A DISPLACED LATERAL
CLAVICLE FRACTURE
Background
Epidemiology
Clavicle
Clavicle
Middle
Proximal
third fractures 5 %
Lateral
/ distal third 15 %
Topographic Anatomy
The
clavicle
is
narrowest in its
midportion, high
incidence
of
fractures in this
area.
Clavicle Functions
(https://online .epocrates.com)
The clavicle function as a strut, bracing the shoulder from the trunk
and allowing the shoulder to function at optimal strength. The
medial one third protect the brachial plexus, the subclavian and
axillary vessels, and the superior lung. (Koval K, Zuckerman JD. 2010)
Mechanism of Injury
Fracture Classification
Neer Classification
AO Classification
Treatment
of
lateral
clavicle
fractures
Conservative or Operative
Problem:
Traditionally, nonsurgical management has been favored as
the initial treatment.
Recent evidence suggests that specific subsets of patients
may be at high risk for nonunion, shoulder dysfunction, or
residual pain after nonsurgical management.
(Tiren D, Vroemen JPAM. 2013)
Treatment Options
Nonoperative
Sling
Brace
Surgical
Plate Fixation
Screw or Pin Fixation
K-Wire
Suture and sling techniques
(Van der Meijden OA, Gaskill TR, Millett PJ. 2011)
Wolter Plate
Balser Plate
(http://eorif.com)
Hook Plate
Locking Plate
(Madsen,
2013)
Coracoclavicular Screw
Belmer and Gelber (1991) Coracoclavicular fixation
provided and maintained reduction of the fracture.
According to their study, healing occurred uneventfully
within nine weeks in all cases.
Coracoclavicular
Screw and Loop
suture
IM Pin Fixation
Loop Suture
Soliman et al: Under-coracoid-around-clavicle (UCAC)
loop rigid fixation and lead to bony union, provides
adequate stability with excellent results.
Figure 2: Arthroscopic view through the anterolateral portal showing the base of
the coracoid with the inferior button of the TightRope device deployed. Figure
3: AP radiograph 6 months postoperatively, revealing osseous union of the distal
clavicle. Figure 4: Symmetric anatomic appearance of the right acromioclavicular
joint and distal clavicle 6 months postoperatively
Comparison Study
Bishop JY et al No significant difference in ultimate load to
failure was found in a biomechanic comparison study among
4 groups : suture fixation with a cerclage suture and
coracoclavicular suture, distal clavicle locking plate, distal
clavicle locking plates with suture augmentation, and distal
clavicle hook plate.
Comparison Study
Karl Wu et al hook plate fixation of unstable lateral
clavicle fractures was associated with statistically better
shoulder function and earlier implant removal than K-wire
tension band fixation.
Comparison Study
Conclusion
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