct demonstrated lower EQV stress than the LCP-SC construct and was comparable to dual plating. Under axial compression and axial torsion, elastic strain produced from the inverted LCP-LC construct was comparable to dual plating, but greater than dual plating when subjected to inferior bending. CONCLUSION: By the results of FE analysis, inverted LCP-LC could be a potential application for fixation of clavicle fracture with short medial fragment.

Silent iatrogenic pseudoaneurysm after intertrochanteric fracture fixation with proximal femoral nailing and cerclage wiring: case report and review of literature.

Pseudoaneurysm is a rare complication after intertrochanteric fracture fixation. Herein, we present a rare case of late development of a pseudoaneurysm with silent clinical symptoms. The case was a 91-year-old woman treated with proximal femoral nailing and cerclage wiring. Postoperatively, the patient was able to ambulate with a walker without abnormal symptoms. During the follow-ups, the radiographic images showed progressive cortical scalloping on the medial femoral shaft. Ultrasonography revealed a yin-yang sign, and a CT scan confirmed a pseudoaneurysm at the profunda femoris artery (PFA). In this case, many possible causes of pseudoaneurysm were hypothesized. We showed that the excessive displaced, long spiral pattern of an intertrochanteric fracture, which was irreducible by a closed technique, is the risk of a PFA injury. An atherosclerotic vessel was seen in preoperative radiography, indicating poor vessel elasticity which may be a risk of vessel tear during fracture reduction using multiple reduction instruments in excessive displaced fracture. Moreover, over-penetration when drilling should not be overlooked. We also discuss the predisposing factors, surgical techniques which may lead to this type of PFA injury and summarize the literature of pseudoaneurysms related to intertrochanteric fracture fixation.

Surgical treatment of osteochondroma on the first rib by double clavicle osteotomy and internal fixation with a reconstruction plate: A case report and literature review.

INTRODUCTION: The accepted indication for surgical removal of osteochondroma is when a lesion becomes symptomatic. There have been no established standard surgical approaches to remove osteochondroma on the first rib and no report on management after that. This report aims to present a novel approach by double clavicle osteotomy followed with internal fixation. CASE PRESENTATION: A 17-year-old female presented with a gradually enlarged bony mass with tenderness at the supraclavicular area. Radiographic images revealed a bony mass attached to the first rib. The provisional diagnosis is osteochondroma. The tumor was approached by osteotomy at the proximal and distal shaft of the clavicle. After removing the entire tumor, the direct reduction and internal fixation of the clavicle were performed. DISCUSSION: Both, size of the mass and mobilization of the clavicle are factors in determining the surgical approach. Clavicular osteotomy, especially two sites, is considered when the lesion is extremely large. A possible complication after the clavicular osteotomy is nonunion or malunion. A proper technique of reduction and method of fixation contributes to reducing complications. CONCLUSION: The double clavicle osteotomy is an effective route for removing a large tumor at the first rib. Plate fixation following clavicular osteotomy contributes to bone union and excellent functional outcomes postoperatively.