Surgical Treatment for Clavicular Fractures.
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Abstract:
We reviewed 127 cases (128 clavicles) who underwent various surgicl procedures for treatment of clavicular fractures between 1988 and 1993.105 cases were treated with plate fixation. Delayed union was seen in 4 cases and nonunion occurred in 6 cases.The rate of nonunion in cases with clavicular fracture treated surgically was 4.7%.All cases of nonunion improved with plate fixation and bone-grafting.Keywords:
Bone grafting
Bony union
Objective To study on the behaviors of nonunion of the clavicle,and evaluate the therapeutic efficacy of the fixation with a reconstruction plate.Methods Retrospective analysis was done on 16 patients who had nonunion of the clavicle and were achieved by fixation with a reconstruction plate later.Results On X-ray, all 16 patients had shortening which rang from 0.8 to 2.8cm in the nonunion clavicle than in the contralateral clavicle (shortening more than 1.5cm or equal 1.5cm on 11 patients). 16 cases were fixated by AO reconstruction plate.When shortening of the clavicle isn't less than 1.5cm,an autogenous bone graft was advocated between the end of clavicle fracture.Each of 14 patients obtained union ,the follow time was from 3 to 12 months,average 8.6 months.Conclusion Painful nonunion of the clavicle usually occur to the clavicle in which shortening is made sure.AO reconstruction plate is effective in the treatment to nonunion of the clavicle.
Bony union
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Open reduction and internal fixation utilizing a full thickness fibular graft was performed on a patient who presented with a 9-year-old functional nonunion of a femoral neck stress fracture. During this period, the patient had remained fully ambulatory, with intermittent episodes of hip pain. Our experience indicates that the treatment of old, nonunited stress fractures of the femoral neck with a fibular bone graft and internal fixation contributes to a successful result, lending support while stimulating osteogenesis as the nonunion heals. Use of rigid internal fixation will eliminate motion at the site of the fracture, enhancing incorporation of the bone graft and, thereby, speeding the patient's recovery.
Stress Fractures
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Objective
To discuss the relationship between the fracture of the clavicle which was fixed by torsional-shaped plate and nonunion after operation.
Methods
Retrospective analysis was conducted in 426 patients with midshaft clavicle fractures.Among the patients, the A group used torsional-shaped plate to meet the anatomical structure of the clavicle: the medial plate matched under the front face of the clavicle, and the lateral plate matched the up face of the clavicle.And the traditional method was used in the B group.Patients were followed up for at least 12 months, the patients were judged by X-ray criteria for nonunion.
Results
A total of 28 patients with nonunion, including 4 cases in A group, 24 cases in B group.After statistics processing, the difference between A group and B group was significant (χ2=6.679, P=0.010).
Conclusion
We find that the treatment of the fracture of the middle part of the clavicle with torsional-shaped plate can effectively reduce the incidence of nonunion.
Key words:
Clavicular fracture; Fracture fixation; Torsional-shaped plate; Nonunion of bone
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Nonunion of the clavicle among children and adolescents is rare. A systematic review was conducted to identify published reports of nonunion of the clavicle among children after conservative treatment. A retrospective study was performed of 2096 children who were treated for clavicle fractures at our institution to identify cases of nonunion. Fourteen studies (27 children) from the literature met the inclusion criteria, and 3 new cases from our institution were identified. The mean age at injury was 11 years. Male sex, age younger than 12 years at the time of injury, and refracture of the clavicle are possible predisposing factors for nonunion. [ Orthopedics . 2022;45(4):e190–e195.]
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Objective To investigate the method of diagnosis an d treatment on clavicle fracture and to improve the quality of treatment. Methods One hundred and fifty patients with clavicle fracture(125 new and 25 old) were performed external or internal fixation in differe nt type. Results All cases were followed up from 6 months to 3 y ears.No function handicap, malunion and nonunion occurred. Conclusion Different classification and treatment can improve the effect and reduce the complication.
Malunion
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Clavicular fractures are a common problem faced by orthopedic surgeons. Conservative treatment usually gives good outcomes, but the development of a nonunion is a very disabling complication for some patients. The literature regarding clavicular nonunions is reviewed, and the senior author-preferred technique for treatment of midshaft clavicle nonunions with bone defect is described, including a preliminary report of the results.
Conservative Treatment
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Malunion
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Clavicular fractures account for around 15% of fractures in children. Although nonunion is a recognized complication in adults, post-traumatic nonunion of the clavicle in children is extremely rare. To the best of our knowledge, post-traumatic nonunion of the clavicle in a child following repeated clavicular fracture has not yet been published in the English literature. Here, we report a case of a 9-year-old boy who presented with post-traumatic nonunion of his right clavicle following his third fracture after radiologically documented healing of the first two fractures. He underwent open reduction and internal fixation, supplemented with ipsilateral iliac crest bone graft, with resultant healing on follow-up radiographs.
Iliac crest
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Objective: To investigate the principles and methods of the treatment of infected nonunion. Methods:Twenty-four patients with infected nonunion were included in this study.After effective anitibiotic administration and complete debridement, the bone defect.As soon as the wound was healed up,immobilization was done by external fixation device.Results: All the patients had bone union within 3 to 14 months (average 6 to 8 months).The infection was completely controlled, the wound went on healing and the length of the limb was maintained. Conclusion: The compound method simplified and shortened the treatment .The bone grafting by the first intention avoided limb shortening.The use of external fixation in infected nonunion showed its distinctive advatanges.
Bone grafting
Debridement (dental)
Bony union
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