The brachial plexus palsy is a rare complication of a clavicle fracture, occurring in 0.5% to 9.0% of cases. This condition is caused by excessive callus formation, which can be recovered by a spur resection and surgical fixation. In contrast, only seven cases have been reported after surgical reduction and fixation. A case of progressive brachial plexus palsy was observed after fixation of the displaced nonunion of a clavicle fracture. The symptom were improved after removing the implant.
PURPOSE We attempted to evaluate the clinical results of modified tension band wiring (MTBW) with additional K-wire fixation and suture for distal clavicle fracture. MATERIALS AND METHODS Fifty-nine patients with a distal clavicle fracture from May 2009 to December 2013 treated with MTBW were enrolled in this study. Their fracture types were type 2, 12; and type 3, 33; type 4, 8; and type 5, 6 according to Craig classification group II; average age was 47.2 years with a mean follow-up period of 27.9 months. The operations were performed within a mean of 3.1 days a fter t rauma. The c linical results were evaluated u sing University of California at Los Angeles scores (UCLA), American Shoulder and Elbow Surgeons scores (ASES) and Korean Shoulder Society scores (KSS) at 1 year after surgery. RESULTS Radiographic bone union was achieved at a mean of 3.7 months after the operation. In the last observation, their range of motion was forward flexion 159.0°, external rotation 59.8°, and internal rotation 4.3 points, and there were 2 cases of nonunion. Each average functional score was UCLA 31.3 points, KSS 91.6 points, and ASES 93.0 points. CONCLUSION For the surgical treatment of distal clavicle fractures, MTBW with additional K-wire fixation and suture is a useful technique allowing early range of motion exercises, minimizing soft tissue damage, and preserving the acromio-clavicular joint.
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Treatment Results for Unstable Distal Clavicle Fractures Using Hybrid Fixations with Finger Trap Wire and Plate Jeong-Seok Yu, Bong-Seok Yang, Byeong-Mun Park, O-Sang Kwon Journal of the Korean Orthopaedic Association.2022; 57(2): 135. CrossRef
Comparison of Locking Compression Plate Superior Anterior Clavicle Plate with Suture Augmentation and Hook Plate for Treatment of Distal Clavicle Fractures Jun-Cheol Choi, Woo-Suk Song, Woo-Sung Kim, Jeong-Muk Kim, Chan-Woong Byun Archives of Hand and Microsurgery.2017; 22(4): 247. CrossRef
PURPOSE This study evaluated the surgical outcomes of unstable distal clavicular fractures treated with a 2.4 mm volar distal radius locking plate. MATERIALS AND METHODS From August 2009 to August 2012, 16 patients with distal clavicle fractures underwent surgical treatment. Mean age was 36 years (18-62 years) and mean follow-up period was 12.9 months (6-32 months). Two cases were Neer type I, six cases IIa, three cases IIb, three cases III, and two cases V. For the radiologic assessment, union time and metal failure were evaluated, and coracoidiologic assessment, union time and metal failure were evaluatethe acromioclavicular joint. The clinical results were evaluated by range of motion, postoperative complication, and University of California at Los Angeles (UCLA) score. RESULTS Mean time to fracture union was 7.4 weeks (6-14 weeks) in all cases. No statistical difference in coracoid-clavicle distance was observed between immediate post-operation group and contra-lateral group (p=0.6), but an increase of 2.1 mm was observed in the last follow up group compared with the contra-lateral group (p<0.01). The UCLA scoring system showed excellent results in 15 cases and good results in one case. Acromial-clavicle instability occurred in one case so that metal removal and distal clavicle resection were performed. CONCLUSION A 2.4 mm volar distal radius locking plate can provide rigid fixation through several screw fixation in the short distal fragment and lead to satisfactory clinical outcomes in unstable distal clavicular fractures.
