UZH-Logo

Maintenance Infos

Anteroinferior plating of midshaft clavicle nonunions and fractures


Kloen, P; Werner, C M L; Stufkens, S A S; Helfet, D L (2009). Anteroinferior plating of midshaft clavicle nonunions and fractures. Operative Orthopädie und Traumatologie, 21(2):170-179.

Abstract

OBJECTIVE: Anatomic reconstruction of clavicle with limited dissection and biomechanically optimal osteosynthesis. Anteroinferior plate placement to minimize patient's discomfort and need for implant removal. INDICATIONS: Midshaft clavicle nonunions. Midshaft clavicle fractures. Clavicle malunions for which osteotomy is needed. CONTRAINDICATIONS: Infection. Compromised skin. Comorbidities causing unacceptable operative risks. SURGICAL TECHNIQUE: Expose anteroinferior aspect of the clavicle. Remove previous implants with minimal dissection. In atrophic nonunions, remove intervening tissue. Obtain cultures. Open medullary canal using drill. Contour standard or Locking Compression (LCP) 3.5-mm pelvic reconstruction plate (Synthes, Paoli, PA, USA) on anteroinferior aspect of clavicle. Use osteotome to petal/shingle the nonunion and add bone graft. In hypertrophic nonunions, bone graft is generally not needed but excess callus should be removed to prevent impingement on neurovascular structures. POSTOPERATIVE MANAGEMENT: Mitella for 10 days to protect wound healing. Start with early pendulum exercises. No active abduction or anteflexion of > 90 degrees or heavy lifting in first 6 weeks. RESULTS: From December 1993 to February 2007, 52 patients (53 clavicles) were treated with anteroinferior plating of clavicle. There were 38 atrophic nonunions or delayed unions, three hypertrophic nonunions, three infected nonunions, six acute fractures, and one malunion. For two patients initial radiographs could not be located. Average age was 45 years. One patient was lost to follow-up prior to healing. The others were followed up after an average of 35 months. All had consolidation at an average of 3 months (range 2-7 months). Two patients underwent removal of a lag screw that was placed from superior to inferior, whereas three patients underwent plate removal.

Abstract

OBJECTIVE: Anatomic reconstruction of clavicle with limited dissection and biomechanically optimal osteosynthesis. Anteroinferior plate placement to minimize patient's discomfort and need for implant removal. INDICATIONS: Midshaft clavicle nonunions. Midshaft clavicle fractures. Clavicle malunions for which osteotomy is needed. CONTRAINDICATIONS: Infection. Compromised skin. Comorbidities causing unacceptable operative risks. SURGICAL TECHNIQUE: Expose anteroinferior aspect of the clavicle. Remove previous implants with minimal dissection. In atrophic nonunions, remove intervening tissue. Obtain cultures. Open medullary canal using drill. Contour standard or Locking Compression (LCP) 3.5-mm pelvic reconstruction plate (Synthes, Paoli, PA, USA) on anteroinferior aspect of clavicle. Use osteotome to petal/shingle the nonunion and add bone graft. In hypertrophic nonunions, bone graft is generally not needed but excess callus should be removed to prevent impingement on neurovascular structures. POSTOPERATIVE MANAGEMENT: Mitella for 10 days to protect wound healing. Start with early pendulum exercises. No active abduction or anteflexion of > 90 degrees or heavy lifting in first 6 weeks. RESULTS: From December 1993 to February 2007, 52 patients (53 clavicles) were treated with anteroinferior plating of clavicle. There were 38 atrophic nonunions or delayed unions, three hypertrophic nonunions, three infected nonunions, six acute fractures, and one malunion. For two patients initial radiographs could not be located. Average age was 45 years. One patient was lost to follow-up prior to healing. The others were followed up after an average of 35 months. All had consolidation at an average of 3 months (range 2-7 months). Two patients underwent removal of a lag screw that was placed from superior to inferior, whereas three patients underwent plate removal.

Citations

13 citations in Web of Science®
17 citations in Scopus®
Google Scholar™

Altmetrics

Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Trauma Surgery
04 Faculty of Medicine > University Hospital Zurich > Division of Surgical Research
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2009
Deposited On:19 Jan 2010 14:39
Last Modified:05 Apr 2016 13:42
Publisher:Springer
ISSN:0934-6694
Additional Information:The original publication is available at www.springerlink.com
Publisher DOI:https://doi.org/10.1007/s00064-009-1705-8
PubMed ID:19685226

Download

Full text not available from this repository.
View at publisher

TrendTerms

TrendTerms displays relevant terms of the abstract of this publication and related documents on a map. The terms and their relations were extracted from ZORA using word statistics. Their timelines are taken from ZORA as well. The bubble size of a term is proportional to the number of documents where the term occurs. Red, orange, yellow and green colors are used for terms that occur in the current document; red indicates high interlinkedness of a term with other terms, orange, yellow and green decreasing interlinkedness. Blue is used for terms that have a relation with the terms in this document, but occur in other documents.
You can navigate and zoom the map. Mouse-hovering a term displays its timeline, clicking it yields the associated documents.

Author Collaborations