The effect of experimental shortening of the clavicle on shoulder kinematics

Hillen, Robert Jan; Burger, Bart J.; Pöll, Ruud G.; Dijk, C. Niek van; Veeger, H.E.J.

doi:10.1016/j.clinbiomech.2012.05.003

Cited by 51 publications

(41 citation statements)

References 25 publications

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“…The clavicle facilitates the placement of the shoulder in a more lateral position, so that the hand can be more effectively positioned to deal with the three dimensional environment. Cadaveric investigations have suggested that clavicle deformity may lead to abnormal biomechanical stresses across the shoulder girdle, including the acromioclavicular, glenohumeral and scapulothoracic joints [5][6][7] . These studies provide a mechanical rationale for the idea that anatomic reduction may mitigate long-term disability.…”

Section: Discussionmentioning

confidence: 99%

Displaced Mid-Shaft Clavicle Fractures: A Subset For Surgical Treatment

Choudhari¹,

Chhabra²

2014

MOJ

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Recent studies have shown a high prevalence of symptomatic malunion and nonunion after nonoperative treatment of displaced midshaft clavicle fractures. We sought to study the result of surgical treatment of displaced mid-shaft fracture of clavicle. Forty mid shaft clavicle fractures in adults, displaced with initial shortening of more than 15 mm, were treated with primary internal fixation with plates. The inclusion criteria were displacement, shortening of clavicle of more than 15 mm and/or impending skin penetration. The follow-up period varied from 6 months to 24 months. Fracture union occurred in all patients (average union time 8.5 weeks). Superficial infection developed in one patient and implant was a problem in one patient. The outcome was assessed by complications, constant score and patient satisfaction questionnaire. Constant scores were excellent in the study group and 96% of the patients were satisfied with the operation. Surgical treatment in displaced fractures of the clavicle in our study produces satisfactory results.

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Section: Discussionmentioning

confidence: 99%

Displaced Mid-Shaft Clavicle Fractures: A Subset For Surgical Treatment

Choudhari¹,

Chhabra²

2014

MOJ

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“…[3][4][5][6][7][8] Although highquality clinical studies have been completed in the adult population, there is limited data regarding the results of nonoperatively managed clavicle fractures in adolescents, for whom clavicle fractures account for approximately 15% of all fractures. 3,4,[9][10][11][12][13][14][15] Owing to the excellent healing potential in children, even significantly displaced adolescent clavicle fractures have traditionally been treated nonoperatively (Fig. 1).…”

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confidence: 99%

Is There a Deficit After Nonoperative Versus Operative Treatment of Shortened Midshaft Clavicular Fractures in Adolescents?

Parry

Straaten

Luo

et al. 2017

Journal of Pediatric Orthopaedics

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“…However, when the scapulothoracic kinematics associated with a shortened clavicle have been examined, these investigations have relied on manual manipulation to achieve forward elevation [17,18]. Nevertheless, they illustrate the limited scapular external rotation and posterior tilting that occur with a shortened clavicle.…”

Section: Introductionmentioning

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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The effect of experimental shortening of the clavicle on shoulder kinematics

Cited by 51 publications

References 25 publications

Displaced Mid-Shaft Clavicle Fractures: A Subset For Surgical Treatment

Displaced Mid-Shaft Clavicle Fractures: A Subset For Surgical Treatment

Is There a Deficit After Nonoperative Versus Operative Treatment of Shortened Midshaft Clavicular Fractures in Adolescents?

Glenohumeral Joint Kinematics following Clavicular Fracture and Repairs

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