• Journal of Korean Orthopaedic Sports Medicine
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• v.5 no.1
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• pp.63-68
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• 2006

Purpose: To assess the effectiveness of the Locking compression plate (LCP) after open reduction for the treatment of the displaced clavicular shaft fracture, the clinical and radiologic outcome of the patients who were managed with the LCP for internal fixation after open reduction has been analyzed. Materials and Methods: We reviewed 26 cases with a displaced clavicular shaft fracture treated by internal fixation using Locking compression plate after open reduction between May 2003 and November 2004. The patients were followed up for at least six months period, and final postoperative outcome was evaluated using clinical results based on Kang's criteria, radiologic signs of fusion. Results: All fractures united by an average of 9.3 weeks without delayed union and showed fast recovery of motion fraction and shoulder function. In addition,24 cases without the fractures of proximal humerus recovered to normal range of shoulder notion within 2.9 weeks. Clinically, according to Kang's criteria, the outcome was good or better in 22 patients. The complications included shoulder joint dysfunction in two cases and keloid formation in one case, and no other complications were observed. Conclusion: The internal fixation using LCP for the treatment of displaced clavicular shaft fracture is a safe, reliable method of treatment, with few complications, and offers rapid recovery of shoulder joint function and bone union.

• Clinics in Orthopedic Surgery
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• v.10 no.4
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• pp.455-461
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• 2018

Background: Surgical-site, multimodal drug injection has recently evolved to be a safe and useful method for multimodal pain management even in patients with musculoskeletal trauma. Methods: Fifty consecutive patients who underwent plating for mid-shaft and distal clavicular fractures were included in the study. To evaluate whether surgical-site injections (SIs) have pain management benefits, the patients were divided into two groups (SI and no-SI groups). The injection was administered between the deep and superficial tissues prior to wound closure. The mixture of anesthetics consisted of epinephrine hydrochloride (HCL), morphine sulfate, ropivacaine HCL, and normal saline. The visual analogue scale (VAS) pain scores were measured at 6-hour intervals until postoperative hour (POH) 72; stress biomarkers (dehydroepiandrosterone sulfate [DHEA-S], insulin, and fibrinogen) were measured preoperatively and at POH 24, 48, and 72. In patients who wanted further pain control or had a VAS pain score of 7 points until POH 72, 75 mg of intravenous tramadol was administered, and the intravenous tramadol requirements were also recorded. Other medications were not used for pain management. Results: The SI group showed significantly lower VAS pain scores until POH 24, except for POH 18. Tramadol requirement was significantly lower in the SI group until POH 24, except for POH 12 and 18. The mean DHEA-S level significantly decreased in the no-SI group ($74.2{\pm}47.0{\mu}g/dL$) at POH 72 compared to that in the SI group ($110.1{\pm}87.1{\mu}g/dL$; p = 0.046). There was no significant difference in the insulin and fibrinogen levels between the groups. The correlation values between all the biomarkers and VAS pain scores were not significantly different between the two groups (p > 0.05). Conclusions: After internal fixation of the clavicular fracture, the surgical-site, multimodal drug injection effectively relieved pain on the day of the surgery without any complications. Therefore, we believe that SI is a safe and effective method for pain management after internal fixation of a clavicular fracture.

• Clinics in Shoulder and Elbow
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• v.2 no.1
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• pp.14-20
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• 1999

