A clinical study of displaced clavicle fractures treated with precontoured locking compression plate
Keywords:, Mid-shaft clavicle fractures, Precontoured locking compression plates, Reunion
Background: Fractures which involve the clavicle are very common and account for almost 5-10% of all the fractures and up to around 45% of those which involve the shoulder girdle. Most of these fractures occur due to a direct blow to the anterior chest wall or by falling on the outstretched hand. Traditionally, clavicular fractures have been treated with conservative methods, but the outcome was poor, leading to patient dissatisfaction. An option is the precontoured locking plates which provide immediate relief, stabilization and early mobilization, more so because they do not require further bending.
Methods: 50 patients, above 18 years of age, with closed displaced clavicular fractures were included in the study. Clinical evaluation was done for all the patients using the Constant-Murley score. Precontoured locking compression plate was inserted surgically for the treatment of the fracture and follow-up was done for 6 months postoperatively.
Results: Out of the 50 patients studied, 42 were males (84%) and 8 (16%) were females. Most of the patients belonged to 21-50 years of the age group. Road traffic accidents were the most common cause (98%) for this type of fractures. Most of the fractures were united by 11-12 weeks of duration (42%), closely followed by a time period of 9-10 weeks (40%). Most of the patients showed full range of movement (84%), while 6% showed movements which were restricted by 200 and 10% showed 300 restrictions. In 32% of the cases, the outcome was excellent while only 6% of the patients showed a fair outcome.
Conclusions: Displaced mid-shaft clavicle fractures treated with precontoured locking compression plates gave good functional outcome and patient satisfaction with excellent reunion rates.
Samy M, Khanfour A. Extra-articular fixation of displaced fracture lateral end clavicle. Eur J Orthop Surg Traumatol. 2011;21(8):557-61.
Robinson CM. Fractures of the clavicle in the adult. Epidemiology and Classification. J Bone Joint Surg Br, 1998;80:476-84.
Robinson CM, Cairns DA. Primary non-operative treatment of displaced lateral fractures of the clavicle. J Bone Jt Surg Am. 2004;86:778-82.
Khan LA, Bradnock TJ, Scott C, Robinson CM. Fractures of the clavicle. J Bone Jt Surg Am. 2009;91:447-60.
Neer II CS. Fractures of the distal third of the clavicle. Clin Orthop Relat Res. 1968;58:43-50.
van der Meijden OA, Gaskill TR, Millet PJ. Treatment of Clavicle fractures: Current concepts review. J Shoulder Elbow Surg. 2012;21(3):423-9.
Nordqvist A, Petersson C, Redlund-Johnell I. The natural course of lateral clavicle fracture. 15 (11-21) years follow-up of 110 cases. Acta Orthop Scand. 1993;64(1):87-91.
Edwards DJ, Kavanagh TG, Flannery MC. Fractures of the distal clavicle: a case for fixation. Injury. 1992;23(1):44-6.
Rokito AS, Zuckerman JD, Shaari JM, Eisenberg DP, Cuomo F, Gallaher MA. A comparison of nonoperative and operative treatment of type II distal clavicle fractures. Bull Hosp Jt Dis. 2003;61(1-2):32-9.
Jupiter JB, Leffert RD. Non-union of the clavicle. Associated complications and surgical management. J Bone Joint Surg Am. 1987;69(5):753-60.
Hill JM, McGuire MH, Crosby LA. Closed treatment of displaced middle-third fractures of the clavicle gives poor results. J Bone Joint Surg Br. 1997;79(4):537-9.
Robinson CM, Court-Brown CM, McQueen MM, Wakefield AE. Estimating the risk of nonunion following nonoperative treatment of a clavicular fracture. J Bone Joint Surg. 2004;86:1359–65.
Wild LM, Potter J. Deficits following nonoperative treatment of displaced midshaft clavicular fractures. J Bone Joint Surg. 2006;88:35–40.
Ali KM, Lucas HK. Plating of fractures of the middle third of the clavicle. Injury. 1978;9(4):263-7.
Jeray K. Acute midshaft clavicular fracture. J Am Acad Orthop Surg. 2007;15:239–48.
Mullaji AB, Jupiter JB. Low-contact dynamic compression plating of the clavicle. Injury. 1994;25:41.
Ring D, Jupiter JB, Miller ME, Ada JR. Injuries to the shoulder girdle: part II. Fractures of the clavicle. In: Browner BD, Jupiter JB, Levine AM, Trafton PG, (eds). Skeletal trauma. Volume 2. Philadelphia: WB Saunders; 1998: 1670.
Hathiwale MI, Sasnur PA, Tapadar MJI. A prospective study on operative management of displaced fracture of midshaft of clavicle. Int J Res Orthop. 2017;3:619-22.
Zlowodzki M1, Zelle BA, Cole PA, Jeray K, McKee MD; Evidence-Based Orthopaedic Trauma Working Group. Treatment of acute midshaft clavicle fractures: systematic review of 2144 fractures: on behalf of the Evidence-Based Orthopaedic Trauma Working Group. J Orthop Trauma. 2005;19(7):504-7.
Lee SK, Lee JW, Song DG, SikChoy W. Precontoured Locking Plate Fixation for Displaced Lateral Clavicle Fractures. Orthopedics. 2013;36(6):801-7.
Gheorghiu D, Sinopidis C, Brown DJ. Treatment of Acute Clavicle fractures with an Anatomical Congruent Plate. J Surg. 2013;1(2):8-10.
Hundekar BB. Internal Fixation of displaced middle third fractures of clavicle with precontoured locking plate. J Orthop. 2013;10:79-85.
Canadian Orthopaedic Trauma Society. Non Operative treatment compared with plate fixation of displaced midshaft clavicular fractures: A multicenter, randomised, clinical trial. J Bone Joint Surg Am. 2007;89:1-10.
Drosdowech DS. Biomechanical Analysis of Fixation of Middle Third Fractures of Clavicle. J Orthop Trauma. 2011;25(1):39-43.