Management of displaced middle third clavicular fractures with superior reconstruction plating
Journal Title: International Journal of Orthopaedics Traumatology & Surgical Sciences - Year 2017, Vol 3, Issue 2
Abstract
Background :The management of clavicle fractures is inclining towards fixation for displaced middle-third clavicle fractures as the conservative treatment gives poor results. There was no evidence to suggest that early operative treatment of displaced clavicular shaft fractures showed a functional benefit when compared with the results of initial non-operative treatment till now. However, recent studies show displaced clavicle fractures was associated with greater risk of non-union, poor clinical outcome, and decrease in shoulder strength. Materials and methods:Various methods have been described for operative fixation of clavicular shaft fractures, implants including extramedullary semi tubular plates, reconstruction plates, Dynamic Compression Plate(DCP), Limited Contact Dynamic Compression Plate (LCDCP), locking plates, intramedullary fixation with Knowle’s pins, Haige pins, Rockwood pins and titanium nails. Results :Intramedullary fixation of clavicle, though more cosmetic is technically more demanding owing to lack of clear cut medullary canal and higher complication rates upto 75%. Plate fixation provides immediate rigid stabilization, pain relief, facilitates early mobilisation and return to pre injury activities. Superior placement of plate is biomechanically more stable especially in presence of inferior cortical communition. So, Open Reduction and Internal Fixation (ORIF) with superior reconstruction plating was preferred in adults with displaced middle third clavicle fracture and those having tenting skin. The aim of this study is to evaluate the functional outcome of midshaft clavicular fracture in adults managed with ORIF with superior reconstruction plating. CONCLUSION: The traditional method of managing middle third clavicular fracture conservatively gives poor functional results. Intramedullary fixation is not favoured for its higher complication rate though better cosmesis. Reconstruction plates can be contoured according to the need and superior placement with six cortical purchases on either side gives stable construct, predictable union and optimum functional outcome. Use of bone Interfragmentary screws should be done carefully as might cause further communition and primary bone graft might be justified in communited fractures. Owing to the subcutaneous anatomy of clavicle, superior implantation of implant might cause hardware prominence especially in lean individuals demanding subsequent removal. Site specific precontoured locking plates in recent use are yet to be fully tested in comparative clinical studies.
Authors and Affiliations
Kalyan Kaushik Bharam, Ram Kalyan T, R Siva Prasad, Rithika Singh
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