• Clinics in Shoulder and Elbow
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• v.19 no.3
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• pp.143-148
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• 2016

Background: The purpose of our study was to evaluate the accuracy of reduction based on postoperative computed tomography (CT) images after arthroscopic stabilization using tightrope system for unstable distal clavicle fracture. Methods: Twelve patients with distal clavicle fracture combined with coracoclavicular (CC) ligament injury (type II, V) who received arthroscopically assisted fixation using a flip button device were evaluated for accuracy of reduction using 3-dimensional postoperative CT scan by measuring the degree of distal clavicular angulation and clavicular shortening. Results: Immediate postoperative plain radiograph confirmed restoration of the CC distance (CCD) in 10 patients. At final follow-up, the CCD remained reduced anatomically on plain radiographs in these patients. All patients showed excessive posterior angulation and shortening compared to the opposite side. The average Constant score recovered to 94.8 at final follow-up. Conclusions: Indirect reduction and arthroscopic subacromial approach with flip button fixation of unstable distal clavicle fractures demonstrated favorable clinical results despite unavoidable posterior angulation of distal clavicle and shortening the total length of clavicle.

• Clinics in Shoulder and Elbow
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• v.17 no.4
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• pp.205-208
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• 2014

Sternoclavicular joint posterior dislocations are considered a very uncommon, and type of injury where if esophagus or airway injury occurs behind the clavicle, it poses a high risk to the patient. In addition, if epiphyseal fracture occurs as a result of the sternoclavicular joint posterior dislocation, surgical treatment is often required. However, in the absence of a complete ossification of the clavicle, it is difficult to differentiate between a simple dislocation and epiphyseal fracture-dislocation solely based on simple radiographs or computed tomography scans. In this case report, the authors present a case in which a sternoclavicular joint posterior dislocation was diagnosed in a 14-year-old male athlete. The case report discusses how the posterior dislocation without epiphyseal fracture was diagnosed using an ultrasound and subsequently treated with successful outcomes using manual reduction. The case report presents our findings along with discussion that includes a literature review of relevant research.

• Journal of Chest Surgery
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• v.23 no.4
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• pp.736-744
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• 1990

From Jan. 1985 to Sep. 1989, four hundred and ten patients were admitted to the department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine with a diagnosis of nonpenetrating chest trauma. The most common cause of injury were motor vehicle accidents(75.1%) with the prevalent age group being their forties. The four most common findings were rib fracture(83.4%), hemothorax(50.7%), pneumothorax(24.6%) and clavicle fracture(12.0%), Fifty piratory insufficiency and the ventilation time was correlated with 6 fators : 1) shock 2) endotracheal intubation or tracheostomy 3) hemothorax 4) clavicle fracture 5) flail chest 6) more than three combined injuries or combined head injury. Ventilatory care was also related with mortality and complications such as pneumonia sepsis and empyema thoracis(p<0.05). The most common organism of post-traumatic infection were Pseudomonas and Staphylococcus.

• Clinics in Shoulder and Elbow
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• v.17 no.4
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• pp.175-180
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• 2014

Background: For Neer type IIB fracture of distal clavicle with coracoclavicular ligament injury, various surgical treatments have been used in literatures. However, there was no consensus on the optimal treatment. The aim of this study is to report the clinical and radiological results of open reduction and internal fixation of unstable distal clavicle fracture and suture augmentation of disrupted coracoclavicular ligament. Methods: A prospective study was performed in 23 patients with Neer type IIB distal clavicle fracture in Seoul Medical Center, Eulji Hospital, and National Medical Center. Firstly, suture anchors are inserted in the base of coracoid process and preliminary reduction was achieved by tie-off of three suture limbs around the clavicle. Then, the final fixation was completed with anatomical locking plate. Bony union and the distance between coracoclavicular ligaments were evaluated. Clinical results and complications including stiffness and secondary procedures were evaluated. Results: Bony union was achieved in all cases except one (22 of 23). At mean 14.9 months, no significant difference in the mean coracoclavicular distance was observed compared to uninjured shoulder ($8.2{\pm}7.9mm$ versus $7.3{\pm}3.4mm$, p=0.14). Pain visual analogue scale, American Shoulder and Elbow Surgeons score, Constant score, and Disabilities of the Arm, Shoulder and Hand score were 0.5, 83.4, 78.5, and 6.2, respectively. Revision surgery was performed in one case of nonunion. Four patients who complained of skin irritation underwent implant removal. Conclusions: In cases of an unstable distal clavicle fracture with coracoclavicular ligament disruption, satisfactory clinical results were obtained by locking plate fixation and coracoclavicular ligament suture augmentation concurrently.

• Clinics in Shoulder and Elbow
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• v.8 no.1
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• pp.19-22
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• 2005

Purpose: The causes of twelve cases of the mid-shaft clavicle nonunion and the results of internal fixation with plate and bone graft were investigated. Materials and method: From August 1997 to March 2003, twelve cases of the mid-shaft clavicle nonunion were operated with internal fixation with plate and bone graft. The duration of follow-up was average 13 months. Results: The causes of the mid-shaft clavicle nonunion included severe associated injury, severe initial displacement of the fracture fragments and insecure fixation. All cases were operated with internal fixation with plate and bone graft. According to the factor for evaluations of results, using a rating scale of excellent (no apparent factors), good (one factor), fair (two factors), poor (more than three factors), the results showed 10 excellent, 1 good and 1 poor. Screw loosening was developed in only one case . Conclusion: The internal fixation with plate and bone graft of the mid-shaft clavicle nonunion after failed conservative treatment achieved excellent results and seemed to be the procedure of choice for mid-shaft clavicle nonunion.

