Objective To investigate the effectiveness of arthroscopic distal clavicle resection for the symptomatic acromioclavicular joint arthritis. MethodsThe clinical data of 14 patients with symptomatic acromioclavicular joint arthritis treated by arthroscopic indirect distal clavicle resection between January 2020 and March 2021 were retrospectively analyzed. There were 5 males and 9 females with an average age of 46.3 years (range, 18-57 years). The 4 cases of left shoulder and 10 cases of right shoulder were accompanied with acromial impingement, without the history of shoulder trauma. The average disease duration was 20.4 months (range, 9-48 months), and the average visual analogue scale (VAS) score was 7.6 (range, 5-9) preoperatively. The results were evaluated using the University of California Los Angeles (UCLA) shoulder rating score before and after operation, further, the patient satisfaction rate was also calculated. Results All 14 patients were followed up 5-18 months, with an average of 13 months. There was no postoperative pain of acromioclavicular joint in 12 patients; 1 case had occasional mild pain, which could be controlled by painkillers. Moreover, there was only 1 acromioclavicular joint subluxation due to early fitness training at 2 weeks postoperatively, and the symptoms gradually relieved after 1 month of conservative treatments. The UCLA score was 22.1±6.2 preoperatively, which improved to 30.2±3.4 at last follow-up, showing significant difference (t=5.359, P<0.001). The patient satisfaction rate was 92.9%, with 12 excellent cases, 1 good case, and 1 fair case. Conclusion Arthroscopic distal clavicle resection for symptomatic acromioclavicular arthritis is a safe, reliable, and repeatable procedure.
ObjectiveTo evaluate the effectiveness of a clavicular hook plate with coracoclavicular ligament augmentation by suture anchor in the treatment of Neer types Ⅱ and Ⅴ distal clavicle fractures.MethodsBetween January 2010 and June 2016, 16 patients with Neer types Ⅱ and Ⅴ distal clavicle fractures were treated with clavicle hook plates and coracoclavicular ligament augmentation by suture anchor. There were 12 males and 4 females with an average age of 45.6 years (range, 14-81 years). The injury mechanism included falling in 10 cases, traffic accident injury in 2 cases, falling from height in 2 cases, and heavy object injury in 2 cases. The Neer classification of clavicle fractures included 2 cases of type Ⅱa, 13 cases of type Ⅱb, and 1 case of type Ⅴ. The injury severity score (ISS) was 6-29, with an average of 11.2. The time from injury to operation was 1-18 days, with an average of 6.4 days. The operation time, intraoperative blood loss, hospitalization stay, fracture healing, and postoperative complications were recorded; the disability of arm, shoulder, and hand (DASH) score, the shoulder joint Constant score, and the Oxford shoulder score (OSS) were used to evaluate the shoulder joint at last follow-up.ResultsAll operations were successfully completed. The operation time was 50-100 minutes, with an average of 75.6 minutes; intraoperative blood loss was 30-100 mL, with an average of 52.8 mL; hospitalization stay was 4-47 days, with an average of 13.7 days. All patients were followed up 1.2-7.5 years, with an average of 3.5 years. All clavicle fractures healed, and the healing time was 9.4-13.6 weeks, with an average of 11.9 weeks. No fracture nonunion, fracture displacement, failure of internal fixation, or incision infection, etc. occurred. Fifteen patients took out the hook plate after fracture healing and functional recovery, and 1 case refused to remove the hook plate from the second operation because of no obvious discomfort. At last follow-up, the DASH score was 0-13, with an average of 2.2; the shoulder joint Constant score was 90-100, with an average of 96.8; the OSS score was 12-14, with an average of 12.3.ConclusionClavicular hook plate with coracoclavicular ligament augmentation by suture anchor can help achieve good effectiveness with less postoperative complication in the treatment of Neer types Ⅱ and Ⅴ distal clavicular fractures.
Objective To evaluate the effectiveness of Kirschner wire fixation and coracoclavicular ligament reconstruction with suture anchor in the treatment of Cho type ⅡC distal clavicle fractures. Methods The data of 17 patients with Cho type ⅡC distal clavicular fractures, who were treated with Kirschner wire fixation and coracoclavicular ligament reconstruction with suture anchor between June 2019 and June 2021, was retrospectively analyzed. There were 11 males and 6 females with an average age of 38.7 years (range, 19-72 years). The fractures were caused by falling in 12 cases and traffic accident in 5 cases. All patients had fresh closed fractures. The interval from injury to operation was 1-5 days (mean, 2.6 days). The preoperative injury severity score (ISS) was 6-27 (mean, 10.2). The operation time, intraoperative blood loss, hospital stay, fracture healing, and postoperative complications were analyzed. The shoulder joint function was evaluated by disabilities of the arm, shoulder, and hand (DASH) score and Constant score at last follow-up. Results All operations were completed successfully. The operation time was 20-50 minutes (mean, 31.6 minutes). The intraoperative blood loss was 30-100 mL (mean, 50.6 mL). The hospital stay was 4-9 days (mean, 5.3 days). All incisions healed by first intention. All patients were followed up 12-16 months (mean, 13 months). All clavicle fractures healed, and the healing time was 8-15 weeks (mean, 11 weeks). No complications such as fracture displacement or nonunion caused by internal fixation failure occurred. During the follow-up, skin irritation caused by the Kirschner wire withdrawal occurred in 3 cases. The Kirschner wires were removed after fracture healing in 17 patients. At last follow-up, the Constant score of shoulder joint was 90-100 (mean, 98.2). The DASH score was 0-10 (mean, 1.5). ConclusionKirschner wire fixation combined with coracoclavicular ligament reconstruction with suture anchor in the treatment of Cho type ⅡC distal clavicle fractures has less postoperative complications and slight complications. It is convenient to remove the internal fixator. The Kirschner wire does not fix the distal clavicle fracture through the acromion, which has little effect on shoulder joint function and can obtain good effectiveness.
