Current classifications of midshaft clavicle fractures are based on radiography. The aim of the study was to evaluate the fracture pattern of clavicle fractures using 3-dimensional computed tomography (3D CT). A retrospective analysis was performed on CT scans of 65 acute clavicle fractures. Using quantitative 3D CT reconstruction techniques, the fracture of the clavicle was virtually reduced. Based on these reconstructions, a group-based fracture heat map and small fragment heat map, and the location of the most common fracture line were determined. Also, the direction and amount of displacement were evaluated. Three fracture patterns could be distinguished. The primary fracture line in type 1 is going from posteromedial to anterolateral and located between 50% and 68% of the clavicle’s length. In type 2, a transverse fracture line is located around 55%, and in type 3, a superolateral to inferomedial line is located between 47% and 56%. Wedged fracture fragments can be seen in types 1 and 2 and are mainly situated inferiorly. The displacement is similar in all types, but the main direction of displacement is specific for the different types (posterior, anterior, inferior). We can conclude that several fracture patterns can be seen in clavicle fractures. Most fractures are located laterally at the midshaft of the clavicle. Wedged segments are mainly located inferiorly, and at the posterior part of the clavicle, no comminution is ever seen. The direction of displacement depends on the fracture pattern.

The purpose of the present study (NCT-00612391) was to compare outcomes for the deltoid split (DS) approach and the classic deltopectoral (DP) approach in terms of function, quality of life, and complications in a prospective randomized multicenter study using consort guidelines. Background: There are two options when choosing the surgical approach for locking plate fixation to treat proximal humerus fractures (PHF). The deltoid split (DS) approach, developed according to minimally invasive surgery principles, and the classic deltopectoral (DP) approach, believed to increase the risk of avascular necrosis and making access to the greater tuberosity more difficult. Methods: From 2007 to 2016, all patients, from two University Trauma Centers, meeting the inclusion criteria (PHF Neer II/III, isolated injury, skeletal maturity, speaking French or English, available for follow-up (FU), ability to fill questionnaires) were invited to participate. Exclusion criteria were: Pre-existing pathology to the limb, patient-refusing or too ill to undergo surgery, patient needing another type of treatment (nail, arthroplasty), axillary nerve impairment, open fracture. After consent, patients were randomized to one of the two treatments using the dark envelope method. Preinjury status was documented by questionnaires (SF12, Q-DASH, Constant score). Range of motion was assessed. Patients were followed at 2-6 weeks, 3-6-12-18-24 months. Power calculation was done with primary outcome: Q-DASH. Results: A total of 83 patients were randomized; 44 to the DS and 39 to the DP approach with a mean age of 62 y.o. (+-14) and 77% were females. Groups were equivalent in terms of age, gender, BMI, severity of fracture and pre-injury scores, Neer II (53%) and Neer III (47%). Minimum FU was 12 months, mean was 26 months. All clinical outcome measures were in favor of the deltopectoral approach. Primary outcome measure, Q-DASH, was better statistically and clinically in the DP group (12 vs 26, p¼0,003). Patients with DP had less pain and better quality of life scores than with DS (VAS 1/10 vs 2/ 10 p¼0,019 and SF12M 56 vs 51, p¼0,049, respectively). Constant-Murley score was higher in the DP group (73 vs 60, p¼0,014). However, active external rotation was better with the DS approach (45 vs 35). There were more complications in DS patients, with four screw cutouts vs zero, four avascular necrosis vs one, and five reoperations vs two. Calcar screws were used for a majority of DP fixations (57%) vs a minority of DS (27%) (p¼0,012). Conclusions: The primary hypothesis on the superiority of the deltoid split incision was rebutted. The added difficulty involved with the use of calcar screws and intramuscular dissection for the DS approach could be partly responsible for this difference. The DP approach should be used during Neer II and III PHF fixation.

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Background: The angle of shoulder slope has been reported in accordance with the specific occupational activities of the aviation and textile industries. However, as no accurate definition nor standardised anatomical landmarks exist within the medical field, this study aimed to devise an appropriate definition with preplaced reference landmarks. In addition, the vertebral level of the acromial tip was also determined.