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Published in: BMC Musculoskeletal Disorders 1/2020

01-12-2020 | Clavicle Fracture | Research article

Treatment of distal clavicle fractures using a Scorpion plate and influence of timing on surgical outcomes: a retrospective cohort study of 105 cases

Authors: Ryogo Furuhata, Masaaki Takahashi, Teppei Hayashi, Miyu Inagawa, Aki Kono, Noboru Matsumura, Yusaku Kamata, Hiroshi Arino, Hideo Morioka

Published in: BMC Musculoskeletal Disorders | Issue 1/2020

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Abstract

Background

Plate fixation is an established method for treating unstable distal clavicle fractures. However, the appropriate timing of surgery for acute distal clavicle fractures remains unclear. The present study aimed to evaluate the clinical outcomes of osteosynthesis using a Scorpion plate and to assess the influence of surgery timing on the surgical outcomes for acute unstable distal clavicle fractures.

Methods

We retrospectively reviewed 105 patients who underwent fixation for acute unstable distal clavicle fractures (Neer type II and V) using the Scorpion plate between 2008 and 2018. Patients were divided into early (45 patients) and delayed (60 patients) treatment groups based on the timing of the surgical intervention (within or after 7 days). The outcomes were postoperative complications (nonunion, peri-implant fracture, plate loosening, plate-related pain, and stiffness). We evaluated the outcomes from X-ray radiographs and clinical notes.

Results

Among the 105 patients, nonunion, plate loosening, plate-related pain, and stiffness were observed in six patients (5.7%), four patients (3.8%), seven patients (6.7%), and one patient (1.0%), respectively. The nonunion rate was significantly higher in the delayed treatment group than that in the early treatment group (P = 0.036). Although the difference was not significant, plate loosening and stiffness were only observed in the delayed treatment group.

