Lateral clavicle fracture-plating options and considerations

Clavicle fractures are among the most prevalent types of fractures with numerous treatment strategies that have evolved over time.In the realm of lateral-third clavicle fracture management,several surgical methods are available,with plate and screw constructs being one of the most frequently employed options.Within this construct,numerous choices exist for fixing the fracture.This editorial provides an overview of the common plate options utilized in the management of distal third clavicle fractures underscoring the critical considerations and approaches that guide clinicians in selecting the most appropriate fixation techniques,considering the complex landscape of clavicle fractures and their challenging management.

Distal clavicle fractures treated by anteroinferior plating with a single screw: Two case reports

BACKGROUND For the treatment of distal clavicle fractures,each treatment method has its own advantages and disadvantages,and there is no optimal surgical solution.CASE SUMMARY Based on this,we report 2 cases of distal clavicle fractures treated utilizing an anterior inferior plate with a single screw placed in the distal,in anticipation of providing a better surgical approach to distal clavicle fracture treatment.Two patients were admitted to the hospital after trauma with a diagnosis of distal clavicle fracture,and were admitted to the hospital for internal fixation of clavicle fracture by incision and reduction,with good postoperative functional recovery.CONCLUSION With solid postoperative fixation and satisfactory prognostic functional recovery,this technique has been shown to be simple,easy to perform and effective.

Erratum:Rates of readmission and reoperation after operative management of midshaft clavicle fractures in adolescents

This is an erratum to an already published paper.We found an error in the results section and Table 1.Specifically,we have revised results with n≤10 to be reflected as such,which is consistent with the reporting instructions by the Agency for Healthcare Research and Quality.Please note,these changes do not affect our results,and we had previously listed this requirement in the results section.We apologize for our unintentional mistake.

Rates of readmission and reoperation after operative management of midshaft clavicle fractures in adolescents

BACKGROUND The national rates of readmission and reoperation after open reduction internal fixation(ORIF)of midshaft clavicle fractures in adolescents is unknown.AIM To determine rates of and risk factors for readmission and reoperation after ORIF of midshaft clavicle fractures in adolescents.METHODS This retrospective study utilized data from the Healthcare Cost and Utilization Project State Inpatient Database for California and Florida and included 11728 patients 10–18 years of age that underwent ORIF of midshaft clavicle fracture between 2005 and 2012.Readmissions within ninety days,reoperations within two years,and differences in patient demographic factors were determined through descriptive,univariate,and multivariate analyses.RESULTS In total,3.29%(n=11)of patients were readmitted within 90 d to a hospital at an average of 18.91±18 d after discharge,while 15.87%(n=53)of patients underwent a reoperation within two years at an average of 209.53±151 d since the index surgery.The most common reason for readmission was a postoperative infection(n<10).Reasons for reoperation included implant removal(n=49)at an average time of 202.39±138 d after surgery,and revision ORIF(n<10)with an average time of 297±289 d after index surgery.The odds of reoperation were higher for females(P<0.01)and outpatients(P<0.01),while the odds of reoperation were lower for patients who underwent surgery in California(P=0.02).CONCLUSION There is a low rate of readmission and a high rate of reoperation after ORIF for midshaft clavicle fractures in adolescents.There are significant differences for reoperation based on patient sex,location,and hospital type.

Surgical treatment of bipolar segmental clavicle fracture:A case report

BACKGROUND Shoulder injuries caused by trauma are common,including clavicle fractures.Even so,bipolar segmental fracture of the clavicle is extremely rare and seldom reported.Therefore,there is still a controversial issue about how to treat these bipolar segmental clavicle fractures.CASE SUMMARY A 56-year-old security guard arrived at our emergency room after falling on his electric bicycle.There was no loss of consciousness or other pain.He had no numbness in his fingers.X-rays and 3D computed tomography revealed that the patient’s right shoulder had a bipolar segmental clavicle fracture.The surgical procedure included both open reduction and internal fixation.At the 1-year follow-up,he had a full range of motion and minimal discomfort in the injured shoulder.CONCLUSION We provide a rare case of bipolar clavicle facture in the right clavicle.We hold the opinion that such patients would get better clinical and radiological outcomes by early and correct operation.

Rates of readmission and reoperation after operative management of midshaft clavicle fractures in adolescents

The present letter to the editor is a commentary on the study titled“Rates of readmission and reoperation after operative management of midshaft clavicle fractures in adolescents”.There is a debate over whether surgical treatment of clavicle shaft fractures improves clinical outcomes in adolescents.The readmission and reoperation rates following surgery should be identified.

