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Concept: Clavicle fracture

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This study reports the safety, efficacy and functional and patient centred outcomes of the largest published series of patients treated with the Rockwood clavicle pin (intramedullary device) to date.

Concepts: Patient, Clavicle fracture

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Malunion after displaced fractures of the clavicle can result in varying degrees of scapular malalignment and potentially scapular winging. The purpose of our study was to quantify the scapular malalignment in patients with midshaft clavicle malunions showing scapular winging.

Concepts: Bone fracture, Clavicle fracture, Clavicle

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Open reduction internal fixation technique has been generally accepted for treatment of midshaft clavicle fractures. Both superior and anterior clavicle plates have been reported in clinical or biomechanical researches, while presently the spiral clavicle plate design has been introduced improved biomechanical behavior over conventional designs. In order to objectively realize the multi-directional biomechanical performances among the three geometries for clavicle plate designs, a current conceptual finite element study has been conducted with identical cross-sectional features for clavicle plates. The conceptual superior, anterior, and spiral clavicle plate models were constructed for virtual reduction and fixation to an OTA 15-B1.3 midshaft transverse fracture of clavicle. Mechanical load cases including cantilever bending, axial compression, inferior bending, and axial torsion have been applied for confirming the multi-directional structural stability and implant safety in biomechanical perspective. Results revealed that the anterior clavicle plate model represented lowest plate stress under all loading cases. The superior clavicle plate model showed greater axial compressive stiffness, while the anterior clavicle plate model performed greater rigidity under cantilever bending load. Three model represented similar structural stiffness under axial torsion. Played as a transition structure between superior and anterior clavicle plate, the spiral clavicle plate model revealed comparable results with acceptable multi-directional biomechanical behavior. The concept of spiral clavicle plate design is worth considering in practical application in clinics. Implant safety should be further investigated by evidences in future mechanical tests and clinical observations.

Concepts: Bone fracture, Fracture, Orthopedic surgery, Clavicle fracture, Elasticity, Clavicle, Torsion, Superiority complex

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Historically, management of displaced midshaft clavicle fractures has consisted of nonsurgical treatment. However, recent literature has supported surgical repair of displaced and shortened clavicle fractures. Multiple options exist for surgical fixation, including plate and intramedullary (IM) fixation. IM fixation has the potential advantages of a smaller incision and decreased dissection and soft-tissue exposure. For the last two decades, the use of Rockwood and Hagie pins represented the most popular form of IM fixation, but concerns exist regarding stability and complications. The use of alternative IM implants, such as Kirschner wires, titanium elastic nails, and cannulated screws, also has been described in limited case series. However, concerns persist regarding the complications associated with the use of these implants, including implant failure, migration, skin complications, and construct stability. Second-generation IM implants have been developed to reduce the limitations of earlier IM devices. Although anatomic and clinical studies have supported IM fixation of midshaft clavicle fractures, further research is necessary to determine the optimal fixation method.

Concepts: Medicine, Clinical trial, Implants, Anatomy, Human anatomy, Dental implant, Clavicle fracture, Kirschner wire

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Clavicle fractures may occur in all age groups, and 70%-80% of clavicle fractures occur in the midshaft. Many methods for treating midshaft clavicular fractures have been reported and remain controversial. To provide some guidance for clinical treatment, 30 artificial polymethyl methacrylate models of the clavicle were sewn obliquely at the midshaft to simulate the most common type of clavicular fractures, and the fracture models were divided into five groups randomly and were fixed as follows: the reconstruction plates were placed at the superior position of the fracture model (R-S group), the reconstruction plates were placed at the anteroinferior position of the fracture model (R-AI group), the locking plates were placed at the superior position (L-S group), the locking plates were placed at the anteroinferior position (L-AI group); and the control models were unfixed (control group). The strain gauges were attached to the bone surface near the fracture fragments, and then, the biomechanical properties of the specimens were measured using the compression test, torsion test and three-point bending test. The results showed that plate fixation can provide a stable construct to help with fracture healing and is the preferred method in the treatment of clavicle fractures. The locking plate provides the best biomechanical stability when placed at the anteroinferior position, and this surgical method can reduce the operation time and postoperative complications; thus, it would be a better choice in clinical practice.

Concepts: Bone, Bone fracture, Fracture, Group, Biomechanics, Clavicle fracture, Reconstruction era of the United States, Mechanics

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A 19-year-old man presented with a congenital skin lesion on the left clavicular region. Closely arranged, dilated follicular openings with keratinous plugs resembling classic comedones were distributed linearly along the left clavicle and extending to the upper back.

Concepts: Clavicle fracture, Upper limb, Tetrapod, Clavicle, Nevus comedonicus syndrome, Nevus comedonicus

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BACKGROUND Surgical managements were recommended for unstable distal clavicle fracture owing to the high incidence of nonunion. The present study compared the efficacy of anatomical locking plate with versus without additional suture anchor fixation for the treatment of unstable Neer type II distal clavicle fractures. MATERIAL AND METHODS Between January 2013 to January 2015, 28 consecutive patients with unstable Neer type II  fractures were treated by using anatomical locking plate with or without additional suture anchor fixation. The patients were divided into anatomical locking plate group (group A) and anatomical locking plate combined with suture anchor group (group B) according to the surgical method. The operative-related parameters such as operation time, blood loss, length of hospitalization, union time, functional outcomes (Constant score, UCLA score and DASH score) and CC distance were compared. RESULTS The mean follow-up period of the 28 patients was 19.60 months (21.80 versus 18.39 months, respectively). No statistical differences in general and peri-operative parameters were found between 2 groups. The group B had significant higher Constant score than group A (P=0.004, 91.67 versus 83.10). While no statistical differences were reached in the UCLA score and DASH score between 2 groups (P=0.112 and 0.163, respectively). The group A had longer CC distance than group B (11.67 versus 8.94 mm), while no statistic difference was found (P=0.067). CONCLUSIONS For the treatment of acute unstable Neer type II distal clavicle fractures, both surgical methods could offer satisfactory outcome. However, anatomical locking plate combined with additional suture anchor fixation had a better functional and radiographic outcome than that without additional suture anchor fixation.

Concepts: Statistics, Fracture, Hospital, Physician, Arithmetic mean, Clavicle fracture, Outcome, Clavicle

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A common method in surgical treatment of midshaft clavicular fractures is the clavicle plating system. In addition to traditional osteosynthetic devices, anatomically preformed plate systems also exist. Advantages are described in greater accuracy of fit and less irritation of surrounding soft tissues. The purpose of this study was to compare the anatomical fit of five different precontoured clavicle plating systems.

Concepts: Medicine, Evolution, Physiology, Physician, Tissues, Anatomical terms of location, Clavicle fracture

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Surgical fixation of displaced midshaft clavicle fractures is predominantly achieved with intramedullary (IM) or plate fixation. Both techniques have potential pitfalls: plate fixation involves greater periosteal stripping and protuberance of the implant, whereas IM fixation may be associated with implant-related complications, such as migration or skin irritation, which may lead to further surgery for implant removal. The aim of this study was to compare these two methods in simple (Robinson 2b.1) and multifragmentary (Robinson 2b.2) displaced midshaft clavicle fractures.

Concepts: Surgery, Clavicle fracture, The Implant, Irritation