Late brachial plexopathy after a mid-shaft clavicle fracture:A case report

BACKGROUND Clavicle fractures can rarely be associated with brachial plexus injury.These are commonly caused by tractional injury at the time of trauma,but unfrequently can be caused by compression of the brachial plexus from excessive callus or granulation tissue formation.CASE SUMMARY We report a rare case of an adult male who sustained a mid-shaft clavicle fracture and had a late presentation of brachial plexus palsy due to compression from excessive callus formation.CONCLUSION We reported a case of a rare occurrence of delayed brachial plexus palsy due to compression from excessive callus formation in a midshaft clavicle fracture.Early diagnosis and surgical decompression of the brachial plexus is critical,as when managed efficiently,a full recovery of the brachial plexus palsy can be expected in these patients.

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.

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.

Fatal pulmonary embolism after surgery for a clavicle fracture: A case report

Patients undergoing upper extremity surgery generally have a low risk of pulmonary embolism. We encountered a rare case of fatal pulmonary embolism after surgical treatment of a clavicle fracture. A 46-year-old man fell off the roof of his car and suffered fractures of the left clavicle, temporal bone and ribs, as well as cerebral and lung contusions. He was admitted to a local hospital, and was later transferred to our hospital for surgical treatment of the clavicle fracture at 6 days after injury. He had no dyspnea and was ambulant. On day 7 after the injury, open reduction and internal fixation of the clavicle fracture using a plate and screws were performed under general anesthesia. Although surgery was uneventful, the patient had bradycardia postoperatively that progressed to cardiopulmonary arrest, which required resuscitation and intubation. Spontaneous cardiac output was restored 10 minutes after cardiac arrest, but the GCS score was E1V1M2. Enhanced CT of the chest revealed a 15 mm defect in the right pulmonary artery, leading to a diagnosis of pulmonary embolism. Thrombolytic therapy was started immediately. However, the patient’s condition worsened and he died 20 days postoperatively. We suggest that use of mechanical and chemical thromboprophylaxis should be considered for clavicle surgery.

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.

Late Thoracic Outlet Syndrome after Clavicle Fractures in Patients with Multiple Trauma: A Pitfall of Conservative Treatment

Late thoracic outlet syndrome is a rare complication of clavicle fractures and usually warrants surgical treatment though its cause of clavicle fractures are a common injury and in most cases are treated conservatively. We report a case of a clavicle fracture accompanying severe multiple trauma, which was necessarily treated conservatively because of the severe associated injuries of the patient. The patient was unable to wear a figure-of-8 bandage for the fracture because of the need for complete supine bed rest, due to his other injuries. In this common situation, the clavicle fracture shortened and eventually resulted in the late thoracic outlet syndrome. We believe the cause of this was because a figure-of-8 bandage could not be applied due to the need for complete supine bed rest, and thus was inevitable because of his general condition. This case suggests that the conservative treatment of clavicle fractures, where there is the need for complete bed rest, potentially induces late thoracic outlet syndrome, and that this is indeed a pitfall in the treatment of clavicle fractures in multiple trauma.

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.

Radiography of Clavicle Fractures— A Review of the Literature —Do Various Radiographic Views of Clavicle Fractures Affect the Management Plan?

Introduction: Fractures of the clavicle are common and make up 5% - 10% of all fractures. Treatment options in part depend on the location of the fracture along the bone and degree of displacement. These two parameters are best determined by good quality, standardized radiographs of the clavicle. We reviewed the literature to determine the optimal radiographs of clavicle fractures and their influence on the treatment plan. Methods: A comprehensive search of Medline? database was undertaken with the following search terms and MeSH headings: clavicle, fractures, bone, radiography, and X-ray. We included articles in English published from 1950 to present. We ruled out fractures in children, fracture dislocations, open fractures, those with neurological and vascular injuries and fractures involving the acromioclavicular or sternoclavicular joints. Findings: Of the 821 citations obtained, only four studies proved eligible. In the most pertinent, four orthopaedic surgeons were shown standard views (antero-posterior and 20&#176;cephalic tilt) of 50 clavicle fractures and then additional two views (45&#176;cephalic and caudal tilt), and found that alternative views influenced their decision making, with more surgeons opting for surgical fixation. In a different study, it was shown that orthogonal views of the clavicle increased surgeons’ understanding and improved their treatment of these fractures. The third paper was a case series on clavicle fractures that were missed on the initial antero-posterior radiograph, and the fourth paper postulated that postero-anterior views of the thorax were most accurate in determining length of the clavicle. Conclusion: Studies showing an optimal view for assessment of clavicle fractures with a decision to then progressing to operative fixation are few, but the evidence points towards surgical fixation when alternative views of mid-shaft clavicle fractures are present.

Posterior Positioning of a Clavicle Hook Plate Is a Risk Factor for Acromial Fractures after Acromioclavicular Joint Dislocation

Purpose: Acromioclavicular (AC) joint dislocation is commonly treated using a clavicle hook plate (HP). However, previous reports have indicated that acromial fractures may occur after HP fixation. The purpose of this study was to identify risk factors for acromial fractures. Methods: A retrospective study was conducted on 39 patients with AC joint dislocation who were treated using clavicle HP fixation in our hospital between 2006 and 2017. Related parameters, including Rockwood classification, hook angle, the degree of reduction, the coverage of the hook under the acromion, and the anteroposterior position of the hook under the acromion, were evaluated to identify risk factors for acromial fractures. Results: The mean age of the participants was 51.7 (range 19 - 81) years;34 were men and 5 were women. Injury occurred on the right side in 18 patients and on the left side in 21. Injuries were categorized as follows: 24 were Rockwood type III, one was type IV, and 14 were type V. Four of the 39 patients (10%) experienced acromial fractures. Statistical analyses indicated that the degree of reduction at the final follow-up was moderately correlated with the Constant score. Posterior positioning of the hook was the only identified risk factor for acromial fractures. Hook angle and the degree of reduction at the time of surgery were not significantly associated with acromial fractures. Conclusions: Postoperative shoulder function was associated with the degree of reduction at the final follow-up, suggesting that anatomical reduction is recommended for AC joint dislocation. Posterior positioning of the hook is a risk factor for acromial fractures;however, clavicle HP fixation provides a positive outcome for AC joint dislocation. Therefore, careful positioning of the hook is required for preventing acromial fractures.

