BRIDGING FIXATION WITH LONG LOCKING PLATE FOR DISPLACED MIDSHAFT CLAVICULAR FRACTURES_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SUN Taicun , XU Xiaofeng , CUI Xuewen , TIAN Jin , CHENG Qian , CAO Xingbing , LIU Yongming.

Department of Orthopaedics, Affiliated Hospital of Jiangsu University, Zhenjiang Jiangsu, 212001, P.R.China. Corresponding author: SUN Taicun, E-mail: drsuntc@yahoo.com.cn;

Corresponding author：

Keywords：

Displaced midshaft clavicular fracture; Long locking plate; Bridging fixation

DOI：

10.7507/1002-1892.20130148

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Objective To evaluate the effectiveness of bridging fixation with long locking plate for displaced midshaft clavicular fractures. Methods Between October 2010 and December 2011, 18 patients with displaced midshaft clavicular fracture were treated with reduction and bridging fixation with 9 or 10 holes locking plate. There were 17 males and 1 female with an average age of 47 years (range, 23-82 years). Fracture was caused by traffic accident in 6 cases, by falling in 10 cases, by crushing in 1 case, and by crashing object in 1 case. All fractures were closed and displaced or shortened (range, 2.1-3.4 cm; mean, 2.62 cm) with angulation deformity. According to Robinson classification criteria, 5 cases were rated as type 2B1 and 13 as type 2B2. The duration from injury to surgery was 5 hours to 19 days (mean, 5 days). The fracture healing time and complication were recorded; the effectiveness evaluation was performed with Constant-Murley score and satisfaction to appearance. Results No neurologic or vascular complication occurred with primary healing of incision. All patients were followed up 12-22 months (mean, 14.7 months). The fracture healing time was 9-14 weeks (mean, 11.4 weeks). During follow-up, no loosening or breakage of internal fixator was observed. The Constant-Murley score was 82-98 (mean, 92.4) at last follow-up; the satisfaction rate of appearance was 88.9% (16/18). Conclusion Bridging fixation with long locking plate is an effective method for treatment of displaced midshaft clavicular fractures. Preserved blood supply and stable angle are important to fracture healing.

Citation： SUN Taicun,XU Xiaofeng,CUI Xuewen,TIAN Jin,CHENG Qian,CAO Xingbing,LIU Yongming.. BRIDGING FIXATION WITH LONG LOCKING PLATE FOR DISPLACED MIDSHAFT CLAVICULAR FRACTURES. Chinese Journal of Reparative and Reconstructive Surgery, 2013, 27(6): 666-669. doi: 10.7507/1002-1892.20130148 Copy

1.	Khan LA, Bradnock TJ, Scott C, et al. Fractures of the clavicle. J Bone Joint Surg (Am), 2009, 91(2): 447-460.
2.	Canadian Orthopaedic Trauma Society. Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial. J Bone Joint Surg (Am), 2007, 89(1): 1-10.
3.	高学峰, 葛伟. 锁定加压钢板内固定失败原因分析. 中国修复重建外科杂志, 2010, 24(12): 1533-1534.
4.	Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res, 1987, (214): 160-164.
5.	McKee RC, Whelan DB, Schemitsch EH, et al. Operative versus nonoperative care of displaced midshaft clavicular fractures: a meta-analysis of randomized clinical trials. J Bone Joint Surg (Am), 2012, 94(8): 675-684.
6.	Wick M, Müller EJ, Kollig E, et al. Midshaft fractures of the clavicle with a shortening of more than 2 cm predispose to nonunion. Arch Orthop Trauma Surg, 2001, 121(4): 207-211.
7.	van der Meijden OA, Gaskill TR, Millett PJ. Treatment of clavicle fractures: current concepts review. J Shoulder Elbow Surg, 2012, 21(3): 423-429.
8.	Assobhi JE. Reconstruction plate versus minimal invasive retrograde titanium elastic nail fixation for displaced midclavicular fractures. J Orthop Traumatol, 2011, 12(4): 185-192.
9.	Houwert RM, Wijdicks FJ, Steins Bisschop C, et al. Plate fixation versus intramedullary fixation for displaced mid-shaft clavicle fractures: a systematic review. Int Orthop, 2012, 36(3): 579-585.
10.	Drosdowech DS, Manwell SE, Ferreira LM, et al. Biomechanical analysis of fixation of middle third fractures of the clavicle. J Orthop Trauma, 2011, 25(1): 39-43.
11.	Lai YC, Tarng YW, Hsu CJ, et al. Comparison of dynamic and locked compression plates for treating midshaft clavicle fractures. Orthopedics, 2012, 35(5): e697-702.
12.	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 Elbow Surg, 2009, 18(1): e22-25.
13.	Wagner M. General principles for the clinical use of the LCP. Injury, 2003, 34 Suppl 2: B31-42.
14.	康庆林, 张春才, 戴力扬. 生物学内固定(BO)概念、原理与方法. 中国矫形外科杂志, 2003, 11(3): 270-273.
15.	Jiang H, Qu W. Operative treatment of clavicle midshaft fractures using a locking compression plate: comparison between mini-invasive plate osteosynthesis (MIPPO) technique and conventional open reduction. Orthop Traumatol Surg Res, 2012, 98(6): 666-671.
16.	Gautier E, Sommer C. Guidelines for the clinical application of the LCP. Injury, 2003, 34 Suppl 2: B63-76.
17.	Will R, Englund R, Lubahn J, et al. Locking plates have increased torsional stiffness compared to standard plates in a segmental defect model of clavicle fracture. Arch Orthop Trauma Surg, 2011, 131(6): 841-847.
18.	Toogood P, Horst P, Samagh S, et al. Clavicle fractures: a review of the literature and update on treatment. Phys Sportsmed, 2011, 39(3): 142-150.
19.	Simon P. Mid-clavicle fractures in adults: surgery or not? Eur J Orthop Surg Traumatol, 2010, 20(7): 521-525.
20.	Sohn HS, Shin SJ, Kim BY. Minimally invasive plate osteosynthesis using anterior-inferior plating of clavicular midshaft fractures. Arch Orthop Trauma Surg, 2012, 132(2): 239-244.
21.	Chen CE, Juhn RJ, Ko JY. Anterior-inferior plating of middle-third fractures of the clavicle. Arch Orthop Trauma Surg, 2010, 130(4): 507-511.
22.	Robertson C, Celestre P, Mahar A, et al. 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): 204-209.

