Treatment of fractures of lateral end of clavicle with open reduction using clavicle hook plate (original) (raw)
Related papers
The role of clavicle hook plate in fracture lateral end of clavicle
2016
Background: Fracture of lateral end clavicle constitutes merely 15% of clavicle fracture, only a third of these fractures are displaced (Neer's Type 2/Edinburgh Type 3B1). (1) No single treatment technique has been hailed as the most preferred technique to manage fracture lateral end clavicle, yielding consistently good union, with least complications. Objective: This initial study attempts to evaluate the role of Clavicle Hook Plate, in the treatment of lateral end clavicle fractures, whether it promises to be the most preferred technique. Material and Methods: To evaluate the results and long term effects in use of this plate we performed a retrospective analysis with a mean follow up of 24 months (2 years) of 16 consecutive patients with acute displaced lateral clavicle fractures, treated with the clavicle hook plate. Results: Our short term results in all patients were good to excellent. None underwent non-union. Impingement symptoms were detected in 3 patients, our 2 patients had skin issues and 1 had significant infection, warranting premature implant removal. Sixteen patients were re-evaluated at a mean follow-up period of 2 years. The Constant-Murley score was 97 and the DASH score was 3.5. Conclusions: Clavicle hook plate presents as a reasonably good primary treatment choice in treating the acute displaced lateral clavicle fractures. Proper selection of patients with good skin conditions and infection control are essential, in this part of the world.
Treatment of displaced lateral clavicular fractures with hook plate, a retrospective review
International Journal of Orthopaedics Sciences, 2017
Fractures of the clavicle have been treated historically by conservative means. However lateral end fractures of clavicle are known to be unstable due to injury to the coracoclavicular ligaments. Hook plate has been used in open reduction and internal fixation of displaced lateral end clavicle fractures. This is a retrospective study of 28 cases of displaced lateral end clavicle fractures treated with ORIF with hook plate, in our hospital between Jan 2009 to Feb 2012. Constant-Murley shoulder function scoring system and DASH scoring was used to evaluate shoulder function. Average Constant Murley score was 86.5 at 4.5 years follow up. Average DASH score was 2.65. Three patients exhibited radiological signs of acromio-clavivular joint arthrosis, and one was symptomatic. All patients achieved bony union. One patient had infection which necessitated debridement, but fracture united
Outcomes of fractures of lateral end of clavicle using different modalities of management
innovative publication, 2017
Background: A fracture of lateral end of clavicle has been greatly underrated in respect to pain and disability. The " usual or routine " treatment is perhaps far short of satisfying, relieving therapy. Aims: Aims of this retrospective study were to study various aspects of patients with fracture of lateral end of clavicle like age, occupation, mode of injuries, type of fracture, etc. Study also aims to evaluate outcome of conservative versus operative treatment of Neer's type II lateral end clavicle fractures and ultimately to determine which treatment modality is most suitable for such fractures. Materials and Methods: Depending on fracture pattern, patients admitted for lateral end clavicle fractures, were either treated conservatively or operatively. Various surgical modalities like plate-screw fixation, K-wiring, tension band wires and coraco-clavicular screw fixation were used. Patients were assessed at admission, 3 months and 6 months post admission. Final outcome was judged in terms of union, range of movement, duration for fracture union, neurological status and ability to perform activities of daily life. The constant shoulder score was used to assess overall functional outcome. Results and Conclusions: Most of the patients were young males having high functional demands who sustained injury due to fall from height or vehicular accident. Although non union was more common in conservative group, functional outcome was acceptable. We conclude that non surgical treatment should be considered as the first line treatment in type I and III and few type II cases. Operative treatment is preferred in type II unstable fractures. Coraco-clavicular fixation turned out to be the most preferred modality of surgical management for such fractures as compared to the plate-screw construct and k-wiring with or without TBW.
Evaluation of hook plate for fixation of displaced lateral third fractures of the clavicle
Menoufia Medical Journal, 2017
Objectives: The objective of this study was to assess the outcome of displaced lateral third clavicle fractures which were fixed using hook plates. Introduction: The lateral third clavicle fractures in adults are unstable fractures requiring operative treatment and are prone to non-union and delayed union. The clavicle hook plate is one of the many operating techniques that can achieve a high rate of union and relatively low rate of complications for this type of fracture, as evident from its extensive use in the last decade or so. Literature suggests good results with many studies reporting union rates of up to 100%. However, the technique is not without its fair share of controversies regarding complications like shoulder impingement, resulting in long term shoulder pain and subacromial osteolysis. We aim to assess the outcome of the patients treated with hook plate and determine whether this technique has good outcome. Methods: 22 patients, who were previously operated on at two health-care centres of Peshawar from April 2016 to March 2019 for displaced fractures of the lateral third of the clavicle by using hook plate technique, were assessed retrospectively from case records and radiographs and clinical examinations of patients, to determine their functional and radiological outcome. The follow-up duration ranged from six months to three years. Result: The average age was 31.6 years with range of 18 to 53 years. Among these 17 were males and 5 females. All the fractures united successfully making the union rate 100%. The implant was removed from 6 of the cases, with only 3 of them due to complications. One of them had a periprosthetic fracture while the other 2 experienced persistent pain and limitation of abduction. Only 37% of the patients had long-lasting pain and 16% complained of stiffness with all of them returning to their work/sports successfully. The functional outcome according to constant score was above 80 in 90% cases. Conclusion: Surgical fixation of lateral-third clavicle fractures with a hook plate is an effective technique resulting in excellent rate of union and relatively good functional outcome.
