Abstract
Objectives
Medial clavicle fractures are rare injuries and historically treated non-operatively. Displaced medial clavicle fractures, however, have a higher incidence of delayed- or non-union compared to non- displaced medial clavicle fractures and might benefit from operative treatment. We describe below a new technique for treating intra-articular fractures or extra-articular fractures with a small medial fragment using special locking plates and present the results of our operatively treated patients.
Methods
First we describe our technique for treating very medial fractures with the radial (VA)-LCP™ Distal Humerus Plate (DePuy Synthes, Switzerland). Second, a retrospective cohort study was performed. All patients operated on for a displaced medial clavicle fracture between 2010 and 2017 were included. Primary outcome was the QuickDASH score and the Subjective Shoulder Value (SSV). Secondary outcomes were operative complications including mal- or non-union and implant removal.
Results
All 15 patients were available for follow-up. Fourteen patients were included in our analysis. One patient was excluded due to severe concomitant injuries. Six patients were treated with the radial (VA)-LCP™ Distal Humerus Plate, eight patients with the LCP™ Superior Anterior Clavicle Plate with lateral extension (DePuy Synthes, Switzerland) and one with a LCP 3.5 plate. The mean follow-up was 39 months (range 9–79). The mean QuickDASH score was 0.81 (range 0–4.50, SD ± 1.44) and the mean SSV was 96 (range 80–100, SD ± 6.53). One patient had an early revision operation and developed an infection after 1.5 years. No mal- or non-unions occurred. Eight patients had their implants removed.
Conclusions
Operative treatment of displaced medial clavicle fractures with well-fitting ‘small fragment’ locking plates provides an excellent long-term functional outcome. Intra-articular fractures or extra-articular fractures with a small medial fragment can be treated with the radial (VA)-LCP™ Distal Humerus Plate.
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References
van der Meijden OA, Gaskill TR, Millett PJ. Treatment of clavicle fractures: current concepts review. J Shoulder Elbow Surg. 2012;21(3):423–9. https://doi.org/10.1016/j.jse.2011.08.053.
Robinson CM. Fractures of the clavicle in the adult. Epidemiology and classification. J Bone Joint Surg Br. 1998;80(3):476–84.
Robinson CM, Court-Brown CM, McQueen MM, Wakefield AE. (2004) Estimating the risk of nonunion following nonoperative treatment of a clavicular fracture. J Bone Joint Surg Am 86-a (7):1359–1365.
Oe K, Gaul L, Hierholzer C, Woltmann A, Miwa M, Kurosaka M, Buehren V. Operative management of periarticular medial clavicle fractures-report of 10 cases. J Trauma. 2011. https://doi.org/10.1097/TA.0b013e31820d1354.
Throckmorton T, Kuhn JE. Fractures of the medial end of the clavicle. J Shoulder Elbow Surg. 2007;16(1):49–54. https://doi.org/10.1016/j.jse.2006.05.010.
Ferree S, van Laarhoven JJ, Houwert RM, Hietbrink F, Verleisdonk EJ, Leenen LP. Distribution and treatment of clavicular fractures in monotrauma and polytrauma patients. J Trauma Manag Outcome. 2014;8:17. https://doi.org/10.1186/1752-2897-8-17.
Salipas A, Kimmel LA, Edwards ER, Rakhra S, Moaveni AK. Natural history of medial clavicle fractures. Injury. 2016;47(10):2235–9. https://doi.org/10.1016/j.injury.2016.06.011.
van Laarhoven JJ, Ferree S, Houwert RM, Hietbrink F, Verleisdonk EM, Leenen LP. Demographics of the injury pattern in severely injured patients with an associated clavicle fracture: a retrospective observational cohort study. World J Emerg Surg WJES. 2013;8(1):36. https://doi.org/10.1186/1749-7922-8-36.
Bartonicek J, Fric V, Pacovsky V. Displaced fractures of the medial end of the clavicle: report of five cases. J Orthop Trauma. 2010;24(4):e31–5. https://doi.org/10.1097/BOT.0b013e3181aa5505.
Sidhu VS, Hermans D, Duckworth DG. The operative outcomes of displaced medial-end clavicle fractures. J Shoulder Elbow Surg. 2015;24(11):1728–34. https://doi.org/10.1016/j.jse.2015.04.011.
Wang Y, Jiang J, Dou B, Zhang P. Inverted distal clavicle anatomic locking plate for displaced medial clavicle fracture. Arch Orthop Trauma Surg. 2015;135(9):1241–5. https://doi.org/10.1007/s00402-015-2259-x.
Kim KC, Shin HD, Cha SM. Surgical treatment of displaced medial clavicle fractures using a small T-shaped plate and tension band sutures. Arch Orthop Trauma Surg. 2011;131(12):1673–6. https://doi.org/10.1007/s00402-011-1367-5.
Marsh JL, Slongo TF, Agel J, Broderick JS, Creevey W, DeCoster TA, Prokuski L, Sirkin MS, Ziran B, Henley B, Audige L. Fracture and dislocation classification compendium – 2007: Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma. 2007;21(10 Suppl):1–133.
Beaton DE, Wright JG, Katz JN. Development of the QuickDASH: comparison of three item-reduction approaches. J Bone Joint Surg Am. 2005;87(5):1038–46. https://doi.org/10.2106/jbjs.d.02060.
Gilbart MK, Gerber C. Comparison of the subjective shoulder value and the Constant score. J Shoulder Elbow Surg. 2007;16(6):717–21. https://doi.org/10.1016/j.jse.2007.02.123.
Jost B, Pfirrmann CW, Gerber C, Switzerland Z. Clinical outcome after structural failure of rotator cuff repairs. J Bone Joint Surg Am. 2000;82(3):304–14.
Wright RW, Baumgarten KM. Shoulder outcomes measures. J Am Acad Orthop Surg. 2010;18(7):436–44.
Hulsmans MH, van Heijl M, Houwert RM, Hammacher ER, Meylaerts SA, Verhofstad MH, Dijkgraaf MG, Verleisdonk EJ. High irritation and removal rates after plate or nail fixation in patients with displaced midshaft clavicle fractures. Clin Orthop Relat Res. 2017;475(2):532–9. https://doi.org/10.1007/s11999-016-5113-8.
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The authors thank Michelle Reynolds for the excellent copy-editing of this manuscript.
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Herman Frima, Roderick M. Houwert and Christoph Sommer declare that they have no conflict of interest.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the Kantonale Ethikkommision Zürich.
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Frima, H., Houwert, R.M. & Sommer, C. Displaced medial clavicle fractures: operative treatment with locking compression plate fixation. Eur J Trauma Emerg Surg 46, 207–213 (2020). https://doi.org/10.1007/s00068-018-1024-6
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DOI: https://doi.org/10.1007/s00068-018-1024-6