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.

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.

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.

Treatment of Displaced Mid-Clavicle Fractures by Closed Titanium Elastic Nail

Introduction: Recently, intramedullary nailing for displaced middle third fractures of clavicle has received wide attention. Though open nailing has been widely described, closed nailing finds less mention. This paper therefore aims to study the outcome of closed titanium elastic nailing for displaced mid-clavicular fractures. Material and Methods: This was a prospective study of 34 patients with displaced middle third clavicle fracture who underwent closed intramedullary nailing with titanium elastic nail at a tertiary care centre. The operative time, length of incision, time for radiological union, pain and functional outcome after union were noted. Results: The mean operative time was 34.33 mins. The mean time of discharge was 2.25 days. The average time of radiological union was 10.23 weeks. All the patients achieved full, painless range of motion of the ipsilateral shoulder. The average Constant-Murley score at 12 months was 94.28 indicating excellent result. Conclusion: Closed titanium elastic nailing offers a safe and minimally invasive method of fixation for fractures of middle-third clavicle with excellent functional outcome.

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.

Subclavian vessels injury:An underestimated complication of clavicular fractures

Clavicle fractures are frequent orthopedic injuries,often resulting from direct trauma or a fall.Most clavicle fractures are treated conservatively without any complications or adverse effects.Concomitant injuries of the subclavian vein or artery are rarely encountered and most commonly associated with high-energy trauma or comminuted clavicle fractures.They are potentially life-threatening conditions leading to hemorrhage,hematoma,pseudoaneurysm or upper limb ischemia.However,the clinical presentation might be obscure and easily missed,particularly in closed and minimally displaced clavicular fractures,and timely diagnosis relies on early clinical suspicion.Currently,computed tomography angiography has largely replaced conventional angiography for the assessment of subclavian vessel patency,as it demonstrates high accuracy and temporal resolution,acute turnaround time,and capability of multiplanar reconstruction.Depending on the hemodynamic stability of the patient and the severity of the injury,subclavian vessel lesions can be treated conservatively with observation and serial evaluation or operatively.Interventional vascular techniques should be considered in patients with serious hemorrhage and limb ischemia,followed by stabilization of the displaced clavicle fracture.This review aims to provide a comprehensive overview of the incidence,clinical presentation,diagnostic approaches,and current management strategies of clavicle fractures associated with subclavian vessel injuries.

Comparison of effect of locking compression plate internal fixation and reconstruction plate fixation for treatment of mid-shaft clavicular fracture

Objective:To compare the effect of locking compression plate internal fixation and reconstruction plate fixation for the treatment of mid-shaft clavicular fracture.Methods: In this study, the medical records of 68 patients with mid-shaft clavicular fractures treated in our department from May 2014 to May 2017 were retrospectively analyzed. 32 patients in the control group received the reconstruction plate fixation, while 36 patients in the observation group received the locking compression plate internal fixation. Patients were followed up for 12 months, thereafter, various indicators including operative indexes, Constant-Murley (CM) score, disability of arm shoulder and hand (DASH) score, activities of daily living (ADL), and complications were compared between groups.Results: The incision length, intraoperative blood loss, operation time, and fracture healing time of the observation group were significantly lower than the control group (P<0.05). The postoperative CM scores of the two groups were significantly increased, moreover, the scores of muscle strength, daily life and activity were significantly in the observation group were higher than those of the control group (P<0.05), and no difference was found in the pain degree (P>0.05). There was a decrease trend in the DASH score and an increase trend in the ADL score in both groups, while both indexes were better in the observation group than in the control group (P<0.05). The total incidence of complications in the observation group was significantly lower than that in the control group (8.33% vs 18.75%,P<0.05).Conclusion: Compared with the reconstruction plate fixation, locking compression plate internal fixation has the advantages of more mini invasive, better amelioration of shoulder joint function and less complication for patients with mid-shaft clavicular fractures.

Ipsilateral Rockwood type V acromioclavicular joint dislocation and midshaft clavicle fracture:A case report

BACKGROUND Clavicle fractures are among the most common fractures seen in the emergency department.While acromioclavicular(AC)joint injuries are much less common.However,ipsilateral combinations of these injuries are quite rare with only a few cases reported in the literature.CASE SUMMARY A 29-year-old man who sustained a combination of ipsilateral AC joint dislocation and midshaft clavicle fracture.He underwent open reduction and plate fixation of the clavicle fracture,as well as semi-rigid surgical implants used to restore both the AC ligaments and the coracoclavicular joint.one year follow-up revealed that the patient had a complete range of motion and excellent shoulder scores.This case presents a rare presentation of such combination of injuries,contributing valuable insights to the literature on such rare injuries.CONCLUSION Combined midshaft clavicle fractures and AC joint dislocations are considered quite rare.Timely diagnosis of such injuries leads to great functional outcomes.AC joint dislocation should be suspected with midshaft clavicle fractures and should be investigated radiologically and clinically in an appropriate manner.Still,there is no consensus on the optimal management of such injuries.

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.