T-plate fixation for unstable proximal clavicula fractures

Abstract

ObjectiveThe aim of this study was to evaluate the clinical results of T-plate fixation and anterior sternoclavicular ligament repair in proximal clavicle fractures.MethodsBetween August 2013 and August 2016, a total 12 patients (10 men and 2 women; mean age: 44.1 ± 9.1 years (range, 25–59 years)) with unstable proximal clavicle fractures (Throckmorton, type D) were treated with T-type plate fixation, bridging the sternoclavicular joint, and anterior sternoclavicular ligament repair. Average operative time, associated injuries, postoperative complications, postoperative fracture healing time and follow-up time were recorded. The outcomes were evaluated with radiographic assessment, visual analog scale (VAS) pain score and Rockwood SCJ scoring system. All the patients were evaluated on postoperative 3rd, 6th, and 12th months.ResultsThe average surgery time was 78.0 ± 8.47 minutes while fracture healing time was 4.51 ± 0.95 months. According to Rockwood SCJ scoring system, 9 cases (75%) were in excellent, 2 cases (16.7%) in good and 1 case (8.3%) in fair condition at 12 months follow-up. The average Rockwood SCJ score was 7.7 ± 0.75 preoperatively, 12.7 ± 0.86 by 3 months, 13.0 ± 0.73 by 6 months and 13.3 ± 0.49 by 12 months. The VAS pain score was 7.9 ± 1.15 (preoperative score), 3.4 ± 1.52 (3 months follow-up), 3.0 ± 1.32 (6 months follow-up) and 2.1 ± 1.07 (12 months follow-up). The VAS and Rockwood SCJ scores were significantly improved postoperatively (p < 0.05). There was no intraoperative complication, while one patient had redislocation of the sternoclavicular joint after implant removal.ConclusionT-type plate fixation with anterior sternoclavicular ligament repair might be a reliable and effective treatment method in unstable proximal clavicle fractures (type D) with few complications and satisfactory clinical results after 12 months follow-up.Level of evidenceLevel IV, therapeutic study.

Displaced medial clavicle fractures: a systematic review of outcomes after nonoperative and operative management

“…When the medial clavicle fragment is small or very comminuted and fixation is of concern, hook plates, 5 , 8 , 38 bridging plates to the sternum 12 , 26 , 39 and double-plating techniques 9 , 15 , 40 have been utilized to minimize the risk of fixation failure in multiple studies. However, despite high satisfaction and union rates, such fixation modalities typically require later removal.…”

A Sternoclavicular Joint-Specific Plate for the Displaced Medial-End Clavicle Fracture

“…Second, if the medial fracture could not provide enough room for the fixation of at least two screws, or medial fractures were comminuted, K-wires were reported to be used with low strength which would delay early rehabilitation and with the risk of migration (21). Also, plate bridging of the SCJ could resolve this problem (12,21). In this situation, the SCJ was also fixed rigidly, and the range of movement of the SCJ would be influenced, which might lead to joint stiffness.…”

“…In this situation, the SCJ was also fixed rigidly, and the range of movement of the SCJ would be influenced, which might lead to joint stiffness. Moreover, for bridging one SCJ, the strength of unicortical screws for the sternum was not so strong that early rehabilitation would be prolonged and the high torsion forces during movement might lead to loose screws (12). Another method reported in the case of a comminuted medial-end clavicle fracture by Li et al was a plate that bridges the two SCJs (22).…”

“…For those patients, surgery might be necessary. Recently, surgery for displaced medial clavicle fractures has shown excellent results with few complications (9)(10)(11)(12)(13)(14), but surgical techniques for fractures with small medial or comminuted fragments are still challenging.…”

Long‐term results for traumatic sternoclavicular joint dislocation treated with a sternoclavicular joint‐specific plate

“…Ligamentous and capsular reconstruction is relatively complex, requires more dissection and has considerable complications 3 . Open reduction and internal fixation are becoming more frequent, with excellent short‐term clinical and radiological results 4–8 . However, to our knowledge, the long‐term results of traumatic SCJD treated with internal fixation are unreported, and whether there are clinical and radiological changes after removal of the implant is unclear.…”