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Surgical treatment of midclavicular fractures: a prospective comparison of Knowles pinning and plate fixation

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Abstract

Although several surgical techniques for midclavicular fractures have been reported, Knowles pinning has rarely been compared with plating. The purpose of this study is to compare the clinical results of these two alternative techniques. There were 88 patients with midclavicular fractures surgically treated with either a Knowles pin or a plate. All patients were followed up for 12 months with a shoulder score evaluation. The Knowles pin group included 56 patients, with an average age of 40.1 years. The plate group included 32 patients, with an average age of 38.2 years. Both groups were similar in injury mechanism and fracture types (all p values>0.5). Plating has a significantly longer operation time, larger wound incision, higher pain level, more analgesic use, more complications and more symptomatic hardware (all p value<0.05). The shoulder score, union rate and healing time are not significantly different between the two groups (all p values>0.2). In conclusion, if the surgery of mid-third clavicular fractures is indicated, fixation with a Knowles pin has more advantages than plate fixation.

Résumé

Plusieurs techniques chirurgicales ont été rapportées pour traiter les fractures de la partie moyenne de la clavicule, l’embrochage étant rarement comparé avec l’ostéosynthèse par plaque. Le propos de cette étude est de comparer les résultats cliniques de ces deux techniques. 88 patients présentant une fracture du tiers moyen de la clavicule ont été traités chirurgicalement par broches de Knowles ou par ostéosynthèses par plaque. Tous les patients ont été suivis pendant une période d’un an avec évaluation clinique de l’épaule. Le groupe broche comportait 56 patients dont l’âge moyen était de 40,1 ans et le groupe des plaques, 32 patients dont l’âge moyen était de 38,2 ans. Les deux groupes avaient le même mécanisme de fracture et le même type de fracture. Les ostéosynthèse par plaques ont conduit un temps opératoire plus important, une incision plus grande et une douleur également plus importante avec utilisation d’un algésique et plus de complications. Par contre l’évaluation de l’épaule, quel que soit le groupe était la même quel que soit le groupe de traitement, plaque ou broche (0.26). En conclusion, l’embrochage par broches de Knowles est une technique plus avantageuse que la fixation par plaque dans les fractures du tiers moyen de la clavicule.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Taipei City Hospital, Heping Branch, No. 33, Section 2, Chung-Hwa Rd, Taipei, Taiwan

    Hui-Ling Huang, Ting-Ying Lo, Yi-Fang Hsieh & Chien-Rae Huang

  2. Department of Orthopedic Surgery, Lin Shin Hospital, No. 36, Section 3, Huizhong Rd., Nanton District, Taichung City, 408, Taiwan

    Yih-Shiunn Lee

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  1. Yih-Shiunn Lee
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  2. Hui-Ling Huang
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  4. Yi-Fang Hsieh
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  5. Chien-Rae Huang
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Correspondence to Yih-Shiunn Lee.

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Lee, YS., Huang, HL., Lo, TY. et al. Surgical treatment of midclavicular fractures: a prospective comparison of Knowles pinning and plate fixation. International Orthopaedics (SICO 32, 541–545 (2008). https://doi.org/10.1007/s00264-007-0352-7

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  • DOI: https://doi.org/10.1007/s00264-007-0352-7

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