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Estudo retrospectivo da placa anterior superior como tratamento para fraturas instáveis da clavícula distal (tipo 2 de Neer) Syed Ibrahim, Jimmy Joseph Meleppuram Revista Brasileira de Ortopedia.2018; 53(3): 306. CrossRef
Retrospective study of superior anterior plate as a treatment for unstable (Neer type 2) distal clavicle fractures Syed Ibrahim, Jimmy Joseph Meleppuram Revista Brasileira de Ortopedia (English Edition).2018; 53(3): 306. CrossRef
PURPOSE The purpose of this study is to evaluate the radiologic and clinical outcomes after tension band wire fixation of Neer type II distal clavicle fractures. MATERIALS AND METHODS Twenty-six patients with Neer type II distal clavicle fractures who underwent tension band wire fixation from March 2002 to May 2011 were included in the study. Fifteen cases were classified as Neer type IIa and 11 cases as type IIb. The postoperative mean follow-up period was 14.3 months. Clinical and radiologic evaluation was performed at two weeks, six weeks, three months, six months, and 12 months postoperatively. RESULTS Bony union on X-rays was observed at an average of 11.7 weeks (range 8-20 weeks) postoperatively. The overall visual analogue scale score for pain was 1.23+/-2.75 postoperatively. The overall postoperative University of California at Los Angeles score increased to 33.5+/-2.15 from the preoperative score of 21.6+/-1.91 (p<0.05). CONCLUSION Among various methods of treatment for Neer type II distal clavicle fracture, K-wire and tension band fixation was used and relatively satisfactory radiological and clinical results were obtained. This surgical method yields excellent clinical results, owing to its relatively easy technique, fewer complications, and allowance of early rehabilitation.
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Clinical and Radiologic Outcomes of Acute Acromioclavicular Joint Dislocation: Comparison of Kirschner's Wire Transfixation and Locking Hook Plate Fixation Yong Girl Rhee, Jung Gwan Park, Nam Su Cho, Wook Jae Song Clinics in Shoulder and Elbow.2014; 17(4): 159. CrossRef
PURPOSE To report on the complications of hook-plate fixation for distal clavicle fractures. MATERIALS AND METHODS Eighteen patients who underwent surgery for distal clavicle fracture with a hook-plate from April 2008 to April 2011 were enrolled with a minimum of 4 months follow-up. The reduction was qualified and evaluated according to the radiologic findings. We analyzed the results by UCLA score, Kona's functional evaluation, and VAS pain score. RESULTS By radiologic evaluation, 17 of 18 cases showed anatomical reduction and solid unions. Although satisfactory results were found in the clinical study as shown by the UCLA score, Kona's functional evaluation, and VAS pain score, complications arose in 7 cases, including osteolysis of the acromion in 2 cases, nonunion in 1 case, periprosthetic fracture in 2 cases, subacromial pain in 1 case, and skin irritation in 1 case. 2 cases of all required reoperation. CONCLUSION To reduce the complications of the hook-plate, a precise surgical technique and the choice of an appropriate size for the hook-plate are needed. We suggest that early removal of the plate is necessary to decrease the risk of subacromial impingement and erosion in hook-plate fixation.
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Clinical outcomes of bending versus non-bending of the plate hook in acromioclavicular joint dislocation Min Su Joo, Hoi Young Kwon, Jeong Woo Kim Clinics in Shoulder and Elbow.2021; 24(4): 202. CrossRef
Surgical Treatment of Unstable Distal Clavicle Fractures: Comparison of Transacromial Pin Fixation and Hook Plate Fixation Young Sung Kim, Ho Min Lee, Han Gil Jang The Journal of the Korean Shoulder and Elbow Society.2013; 16(2): 123. CrossRef
Clavicular fracture is common injury in the upper extremity, but ipsilateral proximal, distal or middle-third clavicular fractures which occur simultaneously are an extremely rare. Seven cases have been reported in the English and Japanese literatures, but it has never been reported in Korea. We report a case of ipsilateral proximal and distal clavicular fracture caused by fall from height and describe its presumed mechanism, diagnosis, treatment with a review of literatures.
PURPOSE To evaluate the result of distal clavicle fracture treated by Hook plate (LCP clavicle hook plate, Synthes(R), Paoli, Switzerland). MATERIALS AND METHODS 10 patients with distal clavicle fracture treated by Hook plate from April 2008 to March 2010 were analyzed. The average follow-up period was 10 (range 4 to 26) months. The reduction was qualified and evaluated according to the immediate post-operative, final radiographs. We analyze the result by UCLA score and Kona's functional evaluation. RESULTS By radiologic evaluation, all cases showed anatomical reduction and solid union. By Kona's functional evaluation, there are 7 cases with excellent results, 3 cases with good results. The UCLA score was average 33.3 (range 29 to 35) points followed by 6 excellent cases, 4 good cases. As complication, 1 case showed post-operative clavicle shaft fracture and 1 case showed acromial osteolysis on X-rays. We found no complications such as skin irritation, infection, loosening of screws, and plate failure. CONCLUSION The Hook plate fixation for distal clavicle fracture is considered effective method for satisfactory reduction and rigid fixation, a lower incidence of nonunion and excellent clinical result.