Conclusion

Our results demonstrated that osteosynthesis using Scorpion plates achieved satisfactory surgical outcomes for unstable distal clavicle fractures. In addition, this study suggested that performing surgery within 6 days after injury is recommended to reduce postoperative complications.
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Literature
1.
go back to reference Nordqvist A, Petersson C, Redlund-Johnell I. The natural course of lateral clavicle fracture. 15 (11-21) year follow-up of 110 cases. Acta Orthop Scand. 1993;64:87–91.CrossRef Nordqvist A, Petersson C, Redlund-Johnell I. The natural course of lateral clavicle fracture. 15 (11-21) year follow-up of 110 cases. Acta Orthop Scand. 1993;64:87–91.CrossRef
2.
go back to reference 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;86:1359–65.CrossRef 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;86:1359–65.CrossRef
3.
go back to reference Rokito AS, Zuckerman JD, Shaari JM, Eisenberg DP, Cuomo F, Gallagher MA. A comparison of nonoperative and operative treatment of type II distal clavicle fractures. Bull Hosp Jt Dis. 2002;61:32–9.PubMed Rokito AS, Zuckerman JD, Shaari JM, Eisenberg DP, Cuomo F, Gallagher MA. A comparison of nonoperative and operative treatment of type II distal clavicle fractures. Bull Hosp Jt Dis. 2002;61:32–9.PubMed
4.
go back to reference Neer CS. Fractures and dislocations of the shoulder. In: Rockwood Jr CA, Green DP, editors. Fractures in adults. Philadelphia: Lippincott; 1984. p. 711–2. Neer CS. Fractures and dislocations of the shoulder. In: Rockwood Jr CA, Green DP, editors. Fractures in adults. Philadelphia: Lippincott; 1984. p. 711–2.
5.
go back to reference Neer CS. Fractures of the distal third of the clavicle. Clin Orthop Relat Res. 1968;58:43–50.PubMed Neer CS. Fractures of the distal third of the clavicle. Clin Orthop Relat Res. 1968;58:43–50.PubMed
6.
go back to reference Banerjee R, Waterman B, Padalecki J, Robertson W. Management of distal clavicle fractures. J Am Acad Orthop Surg. 2011;19:392–401.CrossRef Banerjee R, Waterman B, Padalecki J, Robertson W. Management of distal clavicle fractures. J Am Acad Orthop Surg. 2011;19:392–401.CrossRef
7.
8.
go back to reference Fan J, Zhang Y, Huang Q, Jiang X, He L. Comparison of treatment of acute unstable distal clavicle fractures using anatomical locking plates with versus without additional suture anchor fixation. Med Sci Monit. 2017;23:5455–61.CrossRef Fan J, Zhang Y, Huang Q, Jiang X, He L. Comparison of treatment of acute unstable distal clavicle fractures using anatomical locking plates with versus without additional suture anchor fixation. Med Sci Monit. 2017;23:5455–61.CrossRef
9.
go back to reference Fleming MA, Dachs R, Maqungo S, du Plessis JP, Vrettos BC, Roche SJ. Angular stable fixation of displaced distal-third clavicle fractures with superior precontoured locking plates. J Shoulder Elb Surg. 2015;24:700–4.CrossRef Fleming MA, Dachs R, Maqungo S, du Plessis JP, Vrettos BC, Roche SJ. Angular stable fixation of displaced distal-third clavicle fractures with superior precontoured locking plates. J Shoulder Elb Surg. 2015;24:700–4.CrossRef
10.
go back to reference Flinkkilä T, Ristiniemi J, Lakovaara M, Hyvönen P, Leppilahti J. Hook-plate fixation of unstable lateral clavicle fractures: a report on 63 patients. Acta Orthop. 2006;77:644–9.CrossRef Flinkkilä T, Ristiniemi J, Lakovaara M, Hyvönen P, Leppilahti J. Hook-plate fixation of unstable lateral clavicle fractures: a report on 63 patients. Acta Orthop. 2006;77:644–9.CrossRef
11.
go back to reference Ibrahim S, Meleppuram JJ. Retrospective study of superior anterior plate as a treatment for unstable (Neer type 2) distal clavicle fractures. Rev Bras Ortop. 2017;53:306–13.CrossRef Ibrahim S, Meleppuram JJ. Retrospective study of superior anterior plate as a treatment for unstable (Neer type 2) distal clavicle fractures. Rev Bras Ortop. 2017;53:306–13.CrossRef
12.
go back to reference Kashii M, Inui H, Yamamoto K. Surgical treatment of distal clavicle fractures using the clavicular hook plate. Clin Orthop Relat Res. 2006;447:158–64.CrossRef Kashii M, Inui H, Yamamoto K. Surgical treatment of distal clavicle fractures using the clavicular hook plate. Clin Orthop Relat Res. 2006;447:158–64.CrossRef
13.
go back to reference Martetschläger F, Kraus TM, Schiele CS, Sandmann G, Siebenlist S, Braun KF, Stöckle U, Freude T, Neumaier M. Treatment for unstable distal clavicle fractures (Neer 2) with locking T-plate and additional PDS cerclage. Knee Surg Sports Traumatol Arthrosc. 2013;21:1189–94.CrossRef Martetschläger F, Kraus TM, Schiele CS, Sandmann G, Siebenlist S, Braun KF, Stöckle U, Freude T, Neumaier M. Treatment for unstable distal clavicle fractures (Neer 2) with locking T-plate and additional PDS cerclage. Knee Surg Sports Traumatol Arthrosc. 2013;21:1189–94.CrossRef
14.
