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European Journal of Medical Research

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Open Access 01-12-2021 | Fracture Healing | Research

Comparable results using 2.0-mm vs. 3.5-mm screw augmentation in midshaft clavicle fractures: a 10-year experience

Authors: M. Wurm, M. Zyskowski, F. Greve, A. Gersing, P. Biberthaler, C. Kirchhoff

Published in: European Journal of Medical Research | Issue 1/2021

Abstract

Purpose

Absence of cortical alignment in wedge-shaped and multifragmentary fractures (Fx) results in decreased fixation stability. The aim of this study was to compare the outcome using 2.0- vs. 3.5-mm screws for open reduction and internal fixation (ORIF) in dislocated, wedge-shaped or fragmentary midshaft clavicle fractures.

Materials and methods

Patients suffering from AO/OTA 15 2.A-C midshaft clavicle fractures were operatively treated between 2008 and 2018. 2.0- or 3.5-mm cortical screws were used to restore anatomic alignment in dislocated, wedge-shaped and fragmentary clavicle fractures. Data of radiologic outcome were collected until fracture consolidation was identified.

Results

80 consecutive patients with a mean age of 44.5 ± 16.3 years, who were operatively treated for dislocated midshaft clavicle fractures were enrolled. 40 patients were treated using 2.0-mm and 40 patients using routine 3.5-mm cortical screws, respectively. Time to fracture consolidation was 12.8 ± 7.8 months. No mal- or non-unions occurred during routine follow-up until 18 months postoperatively.

Conclusion

Restoring anatomic alignment in wedge or fragmentary clavicle fractures can ultimately be addressed using cortical screw augmentation. Both groups showed comparable results with respect to fracture reduction, fixation and stability as well as time to consolidation of the fracture, while the 2.0-mm screw diameter was associated with easier handling of small Fx fragments.

Huttunen TT, Launonen AP, Berg HE, Lepola V, Fellander-Tsai L, Mattila VM. Trends in the incidence of clavicle fractures and surgical repair in Sweden: 2001–2012. J Bone Joint Surg Am. 2016;98(21):1837–42. https://doi.org/10.2106/JBJS.15.01284.CrossRefPubMed

Hulsmans MH, van Heijl M, Houwert RM, Burger BJ, Verleisdonk EJM, Veeger DJ, van der Meijden OA. Surgical fixation of midshaft clavicle fractures: A systematic review of biomechanical studies. Injury. 2018;49(4):753–65. https://doi.org/10.1016/j.injury.2018.02.017.CrossRefPubMed

Huber-Wagner S, Lefering R, Kanz KG, Biberthaler P, Stengel D. The importance of immediate total-body CT scanning. Lancet. 2017;389(10068):502–3. https://doi.org/10.1016/S0140-6736(17)30232-5.CrossRefPubMed

Lazarides S, Zafiropoulos G. Conservative treatment of fractures at the middle third of the clavicle: the relevance of shortening and clinical outcome. J Shoulder Elbow Surg. 2006;15(2):191–4. https://doi.org/10.1016/j.jse.2005.08.007.CrossRefPubMed

Wurm M, Beirer M, Zyskowski M, Volk C, Schwarz A, Biberthaler P, Kirchhoff C, Cronlein M. Does implant removal of superior clavicle plate osteosynthesis affect the functional outcome: a prospective trial. Arch Orthop Trauma Surg. 2020. https://doi.org/10.1007/s00402-020-03669-z.CrossRefPubMed

Zlowodzki M, Zelle BA, Cole PA, Jeray K, McKee MD, Working E-B, G, . 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.CrossRef

Beirer M, Banke IJ, Harrasser N, Cronlein M, Pforringer D, Huber-Wagner S, Biberthaler P, Kirchhoff C. Mid-term outcome following revision surgery of clavicular non- and malunion using anatomic locking compression plate and iliac crest bone graft. BMC Musculoskelet Disord. 2017;18(1):129. https://doi.org/10.1186/s12891-017-1488-2.CrossRefPubMedPubMedCentral

Fuglesang HF, Flugsrud GB, Randsborg PH, Stavem K, Utvag SE. Radiological and functional outcomes 2.7 years following conservatively treated completely displaced midshaft clavicle fractures. Arch Orthop Trauma Surg. 2016;136(1):17–25. https://doi.org/10.1007/s00402-015-2354-z.CrossRefPubMed

Robinson CM, Goudie EB, Murray IR, Jenkins PJ, Ahktar MA, Read EO, Foster CJ, Clark K, Brooksbank AJ, Arthur A, Crowther MA, Packham I, Chesser TJ. Open reduction and plate fixation versus nonoperative treatment for displaced midshaft clavicular fractures: a multicenter, randomized, controlled trial. J Bone Joint Surg Am. 2013;95(17):1576–84. https://doi.org/10.2106/JBJS.L.00307.CrossRefPubMed

10.

Murray IR, Foster CJ, Eros A, Robinson CM. Risk factors for nonunion after nonoperative treatment of displaced midshaft fractures of the clavicle. J Bone Joint Surg Am. 2013;95(13):1153–8. https://doi.org/10.2106/JBJS.K.01275.CrossRefPubMed

11.