1. Khan LA, Bradnock TJ, Scott C, et al. Fractures of the clavicle. J Bone Joint Surg (Am), 2009, 91(2): 447-460.
2. Canadian Orthopaedic Trauma Society. Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial. J Bone Joint Surg (Am), 2007, 89(1): 1-10.
3. 高学峰, 葛伟. 锁定加压钢板内固定失败原因分析. 中国修复重建外科杂志, 2010, 24(12): 1533-1534.
4. Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res, 1987, (214): 160-164.
5. McKee RC, Whelan DB, Schemitsch EH, et al. Operative versus nonoperative care of displaced midshaft clavicular fractures: a meta-analysis of randomized clinical trials. J Bone Joint Surg (Am), 2012, 94(8): 675-684.
6. Wick M, Müller EJ, Kollig E, et al. Midshaft fractures of the clavicle with a shortening of more than 2 cm predispose to nonunion. Arch Orthop Trauma Surg, 2001, 121(4): 207-211.
7. van der Meijden OA, Gaskill TR, Millett PJ. Treatment of clavicle fractures: current concepts review. J Shoulder Elbow Surg, 2012, 21(3): 423-429.
8. Assobhi JE. Reconstruction plate versus minimal invasive retrograde titanium elastic nail fixation for displaced midclavicular fractures. J Orthop Traumatol, 2011, 12(4): 185-192.
9. Houwert RM, Wijdicks FJ, Steins Bisschop C, et al. Plate fixation versus intramedullary fixation for displaced mid-shaft clavicle fractures: a systematic review. Int Orthop, 2012, 36(3): 579-585.
10. Drosdowech DS, Manwell SE, Ferreira LM, et al. Biomechanical analysis of fixation of middle third fractures of the clavicle. J Orthop Trauma, 2011, 25(1): 39-43.
11. Lai YC, Tarng YW, Hsu CJ, et al. Comparison of dynamic and locked compression plates for treating midshaft clavicle fractures. Orthopedics, 2012, 35(5): e697-702.
12. 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 Elbow Surg, 2009, 18(1): e22-25.
13. Wagner M. General principles for the clinical use of the LCP. Injury, 2003, 34 Suppl 2: B31-42.
14. 康庆林, 张春才, 戴力扬. 生物学内固定(BO)概念、原理与方法. 中国矫形外科杂志, 2003, 11(3): 270-273.
15. Jiang H, Qu W. Operative treatment of clavicle midshaft fractures using a locking compression plate: comparison between mini-invasive plate osteosynthesis (MIPPO) technique and conventional open reduction. Orthop Traumatol Surg Res, 2012, 98(6): 666-671.
16. Gautier E, Sommer C. Guidelines for the clinical application of the LCP. Injury, 2003, 34 Suppl 2: B63-76.
17. Will R, Englund R, Lubahn J, et al. Locking plates have increased torsional stiffness compared to standard plates in a segmental defect model of clavicle fracture. Arch Orthop Trauma Surg, 2011, 131(6): 841-847.
18. Toogood P, Horst P, Samagh S, et al. Clavicle fractures: a review of the literature and update on treatment. Phys Sportsmed, 2011, 39(3): 142-150.
19. Simon P. Mid-clavicle fractures in adults: surgery or not? Eur J Orthop Surg Traumatol, 2010, 20(7): 521-525.
20. Sohn HS, Shin SJ, Kim BY. Minimally invasive plate osteosynthesis using anterior-inferior plating of clavicular midshaft fractures. Arch Orthop Trauma Surg, 2012, 132(2): 239-244.
21. Chen CE, Juhn RJ, Ko JY. Anterior-inferior plating of middle-third fractures of the clavicle. Arch Orthop Trauma Surg, 2010, 130(4): 507-511.
22. Robertson C, Celestre P, Mahar A, et al. 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): 204-209.

Chinese Journal of Reparative and Reconstructive Surgery

BRIDGING FIXATION WITH LONG LOCKING PLATE FOR DISPLACED MIDSHAFT CLAVICULAR FRACTURES

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