Journal of Shoulder and Elbow Surgery, 2012
Background: Controversy exists with the use of the acromioclavicular hook plate for the treatment of lateral-third clavicle fractures (Neer type II). This is thought to stem from problems associated with the hook plate causing impingement symptoms, which can cause long-term limitation of movement and pain. Our aim was to evaluate the functional outcomes of patients with lateral-third clavicle fractures treated with the hook plate. Methods: We prospectively reviewed all patients who underwent surgery from July 2005 to August 2009 using our prospectively recorded electronic patient information database. All patients were assessed in the clinic to determine both Oxford and Constant shoulder scores. Results: We identified 36 patients who underwent surgery with the hook plate, 26 men and 10 women. The mean age was 36.2 years (range, 22-60 years). Of the patients, 46% were smokers. The median length of hospital stay was 2 days (interquartile range [IQR], 1-3). The median follow-up was 28 months (IQR, 23-37). The median time from date of injury to surgery was 7 days (IQR, 4-76). The mean time to union was 3 months (IQR, 2-4), and the union rate was 95%. In total, 92% of plates were removed. The median time to removal was 4.5 months (IQR,). There were no complications. Two patients presented months later after falls with fractures around the medial end of the hook plate. Conclusion: Hook plates are an effective form of treatment for lateral third clavicle fractures. The best outcomes occur with plate removal before 6 months postoperatively, provided that the fracture has healed.
Journal of Evolution of Medical and Dental Sciences, 2020
BACKGROUND Lateral end clavicle fractures are of three types (Neer type-I, II, & III). In Neer Type-II, the fractures are very unstable due to damage to the coracoclavicular (CC) ligament. So, it is always treated surgically. This comparative cross-sectional prospective study compares the outcome after internal fixation of these fractures with clavicular hook plate and precontoured anatomical locking plate. METHODS Thirty-two (32) patients attending the OPD and ER of R.G. Kar Medical College, Kolkata, having Neer Type-II fractures, were treated surgically within three weeks of injury using either clavicular hook plate (17 patients) or precontoured anatomical locking plate (15 patients) and then systematically reviewed. The relevant literature of the two fixation methods were studied to note union, infection, hardware prominence, implant failure, metaphyseal fracture and other complications. Constant-Murley score was also used for evaluation. RESULTS In our study, with both the fixation modalities, union was achieved in all cases by three months. No impingement was noted. Patients having fixation with precontoured anatomical locking plate had better scores and returned earlier to better function than the other group (p value <0.0001). CONCLUSIONS Precontoured anatomical locking plate might be a better option which provides better functional outcome.
Zagazig University Medical Journal, 2019
Introduction: Fracture clavicle used to be treated conservatively. But, risk of mal-union and shoulder dysfunction has raised many concerns regarding this way of treatment. Operative treatment for clavicle fracture gained popularity recently for displaced fracture clavicle. So, in our study we compared between the two methods of treatment. Patients and methods: We conducted a prospective study for all adult patient presented to our hospital with unstable fracture clavicle from August 2016 to September 2017. Patients were divided in two groups A and B, with exclusion of poly-trauma patients. Group A treated conservatively and group B treated by open reduction and internal fixation with plate and screws on the superior surface of the clavicle. The patients were followed up and assessed by constant shoulder score. Results: The study included 20 patients in two group 10 patient for each group. The demographic data in both groups showed no significant differences. Follow up was 6.2 and 7.3 months in both groups respectively. Union occurred in 5.8 and 5.3 months in both groups respectively. The difference was insignificant for follow up and union; p value> 0.05. Functional outcome was excellent in 8 and good in 2 in group A, and excellent in 6, good in 4 in group B. This difference was found to be significant, p value ˂ 0.05. Conclusion: From our study and supported by others we recommend that conservative treatment should be the first choice for most patients and operative fixation to be reserved for selected cases.
Hydrometallurgy, 2011
We retrospectively evaluate the efficacy of a clavicle hook plate as a fixation device for unstable distal end comminuted clavicle fractures. Seven patients who visited our hospital between March 2004 and January 2009 were included in this study. The patients' age ranged from 26 years to 65 years, and the mean follow-up period was 6.9 months. All fractures were united, and there was no case of delayed union. There were no complications after surgery. At the final follow-up in January 2010, six excellent and one good Constant-Murley scores were noted. We conclude that the use of a hook plate is a reasonable option for fixation of an unstable distal end comminuted clavicle fracture, resulting in a high rate of union and satisfactory functional results.
Current concepts in the management of clavicle fractures
Clavicle fractures comprise approximately 3% of all adult fractures and there is evidence that the incidence is increasing. Fractures of the lateral and middle third of the clavicle present distinct challenges in both surgical fixation techniques and clinical outcome, as such they should be recognised as separate clinical entities. Despite conflicting evidence, most studies indicate that superior clinical results are found in patients with united clavicle fractures rather than those that go onto non-union. Furthermore there is level-1 evidence that operative treatment of clavicle fractures leads to significantly increased rates of union. Despite these findings, significant controversy still exists on which patients would benefit from primary fixation and those who could successfully be managed non-operatively. We present an evidence-based review of clavicle fracture management including surgical indications, techniques, and results.