Purpose: Despite of the popular use of the reconstruction plate for the fixation of clavicular shaft fractures, some disadventages have been raised such as long period of immobilization, long skin incision, loosening of plate and screws, and increased chance of nonunion due to severe periosteal injury. Thus, the authors have performed intramedullary multiple Steinmann pins fixation that could reduce the disadvantages of plate fixation in order to compare the treatment results between the two groups. Materials & Methods: From 1994. Jan. to 1997. Dec. the department of orthopaedic surgery of the Kwak's hospital treated operatively for 56 cases of the clavicular shaft fractures in adult. 39 cases of them were treated with the plate fixation and 17 cases with the intramedullary multiple Steinmann pins fixation(SP group). Reconstruction plates(Plate group) were used for 26 out of 39 patients treated with plate fixation. Among the Plate group and SP group, each 15 cases were selected by age and sex and compared each other according to the bone union time, union rate, complication, and functional results. The follow-up period was 12 months at the shortest and 48 months at the longest and the average was 16 months. Results: The Plate group showed that the bone union time was 7 weeks and the bone union rate was 93%. The SP group showed 6.5 weeks and 100% respectively. In complication, the Plate group had 1 case of loosening of plate and screws and delayed union; SP group had 1 case of pin migration. The functional results according to Kang's criteria, 87% of the Plate group and 93% of the SP group showed good or excellent. Conclusion : The SP group showed very comparable results in terms of the bone union time, bone union rate, complication, and functional results comparing to the Plate group. The intramedullary multiple Steinmann pins fixation showed several advantages over the reconstruction plate fixation, which were simple operative technique, easy removal of pins, being able to perform immediate postoperative full range of motion exercise. Therefore, the intramedullary multiple Steinmann pins fixation is thought to be one of the useful operative techniques in treatment of the clavicular shaft fractures in adult.

• Clinics in Shoulder and Elbow
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• v.26 no.4
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• pp.397-405
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• 2023

Background: A precontoured plate rarely fits properly within the patient's clavicle and must be bent intraoperatively. This study aimed to determine whether anatomical reduction could be achieved using a plate bent before surgery. Methods: This study included 87 consecutive patients with displaced mid-shaft clavicle fractures who underwent plate fixation and were followed-up for a minimum of 1 year. After exclusions, 39 consecutive patients underwent fixation with a precontoured plate bent intraoperatively (intraoperative bending group), and 28 underwent fixation with the plate bent preoperatively (preoperative bending group). Using free software and a three-dimensional (3D) printer, ipsilateral clavicle 3D-printed models were constructed. Using plain radiographs, the distance between the edge of the lateral inferior cortex and the medial inferior cortex was measured. The angle between the line connecting the inferior cortex edge and the line passing through the flat portion of the superior cortex of the distal clavicle was measured. Results: Mean length differences between the ipsilateral and contralateral clavicle were smaller on both anteroposterior (AP; P=0.032) and axial images (P=0.029) in the preoperative bending group. The mean angular differences on both AP (P=0.045) and axial images (P=0.008) were smaller in the preoperative bending group. No significant differences were observed between the two groups in functional scores at the last follow-up. Conclusions: Smaller differences in length and angle between the ipsilateral and contralateral clavicle, indicative of reduction, were observed in the preoperative bending group. Using the precontoured technique with low expense, the operation was performed more effectively as reflected by a shorter operation time. Level of evidence: III.

• Clinics in Shoulder and Elbow
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• v.7 no.1
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• pp.41-45
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• 2004

In adhesive capsulitis of the shoulder of no response to nonoperative treatment, an arthroscopic capsular release and manipulation improves range of motion and pain relief. We performed an arthroscopic examination in the stiff shoulder, of which she had no response to nonoperative treatment, after the conservative treatment of a clavicular shaft fracture by motorcycle-driver traffic accident. We found the intra-articular 'rotator interval bridging scar adhesion' between subscapularis tendon and antero-superior glenoid fossa under the rotator interval which was no adhesion and contracture itself. We performed the scar adhesion removal and synovectomy, maintaining the rotator interval. We recommended nonsteroidal anti-inflammatory drug for postoperative pain relief and continuous active and passive range of motion (ROM) exercise to gain motions. Preoperatively, active and passive range of motion were 70° for forward elevation, 60° for abduction and especially 0° for external rotation. After postoperative 2 months, active ROM were 150° for forward elevation, 130° for abduction and 80° for external rotation. After postoperative 6 months, passive and active ROM were full. UCLA score improved from preoperative 9 points to postoperative 29 points.