• Archives of Plastic Surgery
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• v.51 no.1
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• pp.67-71
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• 2024

Clavicle fractures are frequent injuries accounting for approximately 4% of all fractures in adults with about 35% occurring in the shoulder region among which midshaft fractures are the most common (>66%). Nonsurgical management is the treatment of choice for most clavicle fractures; however, poor functional and aesthetic outcomes may result from nonunion, symptomatic malunion, and aesthetic impairment which are the most common complications. A young woman was referred to our clinic for a "Step Deformity" resulting after primary, nonsurgical treatment of a midshaft clavicle fracture. Residual deformity was corrected with a novel simple and little invasive approach. Midshaft clavicle fractures typically only require conservative nonsurgical treatment, nevertheless suboptimal outcomes may occur. Selective osteotomies and fixation are deemed too invasive when only cosmetic impairment of the clavicle contour is present without any functional or sensitive damage and most patients are discouraged from undergoing surgery. Thus far, no specific focus on this topic, nor exploration of possible correction can be found in the published literature. These residual deformities may be very noticeable sometimes and cause psychological distress and social life impairment. Despite no related functional impairment, this deformity should still be addressed, to improve patients' quality of life.

• Clinics in Shoulder and Elbow
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• v.19 no.1
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• pp.25-32
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• 2016

Background: The goal of this study was to evaluate whether a modified fluoroscopic technique for positioning a hook plate affected the clinical results of treating Neer type II distal clavicle fractures and Rockwood type V acromioclavicular (AC) joint separations with this device. Methods: The study was a retrospective consecutive case series with data analysis. Sixty-four patients with a Neer type II distal clavicle fracture or a Rockwood type V AC joint injury treated between March 2009 and June 2013 were divided into 2 groups: traditional fluoroscopic technique (traditional view, 31 patients) or modified fluoroscopic technique ('hook' view, 33 patients). A visual analogue scale (VAS) score, the modified University of California-Los Angeles (UCLA) shoulder scale score, and radiographic osteolysis were the main outcome measures. Results: The traditional group included a significantly larger number of patients with acromial osteolysis than the hook view group: 23 patients (74.2%) vs. 11 patients (33.3%), respectively (p=0.01). Before plate removal, the hook group reported less pain and higher UCLA shoulder scale scores than the traditional group: average VAS score, 1.55 vs. 2.26, respectively; average UCLA score, 30.88 vs. 27.06, respectively. However, there was no significant difference after plate removal. Conclusions: The hook view allows more accurate bending of the hook plate around the contour of the acromion, resulting in decreased osteolysis, decreased pain, and better function with the plate in situ.

• Archives of Reconstructive Microsurgery
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• v.10 no.2
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• pp.111-117
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• 2001

Introduction : The Functional muscle transfer is used to reconstruct the injuried muscle and paralysis of the shoulder. Especially transfer of the trapezius has been the treatment of choice but it has disadvantages of inadequate function and deformed contour, and instability of humeral head in case of acromion resection. We report an operation for shoulder reconstruction after wide resection of malignant fibrous histiocytoma, using rotational latissimus dorsi flap and review the operation method and clinical outcome. Materials and Methods : A patient, 53 year old, with malignant fibrous histiocytoma in the acromioclavicular joint area had been underwent wide excision, including the deltoid, clavicular head of pectoralis major, part of trapezius, lateral 1/3 of clavicle and acromion including scapular spine. The rotational latissimus dorsi flap with its neurovascular pedicle was dissected and then placed over the resected area and transfer of muscle attached at coracoid process was done to achieve stability of the humeral head. The range of motion of the shoulder and test of muscle power were evaluated for functional outcome. Total follow-up period is 2 years 11 months. Results : At last follow-up, the range of motion of the shoulder is abduction $90^{\circ}$, flexion $90^{\circ}$, internal rotation $40^{\circ}$, external rotation $50^{\circ}$ and the muscle power is 4 grade in all direction and then we obtained good functional results. There are no complications such as instability or subluxation of the humeral head and deformed contour and he is a disease-free survival state. Conclusions : The transfered latissimus dorsi flap provides adequate lever arm and stabilization and covering of the humeral head by sufficient muscle volume and width. This procedure can be useful not only for the paralysed deltoid reconstruction but also for use in reconstructive surgery after wide resection of the shoulder for malignant tumor.