Management of displaced middle third clavicular fractures with superior reconstruction plating
Journal Title: International Journal of Orthopaedics Traumatology & Surgical Sciences - Year 2017, Vol 3, Issue 2
Abstract
Background :The management of clavicle fractures is inclining towards fixation for displaced middle-third clavicle fractures as the conservative treatment gives poor results. There was no evidence to suggest that early operative treatment of displaced clavicular shaft fractures showed a functional benefit when compared with the results of initial non-operative treatment till now. However, recent studies show displaced clavicle fractures was associated with greater risk of non-union, poor clinical outcome, and decrease in shoulder strength. Materials and methods:Various methods have been described for operative fixation of clavicular shaft fractures, implants including extramedullary semi tubular plates, reconstruction plates, Dynamic Compression Plate(DCP), Limited Contact Dynamic Compression Plate (LCDCP), locking plates, intramedullary fixation with Knowle’s pins, Haige pins, Rockwood pins and titanium nails. Results :Intramedullary fixation of clavicle, though more cosmetic is technically more demanding owing to lack of clear cut medullary canal and higher complication rates upto 75%. Plate fixation provides immediate rigid stabilization, pain relief, facilitates early mobilisation and return to pre injury activities. Superior placement of plate is biomechanically more stable especially in presence of inferior cortical communition. So, Open Reduction and Internal Fixation (ORIF) with superior reconstruction plating was preferred in adults with displaced middle third clavicle fracture and those having tenting skin. The aim of this study is to evaluate the functional outcome of midshaft clavicular fracture in adults managed with ORIF with superior reconstruction plating. CONCLUSION: The traditional method of managing middle third clavicular fracture conservatively gives poor functional results. Intramedullary fixation is not favoured for its higher complication rate though better cosmesis. Reconstruction plates can be contoured according to the need and superior placement with six cortical purchases on either side gives stable construct, predictable union and optimum functional outcome. Use of bone Interfragmentary screws should be done carefully as might cause further communition and primary bone graft might be justified in communited fractures. Owing to the subcutaneous anatomy of clavicle, superior implantation of implant might cause hardware prominence especially in lean individuals demanding subsequent removal. Site specific precontoured locking plates in recent use are yet to be fully tested in comparative clinical studies.
Authors and Affiliations
Kalyan Kaushik Bharam, Ram Kalyan T, R Siva Prasad, Rithika Singh
Keywords
Related Articles
- EP ID EP394862
- DOI -
- Views 104
- Downloads 0
Radiographic Morphometry Of Distal End Of Radius, A Retrospective, Observational Study In Indian Population
Background: Distal end of radius fracture is a common fracture due to fall on outstretched hand (15 per 100 fracture patients). Reduction of this fracture is generally assessed by four morphometric measurements of the di...
A comparative study of arthroscopic reconstruction of acl using bone patellar tendon bone graft and quadrupled hamstring tendon graft
Anterior Cruciate Ligament reconstruction (ACLR) using either autologous Bone patellar tendon bone (BPTB) graft or Quadrupled hamstring tendon graft has equal number of proponents worldwide. The aim of this study is to f...
A Clinical Study To Analys Surgical Plating Of Mid Clavicular Fractures In Adults
Clavicular fractures are common injuries. The aim of this study is to present results of surgical treatment of midclavicular fracture managed with open reduction and internal fixation (ORIF). This study involved 30 pat...
Effectiveness Of Platelet Rich Plasma (Prp) Injections In Management Of Chronic Plantar Fasciitis: A Randomized Controlled Trial
Background: Plantar fasciitis is the most common cause of heel pain. With early diagnosis and timely application of conservative methods, symptoms generally resolve over time. However, despite adequate treatment, 20-30%...
A Clinical Study Of Distal Femoral Fractures Treated By Retrograde Femoral Nailing – Biological And Biomechanical Advantages With Review Of Literature
Background: Distal femoral fractures with or without intra-articular extension are often difficult to treat as they are usually associated with a high incidence of complications like knee stiffness, quadriceps wasting, k...