Functional and radiological assessment of displaced midshaft clavicle fractures treated through open reduction and internal fixation surgery using pre-contoured locking compression plates

Authors

  • Rohil Singh Kakkar Department of Orthopaedic Surgery, Ruby Hall Clinic, Pune, Maharashtra, India
  • Deepak Mehta Department of Orthopaedics, Mhaishalkr Shinde Hospital and Research Centre, Sangli, Maharashtra, India
  • Ankit Sisodia Department of Orthopaedics, Mhaishalkr Shinde Hospital and Research Centre, Sangli, Maharashtra, India

DOI:

https://doi.org/10.18203/2349-2902.isj20202833

Keywords:

Clavicle fracture, Surgical fixation, Clavicle plate, Constant-Murley score

Abstract

Background: Fractures of the clavicle constitute approximately 2.6% of all the fractures and nearly 44-66% of fractures around shoulder.

Methods: This particular study is intended to assess the functional and radiological outcomes in a series of 32 patients with closed displaced midshaft clavicle fractures treated through open reduction and internal fixation surgery using pre-contoured clavicle locking compression plates.

Results: All 32 patients achieved fracture union within 6 months follow up period. As per Constant-Murley scoring, 56.25% cases had excellent results, 34.37% cases had good, 6.25% cases had fair and 3.12% of the cases had poor results respectively.

Conclusions: Open reduction and internal fixation surgery with pre-contoured locking compression plates in the displaced midshaft clavicle fractures restores the anatomy, biomechanics and contact loading characteristics of the clavicle and significantly reduces the incidence of non-union with improved functional outcomes resulting in better patient satisfaction.

Author Biography

Rohil Singh Kakkar, Department of Orthopaedic Surgery, Ruby Hall Clinic, Pune, Maharashtra, India

Senior Resident, Department of Orthopaedic Surgery, Ruby Hall Clinic, Pune, India

References

Saha P, Datta P, Ayan S, Garg AK, Bandyopadhyay U, Kundu S. Plate versus titanium elastic nail in treatment of displaced midshaft clavicle fractures A comparative study. Indian J Orthop. 2014;48:6.

Assobhi JEH. Reconstruction plate versus minimal invasive retrograde titanium elastic nail fixation for displaced midclavicular fractures. J Orthopaed Traumatol. 2011;12:185-92.

Wijdicks FJ, Houwert M, Dijkgraaf M, Lange D, Oosterhuis K, Clevers G, et al. Complications after plate fixation and elastic stable intramedullary nailing of dislocated midshaft clavicle fractures: a retrospective comparison. Int Orthop. 2012;36:2139-45.

Khan K, Bradnock TJ, Scott C, Robinson CM. Fractures of the Clavicle. J Bone Joint Surg Am. 2009;91:447-60.

Mckee RC, Whelan DB, Schemisch EH, Mckee MD. Operative versus non operative care of displaced midshaft clavicular fracture: a meta-analysis of randomized control trials. J Bone Joint Surg. 2012;94:675-84.

Altamani SA, Mckee MD. Nonoperative treatment compared with plate fixation of displaced clavicular fractures. J Bone Joint Surg. 2000;90:1-8.

Postacchini F, Gumina S, Santes DP. Epidemiology of clavicle fractures. Shoulder Elbow Surg. 2002;11(5):452-6.

Huang JI, Toogood P, Chen MR, Wilber JH, Cooperman DR. Clavicular anatomy and the applicability of precontoured plates. J Bone Joint Surg Am. 2007;89:2260-5.

Ranalletta M, Rossi LA, Piuzzi NS, Bertona A, Bongiovanni SL, Maignon G. Return to sports after plate fixation of displaced midshaft clavicular fractures in athletes. Am J Sports Med. 2015;43:565-9.

Verborgt O, Pittoors K, Glabbeek VF, Declercq G, Nuyts R, Somville J. Plate fixation of middle-third fractures of the clavicle in the semi-professional athlete. Acta Orthop Belg. 2005;71(1):17-21.

Patel B, Gustafson PA, Jastifer J. Bubble bilevel ventilation facilitates gas exchange in anesthetized rabbits. Clin Biomec. 2012;27(5):436-42.

Rowe CR. An atlas of anatomy and treatment of midclavicular fractures. Clin Orthop. 1968;58:29-42.

Channappa TS, Radhakrishna AM, Sumanth B, Shivakumar HB. A comparative study of functional outcome of clavicular fractures treated by operative and non-operative methods. IJOS. 2017;3(1):509-14.

Chandrasenan J, Espag M, Dias R, Clark DI. The use of anatomic pre-contoured plates in the treatment of midshaft clavicle fractures. J Bone Joint Surg Br. 2009;91-B:179-80.

Sharr JR, Mohammed KD. Optimizing the radiographic technique in clavicular fractures. J Shoulder Elbow Surg. 2003;12:170-2.

Hill JM, McGuire MH, Crosby LA. Closed treatment of displaced middle third clavicular fractures of the clavicle gives poor results. J Bone Joint Surg Br. 1997;79(4):537-9.