go back to reference Zhang C, Huang J, Luo Y, Sun H. Comparison of the efficacy of a distal clavicular locking plate versus a clavicular hook plate in the treatment of unstable distal clavicle fractures and a systematic literature review. Int Orthop. 2014;38:1461–8.CrossRef Zhang C, Huang J, Luo Y, Sun H. Comparison of the efficacy of a distal clavicular locking plate versus a clavicular hook plate in the treatment of unstable distal clavicle fractures and a systematic literature review. Int Orthop. 2014;38:1461–8.CrossRef
15.
go back to reference Lee W, Choi CH, Choi YR, Lim KH, Chun YM. Clavicle hook plate fixation for distal-third clavicle fracture (Neer type II): comparison of clinical and radiologic outcomes between Neer types IIA and IIB. J Shoulder Elb Surg. 2017;26:1210–5.CrossRef Lee W, Choi CH, Choi YR, Lim KH, Chun YM. Clavicle hook plate fixation for distal-third clavicle fracture (Neer type II): comparison of clinical and radiologic outcomes between Neer types IIA and IIB. J Shoulder Elb Surg. 2017;26:1210–5.CrossRef
16.
go back to reference Klein SM, Badman BL, Keating CJ, Devinney DS, Frankle MA, Mighell MA. Results of surgical treatment for unstable distal clavicular fractures. J Shoulder Elb Surg. 2010;19:1049–55.CrossRef Klein SM, Badman BL, Keating CJ, Devinney DS, Frankle MA, Mighell MA. Results of surgical treatment for unstable distal clavicular fractures. J Shoulder Elb Surg. 2010;19:1049–55.CrossRef
17.
go back to reference Xiong J, Chen JH, Dang Y, Zhang DY, Fu ZG, Zhang PX. Treatment of unstable distal clavicle fractures (Neer type II): a comparison of three internal fixation methods. J Int Med Res. 2018;46:4678–83.CrossRef Xiong J, Chen JH, Dang Y, Zhang DY, Fu ZG, Zhang PX. Treatment of unstable distal clavicle fractures (Neer type II): a comparison of three internal fixation methods. J Int Med Res. 2018;46:4678–83.CrossRef
18.
go back to reference Brouwer KM, Wright TC, Ring DC. Failure of superior locking clavicle plate by axial pull-out of the lateral screws: a report of four cases. J Shoulder Elb Surg. 2009;18:e22–5.CrossRef Brouwer KM, Wright TC, Ring DC. Failure of superior locking clavicle plate by axial pull-out of the lateral screws: a report of four cases. J Shoulder Elb Surg. 2009;18:e22–5.CrossRef
19.
go back to reference Jarvis NE, Halliday L, Sinnott M, Mackenzie T, Funk L, Monga P. Surgery for the fractured clavicle: factors predicting nonunion. J Shoulder Elb Surg. 2018;27:e155–9.CrossRef Jarvis NE, Halliday L, Sinnott M, Mackenzie T, Funk L, Monga P. Surgery for the fractured clavicle: factors predicting nonunion. J Shoulder Elb Surg. 2018;27:e155–9.CrossRef
20.
go back to reference Meda PV, Machani B, Sinopidis C, Braithwaite I, Brownson P, Frostick SP. Clavicular hook plate for lateral end fractures:- a prospective study. Injury. 2006;37:277–83.CrossRef Meda PV, Machani B, Sinopidis C, Braithwaite I, Brownson P, Frostick SP. Clavicular hook plate for lateral end fractures:- a prospective study. Injury. 2006;37:277–83.CrossRef
21.
go back to reference Siebenbürger G, Van Delden D, Helfen T, Haasters F, Böcker W, Ockert B. Timing of surgery for open reduction and internal fixation of displaced proximal humeral fractures. Injury. 2015;46:S58–62.CrossRef Siebenbürger G, Van Delden D, Helfen T, Haasters F, Böcker W, Ockert B. Timing of surgery for open reduction and internal fixation of displaced proximal humeral fractures. Injury. 2015;46:S58–62.CrossRef
22.
go back to reference Neer CS. Fracture of the distal clavicle with detachment of the coracoclavicular ligaments in adults. J Trauma. 1963;3:99–110.CrossRef Neer CS. Fracture of the distal clavicle with detachment of the coracoclavicular ligaments in adults. J Trauma. 1963;3:99–110.CrossRef
23.
go back to reference Napora JK, Grimberg D, Childs BR, Vallier HA. Factors affecting functional outcomes after clavicle fracture. J Am Acad Orthop Surg. 2016;24:721–7.CrossRef Napora JK, Grimberg D, Childs BR, Vallier HA. Factors affecting functional outcomes after clavicle fracture. J Am Acad Orthop Surg. 2016;24:721–7.CrossRef
24.
go back to reference Tang X, Liu L, Tu CQ, Li J, Li Q, Pei FX. Comparison of early and delayed open reduction and internal fixation for treating closed tibial pilon fractures. Foot Ankle Int. 2014;35:657–64.CrossRef Tang X, Liu L, Tu CQ, Li J, Li Q, Pei FX. Comparison of early and delayed open reduction and internal fixation for treating closed tibial pilon fractures. Foot Ankle Int. 2014;35:657–64.CrossRef
Metadata
Title
Treatment of distal clavicle fractures using a Scorpion plate and influence of timing on surgical outcomes: a retrospective cohort study of 105 cases
Authors
Ryogo Furuhata
Masaaki Takahashi
Teppei Hayashi
Miyu Inagawa
Aki Kono
Noboru Matsumura
Yusaku Kamata
Hiroshi Arino
Hideo Morioka
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2020
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-020-3169-9

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