ObjectiveTo investigate the effectiveness of anatomical locking plate internal fixation combined with coracoclavicular ligament reconstruction in treatment of the Neer type Ⅱb distal clavicle fractures by comparing with the simple anatomical locking plate internal fixation.MethodsThe clinical data of 40 patients with Neer type Ⅱb distal clavicle fractures who met the criteria between February 2013 and January 2017 were analyzed. Eighteen cases were treated with anatomical locking plate internal fixation and coracoclavicular ligament reconstruction by using a suture anchor (reconstruction group), and 22 cases were treated only with anatomical locking plate internal fixation (non-reconstruction group). There was no significant difference in gender, age, injured side, causes of injury, associated injuries, time from injury to operation between 2 groups (P>0.05). The operation time, medical expense, postoperative coracoclavicular distance, Constant-Murley scores of injured side, and complications were recorded and compared between 2 groups.ResultsAll patients were followed up 12-27 months (mean, 16.3 months). One patient in reconstruction group had superficial wound infection. One patient in non-reconstruction group had pullout of screws from the distal fragment and reduction loss at 1 month postoperatively. The operation time and medical expense in reconstruction group significantly increased when compared with those in non-reconstruction group (P<0.05). All fractures in 2 groups achieved bony union at last follow-up. The rate of coracoclavicular distance increase of injured side in non-reconstruction group was significantly higher than that in reconstruction group (t=2.371, P=0.023). The Constant-Murley scores at 1 month, 3 months after operation, and last follow-up were significantly improved when compared with preoperative values in 2 groups (P<0.05), but no significant difference was observed between 2 groups (P>0.05).ConclusionBoth anatomical locking plate internal fixation with and without coracoclavicular ligament reconstruction can achieve good effectiveness for the Neer type Ⅱb distal clavicle fractures. Therefore, the coracoclavicular ligament reconstruction is not necessary, except for comminuted fractures with the length of lateral fragment less than 1 cm or the patients with poor compliance.
ObjectiveTo investigate the effectiveness of double internal fixations of clavicle and scapula and intraoperative reduction of glenopolar angle in the treatment of floating shoulder injuries.MethodsBetween January 2010 and June 2019, 13 patients with floating shoulder injury were treated with double internal fixation of clavicle and scapula and intraoperative reduction of glenopolar angle. There were 11 males and 2 females with an average age of 48 years (range, 25-65 years). The causes of injury included falling from height in 2 cases, traffic accident injury in 3 cases, heavy object injury in 2 cases, and other injuries in 6 cases. There were 2 cases of Ⅰ-B-3 type, 1 case of Ⅰ-C-2 type, 1 case of Ⅰ-C-3 type, 3 cases of Ⅱ-B-2 type, 1 case of Ⅱ-B-3 type, 1 case of Ⅱ-B-4 type, 2 cases of Ⅱ-C-2 type, 1 case of Ⅱ-C-4 type, and 1 case of Ⅱ-D-3 type according to the classification of floating shoulder injury. All patients had unilateral clavicle fracture with scapular neck fracture, 1-4 superior shoulder suspensory complex (SSSC) injuries. The time from injury to operation was 7-17 days, with an average of 12 days. The glenopolar angle, subacromail space, anteroposterior inclination angle of scapular glenoid, scapular glenoid up and down angle were measured before and after operation; Constant-Murly score and Herscovici score were used to evaluate the recovery of shoulder joint function.ResultsAll incisions healed by first intention, and there was no early postoperative complications such as infection. All 13 cases were followed up 12-48 months, with an average of 25.2 months. Both the clavicle and the scapula had bone union, and the average healing time was 6 months and 4 months respectively. There were no complications such as nonunion, shoulder deformity, plate fracture or failure of internal fixation, acromion impingement syndrome, and frozen shoulder. At last follow-up, the glenopolar angle, subacromail space, anteroposterior inclination angle of scapular glenoid, and scapular glenoid up and down angle were all corrected significantly (P<0.05). The pain, function, activity, muscle strength scores, and total score in Constant-Murly score were significantly improved when compared with preoperative scores (P<0.05). According to the Herscovici scoring standard, the shoulder joint function was evaluated as excellent in 8 cases, good in 3 cases, and fair in 2 cases. The excellent and good rate was 84.6%.ConclusionDouble internal fixation of clavicle and scapula to stabilize SSSC and reduct glenopolar angle during operation is an effective method for treating the floating shoulder injury.