Finite element analysis of the treatment of middle clavicle fracture with wing plate internal fixation

Objective:To investigate the mechanical properties of a new type of biplane locking plate with wings in the treatment of middle clavicle fractures.Methods:Based on the CT data of a healthy adult male volunteer’s clavicle,a three-dimensional finite element model of the middle clavicle fracture was constructed by digital three-dimensional reconstruction technology,and the two kinds of fixation methods of single-plane locking plate(SP)and wing plate(WP)were simulated.Four load cases of axial compression,axial torsion,cantilever bending and pull-out were used to analyze the models.Results:①Under axial compression,axial torsion,cantilever bending and pull-out conditions,compared with SP,the stiffness phase of WP increased by 1.47%,5.82%,1.51%and 3.96%respectively,and the strain energy decreased by 1.50%,5.39%,1.48%and 3.49%respectively.②The stress distribution characteristics of WP under various load conditions were similar to SP,and the high stress area was located around the screw hole of the steel plate above the fracture gap;③Under the pull-out condition of WP,the peak value of screw hole surface stress was greatly reduced compared with SP,especially in the screw hole on both sides of the wing screws,which had higher resistance to pull out.Conclusion:The load-bearing mode of WP under various load conditions is similar to that of SP,and the stability is slightly higher than that of SP and in terms of pull-out resistance,WP has more obvious advantages.The biplane locking plate with wings is expected to be a more ideal choice for patients with comminuted fracture of the middle clavicle or with osteoporosis.

Study of treatment of scapular fractures with associated clavicle fractures

To explore the treatment methods for scapular fractures associated with clavicle fractures.Methods Of 23 cases with scapular fractures associated with clavicle fractures,13 treated conservatively took the function exercise of shoulder joint after two months and 10 treated with open reduction and plate fixation reconstruction began the function exercise of shoulder joint four weeks after operation.The follow up averaged 12 months.Results All patients were healed up.18 cases were followed up,of them 8 cases were treated surgically,10 cases,conservatively.Of eight cases treated surgically,seven got excellent functional recovery of the shoulder joint and one satisfactory.In the meantime,of 10 cases treated conservatively,the recovery of shoulder joint was excellent in six,good in three and poor in one.Conclusion As for scapular fractures with associated clavicle fractures,open reduction and plate fixation reconstruction is a good treatment method for it can keep the stability and the balance of shoulder joint and is helpful for early functional exercise and recovery of the shoulder joint.7 refs,5 figs.

The Treatment of Mid-shaft Clavicle Fractures

Objective： Through reviewing the relevant literature from the past decades, to summarize the assessment and management of fractures of the clavicle, and provide an overview of the clinical results of a range of treatment options. Data Sources： The data analyzed in this review are mainly from articles included in PubMed and EMBASE, published from 1960 to 2015. Study Selection： Studies involving assessment of fractures of the clavicle were reviewed. Further literatures were gathered regarding the conservative and surgical treatment of these fractures, including the methods of fixation and the surgical approaches used. Both conservative and surgical treatments were then compared and contrasted. Results： Through retrieving and reading the abstract, a total of 42 representative articles were selected, which covered all aspects of the conservative treatment and surgical treatment, and compared the advantages and disadvantages of different treatment options. Conclusions： Although the majority of recent data suggest that surgery may be more appropriate as it improves functional outcome and reduces the risk of complications, we recommend that the treatment should be individually assessed.

Outcome of distal end clavicle fractures treated with locking plates

Purpose： Fractures of the lateral end of the clavicle are relatively uncommon. These fractures are unstable due to the various deforming forces which act on the fragments as well as the small distal fracture fragment. At most times the deforming forces are not taken into consideration, and the fracture is not fixed securely. In this study, we assessed a fixation technique using the precontoured locking plates to find out whether it provided a stable fixation with good functional outcome. Methods： Totally, 32 patients with lateral end clavicle fracture （Neer＇s Type ll） were included in the study. After the informed consent and preoperative investigations were obtained, open reduction and intemal fixation was done using a 3.5 mm precontoured superior locking plate with lateral extension under general anesthesia. Postoperative X-rays were done on day I and every 6 weeks after operation, until radiological union was achieved. The postoperative pain was assessed using Visual Analogue Scale （VAS） on postoperative days 1, 2 and 10. Postoperatively arm pouch sling was given for 2 weeks followed by active mobilization. Patients were asked to do their daily routine work and avoid lifting heavy weights. The functional outcome was assessed at the end of 2nd and 6th months with the help of Disabilities of the Arm, Shoulder and Hand （DASH} scoring. Results： There were no intraoperative complications in the procedure. The mean VAS score on post- operative day 1 was found to be 5 which decreased to 3 on day 2 and 0 on day 10. The mean DASH score was calculated as 11.63 at the end of postoperative month 2 and then 4.6 at the end of month 6. There was one case of malunion in whom the overhead abduction was restricted but was not painful and was managed conservatively. Conclusion： The precontoured locking plates with lateral extension may be a good method to fix the fractures of the lateral end clavicle, which provide a stable fixation with good functional outcome with very few instances of stiffness and decreased range of motion of the shoulder with the hook plates and failure of fixation in screw and K-wire fixations. It may well be the answer to the fixation questions of the lateral clavicle fractures, although larger comparative studies between the surgical treatment methods are required to confirm the same.