• Journal of Korean Orthopaedic Sports Medicine
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• v.1 no.2
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• pp.163-166
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• 2002

Introduction: It is frequently occur in sports injury of clavicular fractures in Hapkido players. Weevaluated Hapkido related clavicular fractures and preventive measure. Methods: We experienced 12 cases of Hapkido related clavicle fracture. The age ranged from 13 to18-years-old. All cases were treated by conservative managements. We examined the relationship between the clavicle fractures and Hapkido related pathomechanics.Results: All cases were injured during the practice for the falling-technique. Results were evaluatedby Weitzman and all cases were revealed more than good. Conclusions: In most cases, the correction of the wrong way of falling-technique will reduce theclavicle fractures in the Hapkido players.

• Clinics in Shoulder and Elbow
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• v.24 no.1
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• pp.9-14
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• 2021

Background: Recent studies about completely displaced midshaft clavicle fractures have reported that their nonunion/malunion rates were significantly higher in conservatively treated patients compared to surgically treated patients. The purpose of this study was to evaluate the factors associated with treatment decisions for midshaft clavicle fractures and also the factors that affect patient satisfaction with their treatment choice. Methods: We retrospectively reviewed the records of 75 patients who had been diagnosed with a midshaft clavicle fracture and were treated conservatively at a single institution between March 1, 2013, and December 31, 2014. Their medical records were reviewed to investigate the severity of the initial vertical displacement. A telephone survey was carried out to identify the presence of any patient-perceived deformity and determine if the patient eventually underwent surgery and whether the patient would prefer surgery if the injury recurred. Results: Significantly more patients with vertical displacement ≥100% (9/28) eventually underwent surgery compared to patients with vertical displacement <100% (3/32, p=0.028). Patients with vertical displacement ≥100% (13/28) were significantly more likely to prefer surgery compared to patients with vertical displacement <100% (7/32, p=0.044). Among the conservatively treated patients, nine of 32 participants with a patient-perceived deformity and one of 16 without a patient-perceived deformity responded that they would prefer to receive surgery in same situation in the future (p=0.079). Conclusions: Patients with a midshaft clavicle fracture with vertical displacement of ≥100% may eventually require surgical treatment. When conservative treatment is carried out, the long-term patient results may be unsatisfactory due to perceived residual deformities.

• Clinics in Shoulder and Elbow
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• v.14 no.1
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• pp.59-66
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• 2011

Purpose: We wanted to evaluate the clinical and radiological outcomes and the prognosis of various surgical treatments for the distal clavicle fracture with an acromioclavicular joint injury. Materials and Methods: A retrospective study of 21 patients with a minimum of 12 months follow up was done. We classified acromioclavicular (AC) injury into type I (only intra-articular fracture (IAF), 5 cases), type II (IAF with widening of the AC joint > 7 mm, 9 cases) and type III (IAF with AC joint superior subluxation > 50%, 7 cases). The distal clavicle fractures were fixed using plate (9 cases), mini screws (1 case), K wire and tension band wiring (10 cases) and transarticular pinning (1 case). Acromioclavicular or coracoacromial ligament reconstruction was not done in all the cases. Results: In 20 of 21 cases, bone union was achieved at an average of 8.4 weeks. Traumatic arthritis (5 cases), AC joint widening (4 cases) and AC joint subluxation (2 cases) were noted at the last follow up. The average UCLA score was 32.6 in the type I AC joint injuries, 34 in type II and 34.1 in type III. There was no relationship between the clinical outcomes and the preoperative AC joint injury pattern, postoperative traumatic arthritis, AC joint widening or AC joint subluxation (p>0.05). Conclusion: Satisfactory results were achieved by acute reduction and firm fixation of the distal clavicle fracture with AC joint injury. There was no relationship between the pattern of AC joint injury, the residual radiologic findings and the functional outcome.

• Clinics in Shoulder and Elbow
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• v.19 no.1
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• pp.2-7
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• 2016

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.

• Clinics in Shoulder and Elbow
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• v.3 no.1
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• pp.44-48
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• 2000

Weaver-Dunn's operation for acromioclavicular injury yields satisfactory results in most cases. Although clavicular prominence can recur, it is not frequently symtomatic, but it can cause serious impairment of shoulder function in young and active patients. The authors performed reconstruction of coracoclavicular ligament with an autogenous hamstring tendon graft in a 31 years old electrician with recurrence of clavicular prominence accompanied by pain and limitation of overhead activity. The hamstring tendon and two coracoclavicular sutures looped under the coracoid process were passed through holes in the clavicle and around the clavicle in overreduced position. Even though clavicular prominence recurred somewhat, the modified UCLA score by Rockwood improved to 17 from 11/20 at 2 years after operation and the patient had no restriction in working as an electrician. Symptomatic patient with recurrent clavicular prominence after Weaver-Dunn's operation can benefit from reconstruction of coracoclavicular ligament with a hamstring tendon.