Clement ND, Goudie EB, Brooksbank AJ, Chesser TJ, Robinson CM. Smoking status and the Disabilities of the Arm Shoulder and Hand score are early predictors of symptomatic nonunion of displaced midshaft fractures of the clavicle. Bone Joint J. 2016;98-B(1):125–30. https://doi.org/10.1302/0301-620X.98B1.36260.CrossRefPubMed

12.

Hill JM, McGuire MH, Crosby LA. Closed treatment of displaced middle-third fractures of the clavicle gives poor results. J Bone Joint Surg Br. 1997;79(4):537–9. https://doi.org/10.1302/0301-620x.79b4.7529.CrossRefPubMed

13.

Robinson CM, Court-Brown CM, McQueen MM, Wakefield AE. Estimating the risk of nonunion following nonoperative treatment of a clavicular fracture. J Bone Joint Surg Am. 2004;86-A(7):1359–65.CrossRef

14.

Pang EQ, Zhang S, Harris AHS, Kamal RN. Treatment trends in older adults with midshaft clavicle fractures. J Hand Surg Am. 2017;42(11):875–82. https://doi.org/10.1016/j.jhsa.2017.06.099.CrossRefPubMed

15.

Houwert RM, Smeeing DP, Ahmed Ali U, Hietbrink F, Kruyt MC, van der Meijden OA. Plate fixation or intramedullary fixation for midshaft clavicle fractures: a systematic review and meta-analysis of randomized controlled trials and observational studies. J Shoulder Elbow Surg. 2016;25(7):1195–203. https://doi.org/10.1016/j.jse.2016.01.018.CrossRefPubMed

16.

Ferran NA, Hodgson P, Vannet N, Williams R, Evans RO. Locked intramedullary fixation vs plating for displaced and shortened mid-shaft clavicle fractures: a randomized clinical trial. J Shoulder Elbow Surg. 2010;19(6):783–9. https://doi.org/10.1016/j.jse.2010.05.002.CrossRefPubMed

17.

Chen X, Shannon SF, Torchia M, Schoch B. Radiographic outcomes of single versus dual plate fixation of acute mid-shaft clavicle fractures. Arch Orthop Trauma Surg. 2017;137(6):749–54. https://doi.org/10.1007/s00402-017-2676-0.CrossRefPubMed

18.

Little KJ, Riches PE, Fazzi UG. Biomechanical analysis of locked and non-locked plate fixation of the clavicle. Injury. 2012;43(6):921–5. https://doi.org/10.1016/j.injury.2012.02.007.CrossRefPubMed

19.

Uzer G, Yildiz F, Batar S, Bozdag E, Kuduz H, Bilsel K. Biomechanical comparison of three different plate configurations for comminuted clavicle midshaft fracture fixation. J Shoulder Elbow Surg. 2017;26(12):2200–5. https://doi.org/10.1016/j.jse.2017.06.034.CrossRefPubMed

20.

Wurm M, Beirer M, Biberthaler P, Kirchhoff C. Clavicular fractures: diagnostics, management and treatment. Unfallchirurg. 2018;121(12):983–98. https://doi.org/10.1007/s00113-018-0575-7.CrossRefPubMed

21.

Robinson CM. Fractures of the clavicle in the adult. Epidemiology and classification. J Bone Joint Surg Br. 1998;80(3):476–84. https://doi.org/10.1302/0301-620x.80b3.8079.CrossRefPubMed

22.

Hulsmans MH, van Heijl M, Houwert RM, Hammacher ER, Meylaerts SA, Verhofstad MH, Dijkgraaf MG, Verleisdonk EJ. High irritation and removal rates after plate or nail fixation in patients with displaced midshaft clavicle fractures. Clin Orthop Relat Res. 2017;475(2):532–9. https://doi.org/10.1007/s11999-016-5113-8.CrossRefPubMed

23.

Schemitsch LA, Schemitsch EH, Kuzyk P, McKee MD. Prognostic factors for reoperation after plate fixation of the midshaft clavicle. J Orthop Trauma. 2015;29(12):533–7. https://doi.org/10.1097/BOT.0000000000000331.CrossRefPubMed

24.

Robertson C, Celestre P, Mahar A, Schwartz A. Reconstruction plates for stabilization of mid-shaft clavicle fractures: differences between nonlocked and locked plates in two different positions. J Shoulder Elbow Surg. 2009;18(2):204–9. https://doi.org/10.1016/j.jse.2008.10.002.CrossRefPubMed

Title: Comparable results using 2.0-mm vs. 3.5-mm screw augmentation in midshaft clavicle fractures: a 10-year experience
Authors: M. Wurm
M. Zyskowski
F. Greve
A. Gersing
P. Biberthaler
C. Kirchhoff
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Fracture Healing
Clavicle Fracture
Published in: European Journal of Medical Research / Issue 1/2021
Electronic ISSN: 2047-783X
DOI: https://doi.org/10.1186/s40001-021-00487-w

At a glance: The STEP trials

Springer Medicine

Comparable results using 2.0-mm vs. 3.5-mm screw augmentation in midshaft clavicle fractures: a 10-year experience

Abstract

Purpose

Materials and methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Materials and methods

Results

Conclusion

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