Fractures around the shoulder in the skeletally immature:A scoping review

Fractures around the shoulder girdle in children are mainly caused by sports accidents.The clavicle and the proximal humerus are most commonly involved.Both the clavicle and the proximal humerus have a remarkable potential for remodeling,which is why most of these fractures in children can be treated conservatively.However,the key is to understand when a child benefits from surgical management.Clear indications for surgery of these fractures are lacking.This review focuses on the available evidence on the management of clavicle and proximal humerus fractures in children.The only strict indications for surgery for diaphyseal clavicle fractures in children are open fractures,tenting of the skin with necrosis,associated neurovascular injury,or a floating shoulder.There is no evidence to argue for surgery of displaced clavicle fractures to prevent malunion since most malunions are asymptomatic.In the rare case of a symptomatic malunion of the clavicle in children,corrective osteosynthesis is a viable treatment option.For proximal humerus fractures in children,treatment is dictated by the patient's age(and thus remodeling potential)and the amount of fracture displacement.Under ten years of age,even severely displaced fractures can be treated conservatively.From the age of 13 and onwards,surgery has better outcomes for severely displaced(Neer types III and IV)fractures.Between 10 and 13 years of age,the indications for surgical treatment are less clear,with varying cut-off values of angulation(30-60 degrees)or displacement(1/3–2/3 shaft width)in the current literature.

Pathological clavicular fracture as first presentation of renal cell carcinoma: a case report and literature review

Renal cell carcinoma(RCC) accounts for approximately 3% of all cancer cases. RCCs usually metastasize to the lungs, bones, liver, or brain. Only <1% of patients with bone metastases manifested clavicular RCC metastases. Thus, clavicular metastasis as the initial presentation of RCC is extremely rare. We report a patient with RCC metastasis to the left clavicle, which was first presented with pain caused by a pathological fracture. Magnetic resonance image revealed a renal tumor, and technetium-99m–methylene diphosphonate bone scintigraphy showed multiple osseous metastases. The patient eventually underwent surgery to remove the lateral end of the left clavicle and right kidney. Histopathology revealed renal tumor and clear cell carcinoma in the clavicle. Finally, we review 17 cases of clavicular metastases originating from different malignancies.

右锁骨远端骨折复位后右侧颈部淋巴漏1例

1临床资料患者,男,42岁,因“右侧锁骨骨折固定术后右肩颈部反复肿胀4月余”于2021-08-01收治入院。患者2021-03-22因车祸行右锁骨远端骨折切开复位内固定、右多发肋骨骨折切开复位内固定,术后10 d出现右颈部皮下肿胀,行穿刺治疗,抽出液为清亮透明液体,多次穿刺治疗后,右颈部肿胀反复并向右侧肩后区扩展加重。2021-05-20于我院骨科住院行B超引导下穿刺置管、负压引流和加压包扎治疗.

Low-intensity extracorporeal shock wave therapy for midshaft clavicular delayed union: A case report and review of literature

BACKGROUND One of the most common complications following surgery for midshaft clavicle fracture is nonunion/delayed union.Extracorporeal shock wave therapy(ESWT)is an alternative to promote new bone formation without surgical complications.To date,no literature has reported low-intensity ESWT(LI-ESWT)in delayed union of midshaft clavicle fracture.CASE SUMMARY We reported a 66-year-old Chinese amateur cyclist with clavicle delayed union treated with 10 sessions of LI-ESWT(radial,0.057 mJ/mm^(2),3 Hz,3000 shocks).No anesthetics were applied,and no side effects occurred.At the 4 mo and 7 mo follow-ups,the patient achieved clinical and radiographical recovery,respectively.CONCLUSION In conclusion,our findings indicated that LI-ESWT could be a good option for treating midshaft clavicular delayed union.