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Comparison of Locking Compression Plate Superior Anterior Clavicle Plate with Suture Augmentation and Hook Plate for Treatment of Distal Clavicle Fractures Jun-Cheol Choi, Woo-Suk Song, Woo-Sung Kim, Jeong-Muk Kim, Chan-Woong Byun Archives of Hand and Microsurgery.2017; 22(4): 247. CrossRef
PURPOSE Unstable distal clavicle fractures should be treated surgically but may be difficult in firm fixation because of small distal fragment. Although a variety of fixation methods have been currently used, none of the methods seem to be firm fixation and little pain. We present a new technique using a spring plate which was modified from one third tubular plate and report the early results. MATERIALS AND METHODS Modified spring plate was made from one third tubular plate and the distal hole of the plate was cutting and sharpened by rasp. The sharp edge was bent just like an animal claw (C shape). Between May 2007 and June 2009, a total of six patients with distal clavicle fracture were treated using modified spring plate. A sling was applied in the immediate post operative period for six weeks and exercises were started immediately. RESULTS Union was achieved in all cases with excellent results without complication (mean Constant score, 96). All patients had returned to ordinary daily activities but mild limitation of abduction (150 degrees ) by seven weeks after surgery. After six months, the plate was removed. CONCLUSION The modified spring plate has provided stable fixation for unstable distal clavicle fixation without disturbance to the acromioclavicular joint, subacromial space, or rotator cuff.
PURPOSE To evaluate the clinical results after operative treatment with the double tension band wire fixation in Neer type II and III distal clavicle fractures. MATERIALS AND METHODS Ten patients with type II and III distal clavicle fractures were evaluated, who operated with double tension band wire fixation technique, from Febrary 2007 to June 2008, and could be followed-up for more than 1 year after operation. Postoperative assessments were evaluated on plain x-ray, pain, and clinical finding according to the functional criteria by Kona et al. RESULTS Average duration from operation to fracture union was 8 weeks in all cases. There were 8 excellent and 2 good results. It was no other significant complications such as K-wire migration, breakage, infection, and AC joint arthritis. CONCLUSION Double tension band wire fixation technique seems to be an effective method for type II or III distal clavicle fracture with multiple compressive axis, without injury of the AC joint and loosening of the fixation.
PURPOSE We are reporting the result of comminuted midshaft fractures of clavicle treated by reconstruction plate fixation and PDS augmentation easily fixing butterfly fragments with minimal soft tissue dissection. MATERIALS AND METHODS We reviewed 42 cases of operatively treated displaced comminuted midshaft fractures of clavicle at our hospital from March, 2001 to May 2004 whom were followed up for more than one year after the operation. According to Robinson classification, we grouped simple fractures as group A, and comminuted fractures as group B. Internal fixation using reconstruction plate has been chosen for type A fracture. Type B has been treated by reconstruction plate fixation with PDS augmentations. Shoulder function, union time and complications has been studied according to the fracture type retrospectively. RESULTS All cases had complete bone union with average union time of 8.6 weeks for type A and 8.9 weeks for type B.
Weitzman functional evaluation did not show significant differences. CONCLUSION PDS augmentation in comminuted midshaft fracture of clavicle easily fix the butterfly fragments with least soft tissue damage and lessen the bone graft. Therefore it considered to be one of the available treatment methods for comminuted midshaft fracture of clavicle.
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Does Interfragmentary Cerclage Wire Fixation in Clavicle Shaft Fracture Interfere the Fracture Healing? Jae-Kwang Yum, Yong-Woon Shin, Hee-Sung Lee, Jae-Gu Park Journal of the Korean Fracture Society.2011; 24(2): 138. CrossRef
Sang Hun Ko, Chang Hyuk Choe, Sung Do Cho, Jae Sung Seo, Jong Oh Kim, Jaedu Yu, Sang Jin Shin, In Ho Jeon, Kwang Hwan Jung, Jong Keun Woo, Ji Young Jeong, Gwon Jae No
J Korean Fract Soc 2006;19(1):46-50. Published online January 31, 2006
PURPOSE To evaluate the follow-up result of 11 cases that were operated with internal fixation of scapular neck and internal fixation of clavicle or acromioclavicular dislocation for severely displaced floating shoulder which was high energy injury and unstable. MATERIALS AND METHODS We examined the scapular neck fracture with clavicle fracture or acromioclavicular joint dislocation by multidisciplinary research from August 1997 to July 2004. The scapular neck fractures were operated in the case of translational displacement of more than 25 mm and angular displacement of more than 45 degrees with 3.5 mm reconstruction plate fixation and internal fixation for clavicle fracture or acromioclavicular joint perpormed simultaneously. And we evaluated 11 cases that can be followed up for more than 9 months. RESULTS We achieved bony union in all cases. In ASES functional score, we got average 89.2 (75~95) points. In Rowe functional score, we got average 89.1 (75~100) points. In complication, there was external rotation weakness in 1 case. CONCLUSION In severely displaced floating shoulder due to high energy injury, we got good clinical and functional result after internal fixation for scapular neck and clavicle or acromioclavicular joint.
