Anatomical Reduction of All Fracture Fragments and Fixation Using Inter-Fragmentary Screw and Plate in Comminuted and Displaced Clavicle Mid-Shaft Fracture

Kyoung Hwan Koh; Min Soo Shon; Seung Won Lee; Jong Ho Kim; Jae Chul Yoo

doi:10.12671/jkfs.2012.25.4.300

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Koh, Shon, Lee, Kim, and Yoo: Anatomical Reduction of All Fracture Fragments and Fixation Using Inter-Fragmentary Screw and Plate in Comminuted and Displaced Clavicle Mid-Shaft Fracture

Original Article

Journal of the Korean Fracture Society

Journal of the Korean Fracture Society 2012; 25(4): 300-304.

Published online: 19 October 2012

DOI: https://doi.org/10.12671/jkfs.2012.25.4.300

Anatomical Reduction of All Fracture Fragments and Fixation Using Inter-Fragmentary Screw and Plate in Comminuted and Displaced Clavicle Mid-Shaft Fracture

Kyoung Hwan Koh, M.D.^†, Min Soo Shon, M.D., Seung Won Lee, M.D.^*, Jong Ho Kim, M.D.^†, Jae Chul Yoo, M.D.^*

Department of Orthopedic Surgery, National Medical Center, Seoul, Korea.

^*Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

^†Department of Orthopedic Surgery, Seoul Medical Center, Seoul, Korea.

Address reprint requests to: Jae Chul Yoo, M.D. Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul 135-710, Korea. Tel: 82-2-3410-3501, Fax: 82-2-3410-0061, shoulderyoo@gmail.com

Received 4 September 2012 Revised 10 September 2012 Accepted 17 September 2012

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report the treatment results of anatomical reduction of all fracture fragments and internal fixation using an inter-fragmentary screw and plate in displaced mid-shaft clavicle fracture with comminution.

Materials and Methods

Between June 2005 and August 2011, 13 consecutive displaced clavicle fractures with comminution (Edinburgh classification IIB2) treated by anatomic reduction and internal fixation using inter-fragmentary screw and plate were retrospectively evaluated. There were 11 male and 2 female patients with a mean age of 37.4 years (15~55 years). The right clavicle was injured in 4 patients and the dominant arm was involved in 46%. The mean duration from trauma to surgery was 7.0 days. The cause of injury was a traffic accident in three, a fall in two, and sports activity or direct injury in eight patients. All of the fracture pieces were anatomically reduced and fixed with inter-fragmentary screws. An additional plate was applied to maintain and reinforce the reduction of the fracture. Radiographic assessments for the numbers of fragments and the amount of shortening and displacement were performed. To verify the fracture healing and determine the time from fracture surgery to union and complications, all of the radiographs taken after surgery were evaluated.

Results

The number of fragments was 2 in 7 cases, 3 in 5 cases, and 6 in one case. The mean shortening of the clavicle was 1.1 cm (0.3~2.1 cm) and mean displacement between the main fragments was 2.6 cm (1.3~4.5 cm). The mean duration of follow-up was 16.5 months (8~26 months). Radiographic union was achieved in all patients with a mean time to union of 10.8 weeks (8~14 weeks). There were no complications including metal failure, nonunion, or infection.

Conclusion

Anatomical reduction of all the fracture fragments and fixation using inter-fragmentary screws in addition to the usual plate fixation showed good fracture healing in displaced clavicle fracture with comminution.

Keywords: Clavicle mid-shaft, Comminuted fracture, Inter-fragmentary screw fixation

Figures and Tables

Fig. 1

Isolated segmental comminuted clavicle mid-shaft fractures (Edinburgh classification type IIB2).

Fig. 2

(A) Preoperative radiograph.

(B~E) Intraoperative photograph showing internal fixation of free fragments using cannulated screws and plate.

(F) Final radiographs showing union.

