Corrective osteotomy after malunion of mid shaft fractures of the clavicle

Hillen, Robert Jan; Eygendaal, Denise

doi:10.1007/s11751-007-0024-6

Cited by 27 publications

(24 citation statements)

References 19 publications

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“…Traditionally, the osteotomy was performed for instance for the treatment of the malunion of the clavicle or to release the compression on branchial plexus. For instance, Hileen et al showed that the corrective osteotomy should be performed in a symptomatic malunion of the clavicle after the midshaft fracture and the results are encouraging 9 . The surgical indications for treating symptomatic malunion of the clavicle includes clavicle shortening more than 1 cm, angulation more than 30 degrees, symptomatic thoracic outlet syndrome, easy fatiguability or pain on repetitive movements and significant disability 10 .…”

Section: Discussionmentioning

confidence: 99%

Approach for recurrent thyroid carcinoma with a clavicle osteotomy

Lazim¹,

Abdullah²,

Ismail³

2018

MMJ

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Section: Discussionmentioning

confidence: 99%

Approach for recurrent thyroid carcinoma with a clavicle osteotomy

Lazim¹,

Abdullah²,

Ismail³

2018

MMJ

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“…This loss of strength can be explained by how the change in position of the clavicle results in a change in the scapula, altering GH function [13,14,27,29]. For example, clavicular shortening reduces the moment arm of the pectoralis major, thereby weakening this important forward flexor [17,25].…”

Section: Discussionmentioning

confidence: 99%

Glenohumeral Joint Kinematics following Clavicular Fracture and Repairs

et al. 2017

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BackgroundThe purpose of this biomechanical study was to determine the effect of shortened clavicle malunion on the center of rotation of the glenohumeral (GH) joint, and the capacity of repair to restore baseline kinematics.MethodsSix shoulders underwent automated abduction (ABD) and abbreviated throwing motion (ATM) using a 7-DoF automated upper extremity testing system in combination with an infrared motion capture system to measure the center of rotation of the GH joint. ATM was defined as pure lateral abduction and late cocking phase to the end of acceleration. Torsos with intact clavicle underwent testing to establish baseline kinematics. Then, the clavicles were subjected to midshaft fracture followed by kinematics testing. The fractured clavicles underwent repairs first by clavicle length restoration with plate fixation, and then by wiring of fragments with a 2-cm overlap to simulate shortened malunion. Kinematic testing was conducted after each repair technique. Center of rotation of the GH joint was plotted across all axes to outline 3D motion trajectory and area under the curve.ResultsThroughout ABD, malunion resulted in increased posterior and superior translation compared to baseline. Plate fixation restored posterior and superior translations at lower abduction angles but resulted in excess anterior and inferior translation at overhead angles. Throughout ATM, all conditions were significantly anterior and superior to baseline. Translation with malunion was situated anterior to the fractured and ORIF conditions at lower angles of external rotation. Plate fixation did not restore baseline anteroposterior or superoinferior translation at any angle measured.ConclusionsThis study illustrates the complex interplay of the clavicle and the GH joint. While abnormal clavicle alignment alters shoulder motion, restoration of clavicle length does not necessarily restore GH kinematics to baseline. Rehabilitation of the injured shoulder must address the osseous injury and the dynamic forces of the shoulder girdle.

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“…For clavicles with symptomatic malunion, corrective osteotomy is a reliable and successful treatment option with a good clinical outcome (Bosch et al, 1998;Hillen and Eygendaal, 2007). Accurate restoration of the normal clavicle anatomy has been shown to be crucial for successful treatment (Chan et al, 1999;Smekal et al, 2010).…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of symptomatic non-and mal-union is up to 15% of all clavicle fractures (Hill et al, 1997). In case of surgical treatment for non and mal-union, anatomical accurate reconstruction is considered to be a key element to obtain good functional outcomes (Hillen and Eygendaal, 2007;Schweizer et al, 2012;Bachoura et al, 2013). Often a simultaneous correction of displacement and rotation in multiple planes is required (Huang et al, 2007).…”

Section: Introductionmentioning

confidence: 99%

Three‐dimensional corrective osteotomies of mal‐united clavicles—is the contralateral anatomy a reliable template for reconstruction?

et al. 2015

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In computer-assisted preoperative planning of corrective osteotomies, the unaffected contralateral bone often serves as three-dimensional template for the reconstruction of mal-united bones. Before applying this approach to new anatomy such as the clavicle bone, it is important to study asymmetry between the sides. The purpose of this study was to investigate bilateral symmetry of the clavicle in healthy cadavers using three-dimensional measurement techniques. Bilateral symmetry of 102 clavicles (51 cadavers, mean age: 52.19 years, 37 male) was measured based on three-dimensional models reconstructed from computed tomography. Besides length, volume, and surface, the side-differences were evaluated by considering the mirrored left clavicle as the reconstruction template and the right clavicle as the one that will be realigned by osteotomy. The relative transformation between the aligned segments was measured to express the difference with to three-dimensional translation and rotation. The same procedure was repeated using mean-sized clavicles, one for each gender, as the template. The contralateral side was a significant more accurate reconstruction template compared to a mean-sized clavicle (P < 0.001). Nevertheless, an average side-differences with respect to rotation and translation of 8.79° ± 5.2° and 3.5 mm ± 2.7 mm, respectively. The left clavicles were significant (P = 0.001) longer with 154 mm compared to the right ones (151 mm). Three-dimensional differences between the left and right clavicles exist, but can be considered as small. Therefore, the contralateral side appears to be a reliable reconstruction template, in particular compared to a mean-sized clavicle.

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Corrective osteotomy after malunion of mid shaft fractures of the clavicle

Cited by 27 publications

References 19 publications

Approach for recurrent thyroid carcinoma with a clavicle osteotomy

Approach for recurrent thyroid carcinoma with a clavicle osteotomy

Glenohumeral Joint Kinematics following Clavicular Fracture and Repairs

Three‐dimensional corrective osteotomies of mal‐united clavicles—is the contralateral anatomy a reliable template for reconstruction?

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