Nordgvist A, Petersson CJ, Johnell R. Mid clavicular fractures in adults: end result study after conservative treatment. J Orthop Trauma. 1998;12:572-6.

Robinson CM, Goudie EB, Murray IR, Jenkins PJ, Ahktar MA, Foster CJ, et al. Open reduction and plate fixation versus nonoperative treatment for displaced midshaft clavicular fractures: a multicenter, randomized, controlled tria. J Bone Joint Surg Am. 2013;95(17):1576-84.

Robinson CM, Brown CM, McQueen MM, Walkefield AE. Estimating the risk of non-union following non operative treatment of a clavicular fracture. J Bone Joint Surgery Am. 2004:86:1359-65.

Poigenfurst J, Rappold G, Fischer W. Plating of fresh clavicular fractures: results of 122 operations. Injury. 1992;23:237-41.

McKee MD, Seiler JG, Jupiter JB. The application of the limited contact dynamic compression plate in the upper extremity: an analysis of 114 consecutive cases. Injury. 1995;26:661-6.

Zlowodzki MI, Zelle BA, Cole PA, Jeray K, McKee MD. Evidence-Based Orthopaedic Trauma Working Group. 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(7):504-7.

Mohamed EA, Zanfaly AI. Plate fixation in midshaft fracture clavicle. Egyptian Orthopedic J. 2014;49:299-303.

Jiang H, Qu W. Operative treatment of clavicle midshaft fractures using a locking compression plate: Comparison between mini-invasive plate osteosynthesis (MIPPO) technique and conventional open reduction. Orthop Traumatol Surg Res. 2012;98(6):666-71.

Hundekar B. Internal fixation of displaced middle third fractures of clavicle with pre-contoured locking plate. J Orthop. 2013;10(2):79-85.

Bostman O, Manninen M, Pihlajamaki H. Complications of plate fixation in fresh displaced mid clavicular fractures. J Trauma. 1997;43:778-83.

Lazarus MD. Fractures of the Clavicle. Chapter-26, In: Bucholz RW and Heckma JD, editors, Rockwood and Green’s fractures in adults, 5th edition, Philadelphia: Lippincott Williams and Wilkins; 2001:1041-1078.

Choudhari, Chhabra. Displaced Mid-Shaft Clavicle Fractures: A Subset for Surgical Treatment. Malaysia Orthopaedic J. 2014;8(2):1-5.

Reddy. A study of clinical spectrum and risk factors of cerebral palsy in children. Int J Contemporary Med Res. 2016;3(7):50-43.

Cho CH, Song KS, Min BW, Bae KC, Lee KJ. Reconstruction Plate versus Reconstruction Locking Compression Plate for Clavicle Fractures. Clin Orthopedic Surg. 2010:2:154-9.

Lee SK, Lee JW, Song DG, Choy SW. Pre-contoured Locking Plate Fixation for Displaced Lateral Clavicle Fractures. Orthopedics. 2013;36(6):801-7.

Cdr W, Kulshrestha V. Primary Plating of Displaced Mid-Shaft Clavicular Fractures. Med J Armed Forces India. 2008;64(3):208-11.

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;79:537-9.

Reddy RK, Rathod J, Rao KT. A Study on Surgical Management of Clavicle Midshaft Fractures by Locking Plate. IJCMR. 2016;3(7):2005-7.

Iannotti MR, Crosby LA, Stafford P. Effects of plate location and selection on the stability of midshaft clavicle osteotomies: a biomechanical study. J Shoulder Elbow Surg. 2002;11:457-62.

Craig EV, Basamania CJ, Rockwood CA. Fractures of the clavicle. Chapter 11, In: Rockwood CA, Matsen FA, Wirth MA, Lippitt SB, editors, The shoulder. 3rd edition Philadelphia: Saunders; 2004:455-519.

Demirhan M, Bilsel K, Atalar AC, Bozdag E, Sunbuloglu E, Kale A. Biomechanical comparison of fixation techniques in midshaft clavicular fractures. J Orthop Trauma. 2011;25(5):272-8.

Beek VC, Boselli KJ, Cadet ER, Ahmad CS, Levine WN. Pre-contoured plating of clavicle fractures: Decreased hardware-related complications. Clin Orthop Relat Res. 2011;469(12):3337-43.

Jasper FG, Olivier WAJ, Meijden VD, Millett PJ, Verleisdonk EJMM, Houwert MR. Systematic review of the complications of plate fixation of clavicle fractures. Arch Orthop Trauma Surg. 2012;132(5):617-25.

Zlowodzki M, Zelle BA, Cole PA, Jeray K, McKee MD. Evidence-Based Orthopaedic Trauma Working Group. Treatment of midshaft clavicle fractures: systemic review of 2144 fractures: on behalf of the Evidence-Based Orthopaedic Trauma Working Group. J Orthop Trauma. 2005;19:504-7.

Canadian Orthopaedic Trauma Society. Non-operative treatment compared with plate fixation of displaced midshaft clavicular fractures: a multicenter, randomized clinical trial. J Bone Joint Surg Am. 2007;89(1):1-10.

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Published

2020-06-25

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Original Research Articles