Surgical interventions for treating acute fractures or non-union of the middle third of the clavicle

Lenza, Mário; Faloppa, Flávio

doi:10.1002/14651858.cd007428.pub3

Cited by 48 publications

(33 citation statements)

References 70 publications

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“…In the current discussion of traumatology, the operative therapy is attributed an advantage with regard to the minimization of a pseudoarthrosis formation, which in turn can already be regarded as an indicator of high stress on the clavicle by muscle pull (14).…”

Section: Discussionmentioning

confidence: 99%

Surgical Stabilization of Costoclavicular Injuries - A Combination of Flail Chest Injuries and a Clavicula Fracture

Langenbach¹,

Pinther²,

Krinner³

et al. 2017

chr

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RezumatDate generale: Leziunile cu volet costal (FCI) sunt asociate cu o rată ridicată de morbiditate şi mortalitate. Având în vedere că asocierea unei fracturi de claviculă concomitente cu FCI agravează chiar rezultatul, întrebarea care se pune este cum pot fi aceste leziuni costoclaviculare (CCI) gestionate chirurgical. Metode: 11 pacienţi cu CCI au fost trataţi chirurgical prin osteosinteză a claviculei şi a coastelor subiacente prin placă blocată, prin abordări chirurgicale limitate, sub anestezie generală. Pacienţii au fost urmăriţi la 2, 6, 12, 26 şi 52 de săptămâni. Rezultate: Toţi pacienţii au prezentat o deformare severă a peretelui toracic din cauza fracturilor puternic deplasate ale coastelor şi claviculei. Ei sufereau de durere şi de restrângerea mişcărilor respiratorii. Peretele toracic a putut fi restabilit la forma normală în toate cazurile, cu vindecare lipsită de complicaţii a oaselor şi confort sporit al pacientului. Fracturile claviculei şi celei de-a doua coaste au fost gestionate printr-o abordare inovatoare clavipectorală, iar celelalte prin abordări standard ale peretelui anterolateral şi posterolateral. Doi pacienţi s-au plâns de amorţeală în zona intervenţiei laterale şi de durere periscapulară peristentă. Concluzii: Stabilizarea chirurgicală ar putea reprezenta terapia adecvată în CCI cu fracturi dislocate, deoarece acestea ar putea cauza deformări severe şi pierderea funcţiei peretelui toracic şi a umărului.

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Section: Discussionmentioning

confidence: 99%

Surgical Stabilization of Costoclavicular Injuries - A Combination of Flail Chest Injuries and a Clavicula Fracture

Langenbach¹,

Pinther²,

Krinner³

et al. 2017

chr

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show abstract

“…Current treatment options for displaced mid‐shaft clavicle fractures include fixation with superior or anterior clavicle plating . However, external plating has been associated with post‐surgical complications including infection, hardware malfunction, and fracture re‐occurrence . In addition, exterior plating is aesthetically problematic and uncomfortable, as the underlying hardware can be visualized and palpated from the outer skin surface.…”

Section: Selected Previously Published Work On Clavicular Morphometrmentioning

confidence: 99%

Morphometry of the human clavicle and intramedullary canal: A 3D, geometry‐based quantification

Aira

Simon

Gutiérrez

et al. 2017

Journal Orthopaedic Research

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Midshaft clavicle fractures are a very common occurrence. The current treatment of choice involves internal fixation with superior or anterior clavicle plating, however their clinical success and particularly patient satisfaction are decreasing. The implementation of intramedullary devices is on the rise, but data describing the intramedullary canal parameters are lacking. The aim of this study is to quantify the geometry of the clavicle and its intramedullary canal, and to evaluate the effect of gender and anatomical side. This study used three-dimensional image-based models with novel and automated methods of standardization, normalization, and bone cross-section evaluation. The data obtained in this study present intramedullary canal, and clavicle diameter and center deviation parameterized as a function of clavicle length as well as its radius of curvature and true length. Results showed that both right-sided and female clavicles were shorter and thicker, but only females showed a statistically significant difference in size compared to males (p < 0.0001). The smallest clavicle and intramedullary canal diameters were seen at different clavicle lengths (45% and 52%), suggesting that the narrowest region of intramedullary canal cannot be appreciated based on external visualization of the clavicle alone. The narrowing of the intramedullary canal is of special interest because this is a potential limiting region for surgical planning and intramedullary device design. Furthermore, the location and value of maximum lateral curvature displacement is different in the intramedullary canal, implying there exists an eccentricity of the intramedullary canal center with respect to the clavicle center. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2191-2202, 2017.

