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Surgical treatment of midclavicular fractures: a prospective comparison of Knowles pinning and plate fixation.

ABSTRACT: Although several surgical techniques for midclavicular fractures have been reported, Knowles pinning has rarely been compared with plating. The purpose of this study is to compare the clinical results of these two alternative techniques. There were 88 patients with midclavicular fractures surgically treated with either a Knowles pin or a plate. All patients were followed up for 12 months with a shoulder score evaluation. The Knowles pin group included 56 patients, with an average age of 40.1 years. The plate group included 32 patients, with an average age of 38.2 years. Both groups were similar in injury mechanism and fracture types (all p values>0.5). Plating has a significantly longer operation time, larger wound incision, higher pain level, more analgesic use, more complications and more symptomatic hardware (all p value<0.05). The shoulder score, union rate and healing time are not significantly different between the two groups (all p values>0.2). In conclusion, if the surgery of mid-third clavicular fractures is indicated, fixation with a Knowles pin has more advantages than plate fixation.

SUBMITTER: Lee YS

PROVIDER: S-EPMC2532272 | biostudies-other | 2008 Aug

REPOSITORIES: biostudies-other

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Project description:PurposeThe treatment of distal femur fractures with extensive metaphyseal comminution is frequently complicated by high rates of nonunion and varus collapse. Dual plating with lateral and medial locking plates for these types of fractures has shown promising results in the recent literature. We hypothesize that dual plating of comminuted distal femur fractures leads to higher union rates and lower revision rates compared to an isolated lateral locking plate.MethodsA retrospective medical chart review between January 2015 and December 2017 was conducted. Inclusion criteria included patients 18 years of age and older who sustained a complex distal femur fracture (AO/OTA 33-C2/33-C3 or periprosthetic fracture with significant metaphyseal comminution) and at least 6 months of follow up. Patients with simple fracture patterns, alternative fixation methods, and inadequate follow up were excluded. All patients in the single plating group were treated with a lateral distal femoral locking plate using a lateral approach. In the patients treated with dual plating, an extensile parapatellar approach was utilized for fracture reduction and placement of an adjunctive medial plate. Demographic information, fracture types, injury severity score (ISS), medical comorbidities, type of surgical fixation, union rates, complications, knee range of motion, time to follow up, and need for revision surgery were extrapolated from the medical charts for analysis.ResultsTwenty-one patients were included in the study. Thirteen patients underwent single plate fixation and 8 underwent dual plate fixation. There were no significant differences in demographics, number of co-morbidities, fracture classification, or ISS between single and dual plate groups (p > 0.05 for all). There was a statistically significant difference in union rates between the single plate group (6 nonunions, 4 unions, and 3 delayed unions) and the dual plate group, with no nonunions or delayed unions (p = 0.0049). Although not statistically significant, 4 patients treated with single plating underwent revision ORIF, compared to none in the dual plating group (p = 0.13). There were no significant differences in time to follow up, time to full weight bearing, or infection rates (p > 0.1 for all).ConclusionBased on these results, the medial and lateral locked plating technique demonstrates a higher union rate, with possible lower rates of revision surgery, compared to a single lateral plate in highly comminuted distal femur fractures.Level of evidenceLevel 3. Retrospective Cohort Study.

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Surgical treatment of midclavicular fractures: a prospective comparison of Knowles pinning and plate fixation.

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