Anterior inferior plating versus superior plating for clavicle fracture: a meta-analysis

Ai, Jie; Kan, Shun-Li; Li, Hailiang; Xu, Hong; Liu, Yang; Ning, Guangzhi; Feng, Shiqing

doi:10.1186/s12891-017-1517-1

Cited by 25 publications

(17 citation statements)

References 28 publications

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“…There was no difference in peri-operative complication in either groups of their series. Placement of plate in either position carries the risk of iatrogenic neuro-vascular injury and neither position had significantly decreased risk [41] . In our study of 125 patients, all were treated by open reduction and superior placement of anatomical pre-contoured locking plate.…”

Section: Discussionmentioning

confidence: 96%

Open reduction and internal fixation in close middle third fracture clavicle by pre-contoured anatomical clavicle plate: A study of 125 cases

Dwivedi¹,

Rathva²,

Patel³

2017

Int. J. Orthop. Sci.

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Introduction: The concept of treating displaced, middle third fractures of clavicle by open reduction and stable fixation thereby restoring the clavicular length is gaining more and more acceptance amongst trauma surgeons. The aim of our study was to analyze the clinical outcome of internal fixation of middle third clavicle fracture by anatomical pre-contoured plate. Method: 125 patients with isolated displaced middle third clavicle fractures were treated by open reduction and anatomical pre-contoured locking compression plate and followed prospectively till six months after union. All patients were assessed radiologically, clinically and according to disability of arm, shoulder and hand scoring system (DASH). Results: Average time of union was 8 weeks. Union rate in our study was 97.6%. Most of the patients returned to pre-injury working status by the end of 10 weeks. Average DASH score at the end of 6 months was 12. Conclusion: Superiorly placed anatomical pre-contoured locking plate for operative treatment of displaced middle third fractures is a safe and effective option with early return to pre injury working level and at the same time avoiding potential complications of delayed union, non-union and mal-union.Keywords: clavicle fracture, non-union, mal-union, anatomical clavicle plate Introduction Clavicle fractures are common due to indirect mechanism being fall on an out-stretched hand, accounting for upto 2.6% to 10% of all fractures and upto 44.1% of the fractures involving upper girdle [1] . Fractures of middle third account for approximately 80% of all clavicular injuries. Traditionally, these fractures have been managed non-operatively, even when substantially displaced [2] , with good to excellent results [3, 4] . The limitations of conservatively treated fractures are increased risk of non-union and mal-union resulting in altered biomechanics of upper girdle, cosmetic dissatisfaction and upper extremity weakness [5][6][7][8] . These factors have caused a gradual shift towards surgical treatment of this fracture [7, 9] . Many devices have been described for treatment by internal fixation that included circlage wires, Steinmann pins, Kirschner wires, Knowel's pins, Rush rods, Recon plates etc [10][11][12] . The proponents who favor ORIF in these fractures emphasize on early and accurate reduction achieving clavicular length resulting in quicker pain relief and early functional recovery. As the consensus for operative treatment picks-up, recent studies show lower incidence of nonunion and mal-union rates and early return to work compared to conservative treatment

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Section: Discussionmentioning

confidence: 96%

Open reduction and internal fixation in close middle third fracture clavicle by pre-contoured anatomical clavicle plate: A study of 125 cases

Dwivedi¹,

Rathva²,

Patel³

2017

Int. J. Orthop. Sci.

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“…Two recent meta-analyses investigated the effect of anteroinferior versus superior plating of the clavicle and they both concluded that plating along the superior and anteroinferior aspects of the clavicle leads to similar operative outcomes with respect to union, nonunion, malunion, and implant failure 25,26 . Only the meta-analysis by Nourian et al .…”

Section: Discussionmentioning

confidence: 99%

Variation of the clavicle’s muscle insertion footprints – a cadaveric study

Herteleer

Vancleef²,

Herijgers³

et al. 2019

Sci Rep

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The muscle footprint anatomy of the clavicle is described in various anatomical textbooks but research on the footprint variation is rare. Our goal was to assess the variation and to create a probabilistic atlas of the muscle footprint anatomy. 14 right and left clavicles of anatomical specimens were dissected until only muscle fibers remained. 3D models with muscle footprints were made through CT scanning, laser scanning and photogrammetry. Then, for each side, the mean clavicle was calculated and non-rigidly registered to all other cadaveric bones. Muscle footprints were indicated on the mean left and right clavicle through the 1-to-1 mesh correspondence which is achieved by non-rigid registration. Lastly, 2 probabilistic atlases from the clavicle muscle footprints were generated. There was no statistical significant difference between the surface area (absolute and relative), of the originally dissected muscle footprints, of male and female, and left and right anatomical specimens. Visualization of all muscle footprints on the mean clavicle resulted in 72% (right) and 82% (left) coverage of the surface. The Muscle Insertion Footprint of each specimen covered on average 36.9% of the average right and 37.0% of the average left clavicle. The difference between surface coverage by all MIF and the mean surface coverage, shows that the MIF location varies strongly. From the probabilistic atlas we can conclude that no universal clavicle exists. Therefore, patient-specific clavicle fracture fixation plates should be considered to minimally interfere with the MIF. Therefore, patient-specific clavicle fracture fixation plates which minimally interfere with the footprints should be considered.

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“… 62 , 66 It was found that anterior-inferior plating reduces the time to union, but the location of the plate does not seem to influence functional outcomes or infection rates. 63 …”

Section: Orif Using Plates and Screwsmentioning

confidence: 99%

Midshaft clavicle fractures

2018

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Clavicle fractures are common fractures and the optimal treatment strategy remains debatable. The present paper reviews the available literature and current concepts in the management of displaced and/or shortened midshaft clavicle fractures.Operative treatment leads to improved short-term functional outcomes, increased patient satisfaction, an earlier return to sports and lower rates of non-union compared with conservative treatment. In terms of cost-effectiveness, operative treatment also seems to be advantageous.However, operative treatment is associated with an increased risk of complications and re-operations, while long-term shoulder functional outcomes are similar.The optimal treatment strategy should be one tailor-made to the patient and his/her specific needs and expectations by utilizing a shared decision-making model.Cite this article: EFORT Open Rev 2018;3:374-380. DOI: 10.1302/2058-5241.3.170033

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Anterior inferior plating versus superior plating for clavicle fracture: a meta-analysis

Cited by 25 publications

References 28 publications

Open reduction and internal fixation in close middle third fracture clavicle by pre-contoured anatomical clavicle plate: A study of 125 cases

Open reduction and internal fixation in close middle third fracture clavicle by pre-contoured anatomical clavicle plate: A study of 125 cases

Variation of the clavicle’s muscle insertion footprints – a cadaveric study

Midshaft clavicle fractures

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