Table 1

Number of Free Fracture Fragments

Table 2

Details of 13 Patients Who Were Treated for Displaced Mid-Shaft Clavicle Fracture with Comminution by Open Reduction and Internal Fixation with Inter-Fragmentary Screw and Plate

M: Male, F: Female.

References

1. Ferran NA, Hodgson P, Vannet N, Williams R, Evans RO. Locked intramedullary fixation vs plating for displaced and shortened mid-shaft clavicle fractures: a randomized clinical trial. J Shoulder Elbow Surg. 2010. 19:783–789.

2. Ha SS, Sim JC, Hong KD, Kim JY, Kang JH, Park KH. 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. J Korean Fract Soc. 2007. 20:233–238.

3. 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. 79:537–539.

4. Huang JI, Toogood P, Chen MR, Wilber JH, Cooperman DR. Clavicular anatomy and the applicability of precontoured plates. J Bone Joint Surg Am. 2007. 89:2260–2265.

5. Kim IG, Kim JH, Hwang R, Hong YI. Operative treatment with the reconstruction plate for the displaced clavicle shaft fracture of adults. J Korean Soc Fract. 2000. 13:941–947.

6. Liu HH, Chang CH, Chia WT, Chen CH, Tarng YW, Wong CY. Comparison of plates versus intramedullary nails for fixation of displaced midshaft clavicular fractures. J Trauma. 2010. 69:E82–E87.

7. McKee MD, Pedersen EM, Jones C, et al. Deficits following nonoperative treatment of displaced midshaft clavicular fractures. J Bone Joint Surg Am. 2006. 88:35–40.

8. Millett PJ, Hurst JM, Horan MP, Hawkins RJ. Complications of clavicle fractures treated with intramedullary fixation. J Shoulder Elbow Surg. 2011. 20:86–91.

9. Neer CS 2nd. Nonunion of the clavicle. J Am Med Assoc. 1960. 172:1006–1011.

10. Neer CS 2nd. Fractures of the distal third of the clavicle. Clin Orthop Relat Res. 1968. 58:43–50.

11. Nowak J, Holgersson M, Larsson S. Can we predict long-term sequelae after fractures of the clavicle based on initial findings? A prospective study with nine to ten years of follow-up. J Shoulder Elbow Surg. 2004. 13:479–486.

12. Post M. Current concepts in the treatment of fractures of the clavicle. Clin Orthop Relat Res. 1989. (245):89–101.

13. Robinson CM, Cairns DA. Primary nonoperative treatment of displaced lateral fractures of the clavicle. J Bone Joint Surg Am. 2004. 86-A:778–782.

14. Robinson CM. Fractures of the clavicle in the adult. Epidemiology and classification. J Bone Joint Surg Br. 1998. 80:476–484.

15. Rowe CR. An atlas of anatomy and treatment of midclavicular fractures. Clin Orthop Relat Res. 1968. 58:29–42.

16. Sohn HS, Shin SJ, Kim BY. Minimally invasive plate osteosynthesis using anterior-inferior plating of clavicular midshaft fractures. Arch Orthop Trauma Surg. 2012. 132:239–244.

17. van der Meijden OA, Gaskill TR, Millett PJ. Treatment of clavicle fractures: current concepts review. J Shoulder Elbow Surg. 2012. 21:423–429.

18. Wilkins RM, Johnston RM. Ununited fractures of the clavicle. J Bone Joint Surg Am. 1983. 65:773–778.

19. Yum JK, Shin YW, Lee HS, Park JG. Does Interfragmentary cerclage wire fixation in clavicle shaft fracture interfere the fracture healing? J Korean Fract Soc. 2011. 24:138–143.

20. Zenni EJ Jr, Krieg JK, Rosen MJ. Open reduction and internal fixation of clavicular fractures. J Bone Joint Surg Am. 1981. 63:147–151.

21. Zlowodzki M, 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. 19:504–507.

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