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Clavicle Malunions: Surgical Treatment and Outcome-a Literature Review.

ABSTRACT: Background:Successful treatment of clavicle malunion represents a major challenge for orthopedic surgeons. Questions/Purposes:The aim of this study was to provide an overview of surgical options for the treatment of clavicle malunions regarding their technical details and clinical results. Methods:A comprehensive search of the literature was performed to retrieve articles and conference abstracts regarding the surgical treatment of clavicle malunions. A total of 1873 records were identified and 29 studies were included in the present review, with a total of 103 patients. Results:The majority of the patients (77/103) were treated with an osteotomy and subsequent open reduction internal fixation (ORIF). The next most frequent management choice was debridement, excision, or removal of excess callus or bone (n = 19), but other techniques like resection of the clavicle (n = 5) or nerve exploration and decompression (n = 2) were also reported. The preferred method of fixation was plate fixation (n = 53) followed by pin fixation (n = 6). The complication rate was low, reported in less than 6% of patients. Conclusion:All of the currently reported surgical techniques to manage symptomatic clavicle malunion have resulted in good clinical outcomes with a low complication rate. Considering biomechanical aspects, correction osteotomy followed by plate fixation seems to be the preferred method. Further studies are needed to compare the various surgical techniques and their specific outcomes in a prospective manner. Nevertheless, this review article can be used as an overview to help choose an optimal operative treatment for patients presenting with a clavicle malunion.

SUBMITTER: Sidler-Maier CC

PROVIDER: S-EPMC5786594 | biostudies-other | 2018 Feb

REPOSITORIES: biostudies-other

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Clavicle Malunions: Surgical Treatment and Outcome-a Literature Review.

Sidler-Maier Claudia Christine CC Dedy Nicolas J NJ Schemitsch Emil H EH McKee Michael D MD

HSS journal : the musculoskeletal journal of Hospital for Special Surgery 20171102 1

<h4>Background</h4>Successful treatment of clavicle malunion represents a major challenge for orthopedic surgeons.<h4>Questions/purposes</h4>The aim of this study was to provide an overview of surgical options for the treatment of clavicle malunions regarding their technical details and clinical results.<h4>Methods</h4>A comprehensive search of the literature was performed to retrieve articles and conference abstracts regarding the surgical treatment of clavicle malunions. A total of 1873 record ...[more]

PMID: 29399001

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Project description:BackgroundBipolar clavicle injury is a rare injury involving any combination of dislocation and/or fracture at both ends of the clavicle. Most reports of bipolar clavicle injury have been based on a single case, and treatment of this injury remains controversial. The present study was performed to evaluate the efficacy of surgical management with internal plating for bipolar clavicle injuries.MethodsWe performed internal plating to treat seven consecutive bipolar clavicle injuries with different injury patterns from May 2013 to June 2021. A clavicle hook plate was used for five sternoclavicular joint injuries (including a revision surgery) and three acromioclavicular joint dislocations, a T plate was used for one sternoclavicular joint injury, and an anatomic plate was used for one distal clavicle fracture. At follow-up, radiographs were assessed for bone alignment, joint congruity, fracture union or malunion, and implant failure or migration. Clinical evaluation included determination of the Disability of the Arm, Shoulder, and Hand (DASH) score; Constant-Murley score; visual analog scale (VAS) score; and complications.ResultsThe patients were regularly followed up after the operation, and functional parameters were assessed over time. At a mean follow-up of 28.1 ± 22.0 months, each fracture had solid bone union, and each dislocation showed no sign of recurrent instability. The mean shoulder forward flexion was 159.3° ± 7.9°, and the mean DASH score was 8.8 ± 5.1. The mean Constant-Murley score was 88.9 ± 7.9, with six cases assessed as excellent and one case assessed as good. The mean VAS score was 1.0 ± 1.5, and the mean patient satisfaction score was 9.3 ± 0.8. No complications occurred, and each patient was able to resume their preinjury daily activity and was highly satisfied with their treatment.ConclusionsIn the present study, internal plating for bipolar clavicle injury allowed early mobilization and resulted in good joint function. We recommend fixation of the more severely affected side first because the other side may be passively reduced and acquire stability once the more severely affected side has been fixed. Internal fixation of the other end may therefore be unnecessary unless residual instability exists.

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Clavicle Malunions: Surgical Treatment and Outcome-a Literature Review.

Publications

Clavicle Malunions: Surgical Treatment and Outcome-a Literature Review.

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