Yi ZHENG, Xin-Hua YUAN, Yi-Hong YİN, Wei-Bin WANG, Qing-Song FU, Qing-Jiang PANG

T-plate fixation for unstable proximal clavicula fractures

Objective: The aim of this study was to evaluate the clinical results of T-plate fixation and anteriorsternoclavicular ligament repair in proximal clavicle fractures.Methods: Between August 2013 and August 2016, a total 12 patients (10 men and 2 women; mean age:44.1 ± 9.1 years (range, 25e59 years)) with unstable proximal clavicle fractures (Throckmorton, type D)were treated with T-type plate fixation, bridging the sternoclavicular joint, and anterior sternoclavicularligament repair. Average operative time, associated injuries, postoperative complications, postoperativefracture healing time and follow-up time were recorded. The outcomes were evaluated with radiographicassessment, visual analog scale (VAS) pain score and Rockwood SCJ scoring system. All the patients wereevaluated on postoperative 3rd, 6th, and 12th months.Results: The average surgery time was 78.0 ± 8.47 minutes while fracture healing time was 4.51 ± 0.95months. According to Rockwood SCJ scoring system, 9 cases (75%) were in excellent, 2 cases (16.7%) ingood and 1 case (8.3%) in fair condition at 12 months follow-up. The average Rockwood SCJ score was7.7 ± 0.75 preoperatively, 12.7 ± 0.86 by 3 months, 13.0 ± 0.73 by 6 months and 13.3 ± 0.49 by 12 months.The VAS pain score was 7.9 ± 1.15 (preoperative score), 3.4 ± 1.52 (3 months follow-up), 3.0 ± 1.32 (6months follow-up) and 2.1 ± 1.07 (12 months follow-up). The VAS and Rockwood SCJ scores weresignificantly improved postoperatively (p < 0.05). There was no intraoperative complication, while onepatient had redislocation of the sternoclavicular joint after implant removal.Conclusion: T-type plate fixation with anterior sternoclavicular ligament repair might be a reliable andeffective treatment method in unstable proximal clavicle fractures (type D) with few complications andsatisfactory clinical results after 12 months follow-up.

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Sidhu VS, Hermans D, Duckworth DG. The operative outcomes of displaced medial-end clavicle fractures. J Shoulder Elbow Surg. 2015;24:1728e1734.

Ahmadreza M, Mirmostafa S, Mohammadreza G, et al. Distal clavicular fracture treatment with suture anchor method. Acta Orthop Traumatol Turc. 2016;50: 298e302.

Ropars M, Thomazeau H, Huten D. Clavicle fractures orthopaedics & traumatology. Surg Res. 2017;103:s53es59.

Robinson CM, Goudie EB, Murray IR, et al. Open reduction and plate fixation versus nonoperative treatment for displaced midshaft clavicular fractures: a multicenter, randomized, controlled trial. J Bone Joint Surg Am. 2013;95: 1576e1584.

Wang Y, Jiang J, Dou B, et al. Inverted distal clavicle anatomic locking plate for displaced medial clavicle fracture. Arch Orthop Trauma Surg. 2015;135: 1241e1245.

McKenna M. Plating of a periarticular medial clavicle fracture. Orthopedics. 2009;32:366e368.

Ryan C, Robert B, James S, et al. Operative treatment of the painful sternoclavicular joint: a new technique using interpositional arthroplasty. J Shoulder Elbow Surg. 2006;15:60e66.

Khan LAK, Bradnock TJ, Scott C, et al. Fractures of the clavicle. J Bone Joint Surg. 2009;91:447e460.

Luke R, Riyad G, Ron A, et al. Sports participation and radiographic findings of adolescents treated nonoperatively for displaced clavicle fractures. Injury. 2015;46:1372e1376.

Fu Beigang. Minimally invasive intramedullary nailing of clavicular fractures by a new titanium elastic nail. Acta Orthop Traumatol Turc. 2016;50:494e500.

Yi JW, Kim DH, Heo YM, et al. Bilateral sternoclavicular joint dislocation due to sternal fracture: is it a dislocation or a separation? Arch Orthop Trauma Surg. 2016;136:605e608.

Hwang WJ, Lee Y, Yoon YS, et al. Surgical treatment of sternoclavicular joint dislocation using a T-plate. Korean J Thorac Cardiovasc Surg. 2016;49:221e223.

Sinan Z, Murat C, Ercan S, et al. Comparison between locked intramedullary nailing and anatomical locking plating in the treatment of displaced clavicular midshaft fractures. Acta Orthop Traumatol Turc. 2016;50:291e297.

Siebenlist S, Sandmann G, Kirchhoff C, et al. Anatomically precontoured LCP for delayed union of a medial third clavicle fracture. Case report with review of the literature. Acta Chir Orthop Traumatol Cech. 2013;80:407e410.

Bartonícek J, Fric V, Pacovský V. Displaced fractures of the medial end of the clavicle: report of five cases. J Orthop Trauma. 2010;24:e31ee35.

Tennent TD, Pearse EO, Eastwood DM. A new technique for stabilizing adolescent posteriorly displaced physeal medial clavicular fractures. J Shoulder Elbow Surg. 2012;21:1734e1739.

Al-Yassari G, Hetzenauer M, Tauber M, et al. Novel method to treat sternoclavicular joint instability and medial clavicle fracture symptomatic nonunion. J Shoulder Elbow Surg. 2009;18:553e555.

Negri JH, Malavolta EA, Assunç~ ao JH, et al. Assessment of the function and resistance of sternoclavicular ligaments: a biomechanical study in cadavers. Orthopaedics Traumatol Surg Res. 2014;100:727e731.

Morell DJ, Thyagarajan DS. Sternoclavicular joint dislocation and its management: a review of the literature. World J Orthop. 2016;7:244e250.

Katthagen JC, Tahal DS, Menge TJ, et al. Minimum 2-year outcomes and return to sport following resection arthroplasty for the treatment of sternoclavicular osteoarthritis. J Shoulder Elbow Surg. 2017;26:e37ee43.

Yousefifard M, Baikpour M, Ghelichkhani P, et al. Comparison of ultrasonography and radiography in detection of thoracic bone fractures; a systematic review and meta-analysis. Emerg (Tehran). 2016;4:55e64.