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“…Clavicle fractures account for 2.6% to 5.0% of all human fractures, and nearly 80% of clavicle fractures occur in the middle and outer third segments. 12,18 Most clavicle fractures heal uneventfully without serious consequences with nonoperative treatment, but several patients with complex fractures experience residual deformity, impaired function, or unsightly appearance. 11,15 Therefore, surgery has become the main treatment strategy for displaced fractures in the middle and outer thirds of the clavicle.…”

mentioning

confidence: 99%

“…11,15 Therefore, surgery has become the main treatment strategy for displaced fractures in the middle and outer thirds of the clavicle. 8,12,14,18 Nail fixation is a good option with few complications for simple fractures [8][9][10]13,20 but is not appropriate for comminuted factures, and the anatomic plate is still considered the first choice treatment method. 7,22 Precontoured locking plates have advantageous biomechanical properties and low complication rates in the elderly, [2][3][4]22 but supraclavicular neuropathy and numbness may occur because of damage to the supraclavicular nerve.…”

mentioning

confidence: 99%

Comparison of the effectiveness of oblique and transverse incisions in the treatment of fractures of the middle and outer third of the clavicle

Xiong

et al. 2019

Journal of Shoulder and Elbow Surgery

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Background: Iatrogenic supraclavicular nerve injury is frequent during surgical repair of clavicle fractures through a transverse incision. The use of an oblique incision may be a potential approach to avoiding this complication. This study compared the clinical effectiveness of oblique and transverse incisions in the treatment of fractures in the middle and outer thirds of the clavicle. Methods: This prospective observational study included patients with fracture of the mid-to-outer third of the clavicle between August 2011 and August 2016. We allocated the patients into 2 groups based on their choice of treatment: oblique incision (n ¼ 62) and transverse incision (n ¼ 64). We compared the following parameters between the 2 groups: operative time, intraoperative blood loss, postoperative fracture healing time, incision size, clinical complications, postoperative subjective satisfaction, and shoulder function. Results: Operative time, postoperative fracture healing time, postoperative shoulder function (Constant-Murley and disabilities of the arm, shoulder and hand [DASH] scores), and clinical complications did not differ significantly between groups (all P > .05). The oblique incision group had less intraoperative blood loss (41.4 AE 16.4 vs. 65.3 AE 10.4 mL, P < .001) and smaller surgical incisions (3.6 AE 1.6 vs. 10.3 AE 2.6 cm, P < .001). The oblique incision group showed better outcomes for postoperative satisfaction (85.5% vs. 64.1%, P ¼ .015), absence of shoulder numbness at the last follow-up (89.3% vs. 70.3%, P ¼ .010), and satisfaction with the scar (90.3% vs. 3.1%, P < .001). Conclusion: Oblique incisions have several advantages over transverse incisions: less bleeding, smaller incisions, less iatrogenic injury to supraclavicular nerves, and higher patient satisfaction. These 2 approaches have equivalent effects on recovery of shoulder joint function. This study was approved by the ethics committee of the Second Fuzhou Hospital Affiliated to Xiamen University (Approval No. FZSE2011-06-09). Written informed consent was obtained from all participants.

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Surgical interventions for treating acute fractures or non-union of the middle third of the clavicle

Cited by 48 publications

References 70 publications

Surgical Stabilization of Costoclavicular Injuries - A Combination of Flail Chest Injuries and a Clavicula Fracture

Surgical Stabilization of Costoclavicular Injuries - A Combination of Flail Chest Injuries and a Clavicula Fracture

Morphometry of the human clavicle and intramedullary canal: A 3D, geometry‐based quantification

Comparison of the effectiveness of oblique and transverse incisions in the treatment of fractures of the middle and outer third of the clavicle

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