PURPOSE To evaluate the efficacy of the tension band wire fixation for type II distal clavicle fractures. MATERIALS AND METHODS Twenty one patients with type II distal clavicle fractures were evaluated, who were operated with tension band fixation technique with sparing AC joint, from May 2000 to December 2003, and could be followed-up for more than 1 year after operation. Average age at injury is 40.7 years old (14~73). 13 cases were males and 8 were females. And 16 cases were classified as type IIa and 5 cases as type IIb. Judgement of union was based on plain x-ray and clinical finding and postoperative assessment was evaluated on ASES and Constant scoring system. RESULTS Outcomes in all patients showed more than good, average ASES score was 96.1 (88~98) and Constant score was 93.1 (82~100). Radiologic union was achieved at 11.7 (6~16) weeks postoperatively. One patient suffered from non union, and there was no other significant complications such as K-wire migrations, breakage, infection, and AC joint arthritis. CONCLUSION Tension band fixation technique for type II distal clavicle fracture seems to be a useful and effective method, which is relatively simple and provides rigid fixation without violating the AC joint.
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Comparison of Results of Tension Band Wire and Hook Plate in the Treatment of Unstable Fractures of the Distal Clavicle Chul-Hyun Park, Oog-Jin Shon, Jae-Sung Seo Journal of the Korean Fracture Society.2011; 24(1): 55. CrossRef
Modified Spring Plate for Treatment of Unstable Distal Clavicle Fractures Sang-Myung Lee, Il-Jung Park, Hyung-Min Kim, Jae-Chul Park, Sung-Gil Cho, Yoon-Chung Kim, Seung-Koo Rhee Journal of the Korean Fracture Society.2010; 23(1): 64. CrossRef
Distal clavicle fracture in children may mimic acromioclavicular joint separation, but have very different prognosis and treatment. We are reporting two cases of distal clavicle fracture in adolescence mimicking type IV acromioclavicular injury. This report demonstrates the importance of shoulder axillary view, computerized tomography as well as physical examination on diagnosis of the distal clavicle fracture in adolescence.
PURPOSE To evaluate the radiological and clinical results of the treatment of distal clavicular fractures with coracoclavicular ligament injury by coracoclavicular fixation with plating or repair of coracoclavicular ligament. MATERIALS AND METHODS Sixteen cases with minimum six months of follow-up were included in our study. Male was twelve and average age was 43(28-80). Ten cases of Craig type 2 were treated with coracoclavicular screw fixation with plating. Six cases of Craig type 5 were treated with coracoclavicular screw fixation with repair of coracoclavicular ligament. The radiologic assessment including coracoclavicular distance and union time and the clinical assessment including range of motion and degree of pain were evaluated. RESULTS Fifteen cases were united, but one case developed osteomyelitis and nonunion. Full range of motion was achieved in fifteen cases at last follow-up. Average coraco- clavicular distance compared to contralateral site in AP view was 2.1 mm increase in patients with plate fixation and 1.3 mm increase in patients with ligament repair. Average union time was 14.3 weeks and little differenece was noted between two groups(P>0.05). CONCLUSION Coracoclavicular screw fixation with plating or repair of coracoclavicular ligament were a useful method to treat distal clavicular fractures combined with coracoclavicular ligament injury.
