clavicle fracture

Comparison of two different plates in

treatment of displaced mid-shaft clavicle fracture

By Wafer Aldulaimi /Denmark

Clavicle fracture represents 2,6-5 % of all adult fractures

Several studies suggest that operative treatment of a dislocated and / or comminute midshaft clavicle fracture is superior to non-operative treatment , based on functional results and non-union frequency

Several methods have been proposed

The clinical relevance of the statistical difference is questionable because no study showed a difference in Constant shoulder score of 10 points which is the minimal difference that has a clinical relevance

To compare the results of surgical treatment of two different plates

The anatomical LCP versus reconstruction LCP plate

Anatomical precontoured LCP plate is about 10 times more expensive than reconstruction LCP plate, therefore, the study has an economical impaction

Retrospective cohort study, from a single institution in a period from 01.01.2006 to 01.10.2011.

The primary search is by the diagnoses clavicle fracture “DS420”

Medical charts and plane radiograph reviewed

No differences in complication rates between the two operated patient groups

1. Fracture in the middle third of clavicle2. Fully displaced (no cortical contact between the

proximal and distal fragments) midshaft clavicular fracture ,and/or shortening by > 2 cm and/or comminute ( >3 fragments)

3. Closed fracture4. Same operative technique 

1. Patients younger than 16 2. A fracture in the proximal or distal third of

the clavicle3. Open fracture4. Pathological fracture5. Patients not living in Denmark

Variables are included as age at injury ,sex, mechanism of injury, smoking , high levels of alcohol consumption which defined as consumption > 21 units/week for male and >14 units/week for female according to the Danish standards

Assessment is done by chart and plane radiograph review  The complications was defined as :

1. Infection : local infection necessitate surgical revision

2. Non-union : no clinical and radiological healing after 4 months

3. Plate breakage 4. Local irritation from the plate that necessitate

plate removal  The results was evaluated statistically by using GraphPad

software

P value it was set to be significant when it is less or equal to 0.05

Variables Anatomic Plate Reconstruction plat P-valueNumber (177) 93 84

Age ,median 38.27± 13.84(SD) 36.48±13.50(SD 0.38

Sex M: 82 (88%) F: 11 (12%)

M: 67 (81%) F: 16 (19%)

0.650.30

Smoking 26 (29%) 27 (32%) 0.75

Alcohol 8 (7%) 7 (8%) 0.10

Diabetes mellitus 0 0 N/A

Infection 1 (1%) 0 1.00

Plate fracture 1 (1%) 5 (6%) 0.16

Local irritation 19 (20%) 33 (39%) 0.05

Non-union 2 (2%) 2 (2%) 0.62

Mechanism of injury Motor-vehicle or motorcycle accident

30 29>0.05 for all

Bicycling 23 23

Sports 27 15

Fall 11 17

Others 2 0

Local plate irritation that necessitate plate removal was seen in 17(18%) patients operated by anatomical plate and in 35 (41%) patients operated by reconstruction plate

It is a significantly higher level of plate removal in reconstruction plate in comparison to the anatomic precontoured plate. P-value 0.05

Six patients experienced plate fracture. Five of them had reconstruction plate when the plate fracture occurred without trauma after 6 weeks in 3 of them and the other two after 3 and 23 months from the operations date

Only one patient experienced Anatomic LCP plate fracture after a motorcycle accident about 3 months from the operation

The Anatomic precontoured LCP plate has a lower level of reoperation in comparison to the reconstruction LCP plate , mostly due to local irritation from the plate which necessitate plate removal

The null hypothesis was rejected

1)Operative versus nonoperative management of displaced midshaft clavicle fractures: a prospective cohort study. Kulshrestha V, Roy T, Audige L. J Orthop Trauma. 2011 Jan;25(1):31-8.

 2) Acumed : locking clavicle plating system 3) J Orthop Trauma. 2011 May;25(5):272-8. Biomechanical comparison of fixation techniques in midshaft clavicular fractures. Demirhan M,

Bilsel K, Atalar AC, Bozdag E, Sunbuloglu E, Kale A.Source: Department of Orthopaedics and Traumatology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey. demirhan@istanbul.edu.tr 4) Clin Orthop Relat Res. 2011 Mar 17. [Epub ahead of print]Precontoured Plating of Clavicle Fractures: Decreased Hardware-related Complications?Vanbeek C, Boselli KJ, Cadet ER, Ahmad CS, Levine WN.Source:Center for Shoulder, Elbow and Sports Medicine, Department of Orthopaedic Surgery, Columbia University Medical Center, 622 West 168th

Street PH 11, New York, NY, 10032, USA.5) J Shoulder Elbow Surg. 2008 Nov-Dec;17(6):951-3. Epub 2008 Sep 20.Nonunion of the clavicle treated with plate fixation: a review of forty-seven consecutive cases.Endrizzi DP, White RR, Babikian GM, Old AB.Source:Orthopaedic Associates of Portland, Maine Medical Center, Portland, ME 04102, USA. endrizzi@orthoassociates.com6) Reconstruction plate fixation with bone graft for mid-shaft clavicular non-union in semi-professional athletes. Wentz S, Eberhardt C,

Leonhard T.Source: Department of Orthopaedic Surgery 'Friedrichsheim', Johann Wolfgang Goethe University, Marienburgstrasse 2, 60528 Frankfurt/M., Germany.7) J Orthop Trauma. 2011 Jan;25(1):39-43.Biomechanical analysis of fixation of middle third fractures of the clavicle.Drosdowech DS, Manwell SE, Ferreira LM, Goel DP, Faber KJ, Johnson JA.Source : Bioengineering Research Lab, Hand and Upper Limb Centre, St. Joseph’s Health Care, 268 Grosvenor Street, London, Ontario, Canada.

ddros@mac.com8) Rockwood and Green's Fractures in Adults . Clavicle fractures.9) European Journal of Orthopaedic Surgery & TraumatologyAugust 2013, Volume 23, Issue 6, pp 621-629Should displaced midshaft clavicular fractures be treated surgically? A meta-analysis based on current evidenceChang-peng Xu, Xue Li, Zhuang Cui, Xi-cai Diao, Bin Yu