Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
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Comparison between Accurate Anatomical Reduction and Unsuccessful Reduction with a Remaining Gap after Open Reduction and Plate Fixation of Midshaft Clavicle Fracture

  • Kim, Joon Yub (Department of Orthopedic Surgery, Myongji Hospital, Seonam Univeristy School of Medicine) ;
  • Choe, Jung Soo (Department of Orthopedic Surgery, Myongji Hospital, Seonam Univeristy School of Medicine) ;
  • Chung, Seok Won (Department of Orthopedic Surgery, Konkuk University Medical Center)
  • Received : 2014.12.19
  • Accepted : 2015.04.04
  • Published : 2016.03.31
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Abstract

Background: The purpose of this study is to compare the radiological and clinical outcomes after open reduction and plate fixation of midshaft clavicle fractures between patients who achieved successful anatomical reduction and those who had a remaining fracture gap even after open reduction and plate fixation, and were thus treated with additional demineralized bone matrix (DBM). Methods: This retrospective analysis was conducted on 56 consecutive patients who underwent open reduction and internal fixation using a locking compression plate for acute displaced midshaft clavicle fractures, and who underwent radiographic and clinical outcome evaluations at least 6 months postoperatively. The outcomes between those who achieved perfect anatomical reduction without remnant gap (n=32) and those who had a remaining fracture gap even after open reduction and plate fixation treated with additional DBM (n=24) were evaluated. Results: There were no differences in the use of lag screws or wiring and operation time (all p>0.05) between those with and without remnant gap. No difference in the average radiological union time and clinical outcomes (satisfaction and Constant score) was observed between the two groups (all p>0.05). However, significantly faster union time was observed for AO type A fracture compared with other types (p=0.012), and traffic accident showed association with worse clinical outcomes compared with other causes of injury. Conclusions: Surgical outcome of midshaft clavicle fracture was more affected by initial fracture type and event, and re-reduction and re-fixation of the fracture to obtain a perfect anatomical reduction spending time appears to be unnecessary if rigid fixation is achieved.

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References

  1. O'Neill BJ, Hirpara KM, O'Briain D, McGarr C, Kaar TK. Clavicle fractures: a comparison of five classification systems and their relationship to treatment outcomes. Int Orthop. 2011; 35(6):909-14. https://doi.org/10.1007/s00264-010-1151-0
  2. Postacchini F, Gumina S, De Santis P, Albo F. Epidemiology of clavicle fractures. J Shoulder Elbow Surg. 2002;11(5):452-6. https://doi.org/10.1067/mse.2002.126613
  3. Nordqvist A, Petersson C. The incidence of fractures of the clavicle. Clin Orthop Relat Res. 1994;(300):127-32.
  4. Postacchini R, Gumina S, Farsetti P, Postacchini F. Long-term results of conservative management of midshaft clavicle fracture. Int Orthop. 2010;34(5):731-6. https://doi.org/10.1007/s00264-009-0850-x
  5. McKee MD, Pedersen EM, Jones C, et al. Deficits following nonoperative treatment of displaced midshaft clavicular fractures. J Bone Joint Surg Am. 2006;88(1):35-40.
  6. Smekal V, Oberladstaetter J, Struve P, Krappinger D. Shaft fractures of the clavicle: current concepts. Arch Orthop Trauma Surg. 2009;129(6):807-15. https://doi.org/10.1007/s00402-008-0775-7
  7. Zlowodzki M, Zelle BA, Cole PA, Jeray K, McKee MD; Evidence-Based Orthopaedic Trauma Working Group. Treatment of acute midshaft clavicle fractures: systematic review of 2144 fractures: on behalf of the Evidence-Based Orthopaedic Trauma Working Group. J Orthop Trauma. 2005;19(7):504-7. https://doi.org/10.1097/01.bot.0000172287.44278.ef
  8. Martin GJ Jr, Boden SD, Titus L, Scarborough NL. New formulations of demineralized bone matrix as a more effective graft alternative in experimental posterolateral lumbar spine arthrodesis. Spine (Phila Pa 1976). 1999;24(7):637-45. https://doi.org/10.1097/00007632-199904010-00005
  9. Ziran BH, Smith WR, Morgan SJ. Use of calcium-based demineralized bone matrix/allograft for nonunions and posttraumatic reconstruction of the appendicular skeleton: preliminary results and complications. J Trauma. 2007;63(6):1324-8. https://doi.org/10.1097/01.ta.0000240452.64138.b0
  10. Oakes DA, Lee CC, Lieberman JR. An evaluation of human demineralized bone matrices in a rat femoral defect model. Clin Orthop Relat Res. 2003;(413):281-90.
  11. Marsh JL, Slongo TF, Agel J, et al. Fracture and dislocation classification compendium - 2007: Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma. 2007;21(10 Suppl):S1-133. https://doi.org/10.1097/00005131-200711101-00001
  12. Caneva M, Botticelli D, Stellini E, Souza SL, Salata LA, Lang NP. Magnesium-enriched hydroxyapatite at immediate implants: a histomorphometric study in dogs. Clin Oral Implants Res. 2011;22(5):512-7. https://doi.org/10.1111/j.1600-0501.2010.02040.x
  13. Jiang H, Qu W. Operative treatment of clavicle midshaft fractures using a locking compression plate: comparison between mini-invasive plate osteosynthesis (MIPPO) technique and conventional open reduction. Orthop Traumatol Surg Res. 2012;98(6):666-71. https://doi.org/10.1016/j.otsr.2012.02.011
  14. Altamimi SA, McKee MD; Canadian Orthopaedic Trauma Society. Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. Surgical technique. J Bone Joint Surg Am. 2008;90 Suppl 2 Pt 1:1-8.
  15. Khorami M, Fakour M, Mokarrami H, Arti HR, Nasab AM, Shahrivar F. The comparison of results of treatment of midshaft clavicle fracture between operative treatment with plate and non-operative treatment. Arch Bone Jt Surg. 2014;2(3):210-4.
  16. Haidukewych GJ. Innovations in locking plate technology. J Am Acad Orthop Surg. 2004;12(4):205-12. https://doi.org/10.5435/00124635-200407000-00001
  17. Perren SM. Evolution and rationale of locked internal fixator technology. Introductory remarks. Injury. 2001;32 Suppl 2:B3-9.
  18. Phillips AM. Overview of the fracture healing cascade. Injury. 2005;36 Suppl 3:S5-7. https://doi.org/10.1016/j.injury.2005.07.027
  19. Edwards JT, Diegmann MH, Scarborough NL. Osteoinduction of human demineralized bone: characterization in a rat model. Clin Orthop Relat Res. 1998;(357):219-28.
  20. Rabie AB, Wong RW, Hägg U. Composite autogenous bone and demineralized bone matrices used to repair defects in the parietal bone of rabbits. Br J Oral Maxillofac Surg. 2000;38(5): 565-70. https://doi.org/10.1054/bjom.2000.0464

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