PURPOSE To report our experiences of treatment with reviewing literatures and articles about the fractures of plate and nonunion after open reduction and internal fixation of clavicle fracture. MATERIALS AND METHODS 9 cases among 104 cases of clavicle fractures of reoperation due to the fractures of plate or nonunion after open reduction and internal fixation were included. Treatment results were analyzed after 5 months in regard to fracture site pain, gross deformities, limitation of movement of shoulder, discomfortness of casual activity, and patients' personal satisfaction. RESULTS According to the criteria of Kang et al 9 cases were classified into excellent 2 cases, good 4 cases, fair 2 cases, poor 1 case. All cases showed bone union average 14.4(12-26) weeks after reoperation. 3 cases of complications were 3 limitation of movement of shoulder, I superficial wound infection. CONCLUSION In operative treatment of clavicle fracture more than three screws in both side of fracture line shoulder be fixated and early exercise of shoulder motion seemed to be needed. In cases of less than three screws fixated, additional external protection is thought be necessary.
Clavicle fracture is one of the most common fractures and can be treated by conservative methods with a high rete of union and operative treatment itself was rearded as a cause of nonunion. But recently, we experienced some cases of delayed or nonunion following conservative treatment especially in high energy trauma patient. So we tried to treat 35 cases of clavicle fractures by open reduction and internal fixation with or without bone graft and analyzed the results. Results were as following. 1. The functional results were excellent in 16 cases(45.7%), good in 13 cases(37.1%), fair in 4 cases(11.4%) and poor in 1 case(0.28%), except 1 case of initial brachial plexus injury. 2. Of the 34 cases (except 1 case of nonunion), average time to union was 8.2 weeks in Knowles pin fixation and 8.4 weeks using plate with or without bone graft. Knowles pin fixation and 8.4 weeks using plate with or without bone graft. In the treatment of flesh clavicle fracture for early rehabilitation especially in young patients, open reduction and internal fixation is thought to be good method.
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Does cerclage wiring interfere with fracture healing of osteosynthesis in comminuted midshaft clavicle fractures? A multicenter study Hyo Jin Lee, Yong Bok Park, Chang Heon Shim, Young Min Noh Orthopaedics & Traumatology: Surgery & Research.2021; 107(8): 103091. CrossRef
Comparison of Plate Versus Threaded K-wire for Fixation of Midshaft Clavicular Fractures Young-Jin Ko, Chul-Hyun Park, Oog-Jin Shon, Jae-Sung Seo Journal of the Korean Fracture Society.2012; 25(2): 123. CrossRef
Surgical Techniques for Percutaneous Reduction by Towel Clips and Percutaneous Intramedullary Fixation with Steinmann Pins for Clavicle Shaft Fractures Ki-Do Hong, Jae-Chun Sim, Sung-Sik Ha, Tae-Ho Kim, Jong-Hyun Kim, Jong-Seong Lee Journal of the Korean Fracture Society.2012; 25(1): 31. CrossRef
Does Interfragmentary Cerclage Wire Fixation in Clavicle Shaft Fracture Interfere the Fracture Healing? Jae-Kwang Yum, Yong-Woon Shin, Hee-Sung Lee, Jae-Gu Park Journal of the Korean Fracture Society.2011; 24(2): 138. CrossRef
Comparison of Results in Two Operative Treatments for Clavicle Shaft Fractures in Adult: Comparison of Results between Open Reduction and Internal Fixation with the Plate and Percutaneous Reduction by Towel Clip and Intramedullary Fixation with Steinmann Sung-Sik Ha, Jae-Chun Sim, Ki-Do Hong, Jae-Young Kim, Jung-Ho Kang, Kwang-Hee Park Journal of the Korean Fracture Society.2007; 20(3): 233. CrossRef
Brachial plexus neuropraxia is a rare complication of the fractured clavicle although neurovascular injury following clavicular fracture is significant problem. The clavicular midshaft fracture can almost always be treated by conservative methods with a high rate of healing. There are some operative indication for clavicular fracture, which contains severe angulation or comminution of clavicle fracture, neurovascular compromise that is progressive, open fracture and closed method of immobilization are immpossible. Nearly all fracture was healed without complications such as infection, neurovascular compromise and nonunion. The authors describe two cases of brachial plexus injury secondary to exuberant callus formation of the clavicular fracture.
Comparative analysis of functional outcome of anatomical precontoured locking plate versus reconstruction plate in the management of displaced midshaft clavicular fractures P Kingsly, M Sathish, N Deen Muhammad Ismail Journal of Orthopaedic Surgery.2019;[Epub] CrossRef
Operative Treatment of Clavicle Midshaft Fractures: Comparison between Reconstruction Plate and Reconstruction Locking Compression Plate Chul-Hyun Cho, Kwang-Soon Song, Byung-Woo Min, Ki-Cheor Bae, Kyung-Jae Lee Clinics in Orthopedic Surgery.2010; 2(3): 154. CrossRef