Results after Treatment of Displaced Midshaft Fractures of the Clavicle with the Contoured Clavicle Plate

Abstract

Objective: There are controversial discussions about the operative treatment of displaced midshaft fractures of the clavicle. While some authors still prefer a conservative treatment, latest studies showed in many cases better results for operatively treated fractures compared with the conservative. The functional outcome and complications after plate and screw fixation of dislocated midshaft fractures of the clavicle should be analyzed and compared to international studies. Patients and methods: From January 2005 up to December 2006 a retrospective inspection on 71 patients with displaced midshaft fractures of the clavicle has been carried out. All of these patients were treated by open reduction and internal fixation with the contoured clavicle plate, a new preformed titanium implant. 53 patients (75 %) completed the follow-up. The average time of follow-up was 11.5 months (range 2 to 43 months). The patients were evaluated by two standard scores (DASH-Score, Constant-Score). Results: The clinical results can be rated as very good. The average results were 91.98 using the Constant Score measure (range 60-100) and 11.87 for the DASH measure (range 0-50). 91 % of the results based on the Constant-Score method were very high with 72 % excellent and 19 % good. The complication rate was 12.7 %. There were two pseudoarthroses, one implant failure (Fig. [4]), two superficial infections and one haematoma. Conclusion: The results of this study are promising and comparable to the latest studies regarding the operative treatment of displaced midshaft fractures of the clavicle. The contoured clavicle plate is a suitable implant for the fracture care of the clavicle.

Key words

Clavicle fracture - operative treatment - plate osteosynthesis

References

• 1 Allman Jr  F L. Fractures and ligamentous injuries of the clavicle and its articulation.  J Bone Joint Surg [Am]. 1967;  49 774-784
• 2 Boehm T D. Scores. In: Gohlke F, Hedtman A (eds). Schulter: Das Standardwerk für Klinik und Praxis. Thieme, Stuttgart, New York 2002; 98-104
• 3 Böstman O, Manninen M, Pihlajamaki H. Complications of plate fixation in fresh displaced midclavicular fractures.  J Trauma. 1997;  43 778-783
• 4 Canadian Orthopaedic Trauma Society . Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial.  J Bone Joint Surg [Am]. 2007;  89 1-10
• 5 Collinge C, Devinney S, Herscovici D, Dipasquale T, Sanders R. Anterior-inferior plate fixation of middle-third fractures and nonunions of the clavicle.  J Orthop Trauma. 2006;  20 680-686
• 6 Constant C R, Murley A HG. A clinical method of functional assessment of the shoulder.  Clinical Orthopaedics and Related Research. 1987;  214 160-164
• 7 Coupe B D, Wimhurst J A, Indar R, Calder D A, Patel A D. A new approach for plate fixation of midshaft clavicular fractures.  Injury. 2005;  36 1166-1171 , Epub 2005 Aug 1
• 8 Denard P J, Koval K J, Cantu R V, Weinstein J N. Management of midshaft clavicle fractures in adults.  . 2005;  34 527-536
• 9 Eskola A, Vainionpaa S, Myllynen P, Patiala H, Rokkanen P. Surgery for ununited clavicular fracture.  Acta Orthop Scand. 1986;  57 366-367
• 10 Eskola A, Vainionpaa S, Myllynen P, Patiala H, Rokkanen P. Outcome of clavicular fracture in 89 patients.  Arch Orthop Trauma Surg. 1986;  105 337-338
• 11 Freeland A. Unstable adult midclavicular fracture.  Orthopedics. 1990;  13 1279-1281
• 12 Germann G, Wind G, Harth A. Der DASH-Fragebogen - Ein neues Instrument zur Beurteilung von Behandlungsergebnissen an der oberen Extremität.  Handchir Mikrochir Plast Chir. 1999;  31 149-152
• 13 Graves M L, Geissler W B, Freeland A E. Midshaft clavicular fractures: the role of operative treatment.  Orthopedics. 2005;  28 761-764
• 14 Herbsthofer B, Schuz W, Mockwitz J. Indications for surgical treatment of clavicular fractures.  Aktuelle Traumatol. 1994;  24 263-268
• 15 Hill J M, McGuire M H, Crosby L A. Closed treatment of displaced middle-third fractures of the clavicle gives poor results.  J Bone Joint Surg [Br]. 1997;  79 537-539
• 16 Hudak P L, Amadio P C, Bombardier C. Development of an upper extremity outcome measure: the DASH disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG).  Am J Ind Med. 1996;  29 602-608
• 17 Klonz A, Hockertz T, Reilmann H. Clavicular fractures.  Unfallchirurg. 2001;  104 70-81 , quiz 80
• 18 Lazarides S, Zafiropoulos G. Conservative treatment of fractures at the middle third of the clavicle: the relevance of shortening and clinical outcome.  J Shoulder Elbow Surg. 2006;  15 191-194
• 19 Lipton H A, Jupiter J B. Nonunion of clavicular fractures: characteristics and surgical management.  Surgical Rounds for Orthopaedics. 1988;  2 17-21
• 20 Matis N, Kwasny O, Gaebler C, Vecsei V. Effects of the clavicle shortening after clavicle fracture.  Hefte zu der Unfallchirurg. 1999;  275 314-315
• 21 Müller M E, Nazarian S, Koch P, Schatzker J. The Comprehensive Classification of Fractures of Long Bones. Springer, Berlin 1990
• 22 Neer II C S. Nonunion of the clavicle.  J Am Med Assn. 1960;  172 1006-1011
• 23 Nordqvist A, Petersson C. The incidence of fractures of the clavicle.  Clin Orthop Relat Res. 1994;  (300) 127-132
• 24 Nowak J, Mallmin H, Larsson S. The aetiology and epidemiology of clavicular fractures. A prospective study during a two-year period in Uppsala, Sweden.  Injury. 2000;  31 353-358
• 25 Poigenfurst J, Rappold G, Fischer W. Plating of fresh clavicular fractures: Results of 122 operations.  Injury. 1992;  23 237-241
• 26 Postacchini F, Gumina S, De Santis P, Albo F. Epidemiology of clavicle fractures.  J Shoulder Elbow Surg. 2002;  11 452-456
• 27 Robinson C M. Fractures of the clavicle in the adult. Epidemiology and classification.  J Bone Joint Surg [Br]. 1998;  80 476-484
• 28 Rowe C R. An atlas of anatomy and treatment of midclavicular fractures.  Clin Orthop Relat Res. 1968;  58 29-42
• 29 Schwarz N, Hocker K. Osteosynthesis of irreducible fractures of the clavicle with 2.7-MM ASIF plates.  J Trauma. 1992;  33 179-183
• 30 Shen W J, Liu T J, Shen Y S. Plate fixation of fresh displaced midshaft clavicle fractures.  Injury. 1999;  30 497-500
• 31 Smith C A, Rudd J, Crosby L A. Results of operative treatment versus non-operative treatment for 100 % displaced mid-shaft clavicle fractures: a prospective randomized trial. In: Proceedings from the 68th Annual Meeting of the American Academy of Orthopaedic Surgeons 2001
• 32 Weigel B, Nerlich M. Praxisbuch Unfallchirurgie. Springer, Berlin, Heidelberg, New York 2005
• 33 Wick M, Muller E J, Kollig E, Muhr G. Midshaft fractures of the clavicle with a shortening of more than 2 cm predispose to nonunion.  Arch Orthop Trauma Surg. 2001;  121 207-211
• 34 Zlowodzki M, Zelle B A, Cole P A, Jeray K, McKee M D. 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 Review 504-507