ObjectiveTo investigate the effectiveness of Endobutton plate coracoclavicular fixation combined with fracture site high-strength suture Nice knot cerclage fixation in the treatment of distal clavicle fracture with coracoclavicular ligament injury. Methods The clinical data of 33 cases of distal clavicular fracture with coracoclavicular ligament injury treated by Endobutton coracoclavicular plate fixation between January 2017 and December 2020 were analyzed retrospectively. According to the fixation methods of fracture site, they were divided into two groups: the high-strength suture Nice knot fixation group (study group, 16 cases) and the transacromial Kirschner wire fixation group (control group, 17 cases). There was no significant difference between the two groups in common data such as age, gender, injury side, cause of injury, Craig type, combined injury, time from injury to operation, and preoperative visual analogue scale (VAS) score and Constant-Murley score (P>0.05). Postoperative fracture healing and complications were observed, and the increase rate of coracoclavicular space on the affected side was calculated at last follow-up. VAS score was used to evaluate shoulder pain before operation, at 1 week, 1 month, 3 months after operation, and at last follow-up. The shoulder function was evaluated according to Constant-Murley shoulder score before operation, at 1 month, 3 months after operation, and at last follow-up. Results The operations were successfully completed in both groups without severe complications such as vascular nerve injury and coracoid fracture. In the control group, 1 case (5.9%) had slight pin tract infection and 1 case (5.9%) had Kirschner wire displacement; there was no obvious complication in the study group. The patients in both groups were followed up 9-36 months (mean, 22.9 months). The fracture healing time of the study group and the control group were (12.56±0.73) weeks and (13.59±0.87) weeks, respectively, and the difference was significant (t=−3.661, P=0.001). At last follow-up, the increase rates of coracoclavicular space on the affected side of the study group and the control group were 8.88%±1.19% and 8.55%±1.07%, respectively, showing no significant difference (t=0.837, P=0.409). The postoperative VAS score and Constant-Murley score of the two groups significantly improved when compared with those before operation, and the two scores gradually improved with the extension of time after operation (P<0.05). Except that the VAS score at 1 week and 1 month after operation and the Constant-Murley score at 1 month after operation in the study group were significantly better than those in the control group (P<0.05), there was no significant difference between the two groups at other time points after operation (P>0.05). Conclusion For oblique fracture or combined with butterfly fracture in the distal clavicle fracture with coracoclavicular ligament injury, the fracture site high-strength suture Nice knot fixation is a good supplement to the Endobutton plate coracoclavicular fixation. It can stabilize the fracture end, reduce the complications of Kirschner wire fixation, and is more conducive to fracture healing. The effectiveness is satisfactory.
ObjectiveTo systematically review the safety and efficacy of operative versus non-operative treatment for displaced midshaft clavicle fractures.MethodsDatabases including PubMed, The Cochrane Library, EMbase, MEDLINE(Ovid), CBM, CNKI and WanFang Data were searched to collect randomized controlled trials (RCTs) and cohort studies about operation versus non-operation for displaced midshaft clavicle fractures from inception to June 3rd, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed by RevMan 5.2 software.ResultsA total of 14 RCTs and 5 prospective cohort studies involving 1 543 patients were included. The results of meta-analysis showed that operation was superior to non-operation in the Constant score (SMD=0.76, 95%CI 0.40 to 1.13, P<0.000 1), DASH score (SMD=–0.49, 95%CI –0.91 to 0.06,P=0.02), nonunion rate (RR=0.17, 95%CI 0.10 to 0.30, P<0.000 01), malunion (RR=0.20, 95%CI 0.12 to 0.33,P<0.000 01) and patients’ satisfaction rate (RR=1.39, 95%CI 1.13to 1.71,P=0.002), respectively.ConclusionCurrent evidence shows that operation could improve the function of the upper limbs, reduce nonunion and malunion, and improve the satisfaction of the patients with midshaft clavicle fractures. Due to the limited quality of the included studies, more large-scale, high-quality studies are required to verify the above conclusion.
Objective To compare the effectiveness of clavicular hook plate fixation in the treatment of acromioclavicular joint dislocation and distal clavicle fractures. Methods A clinical data of 90 patients, who underwent clavicular hook plate fixation between January 2014 and June 2023, was retrospectively analyzed. There were 40 patients with distal clavicle fractures (fracture group) and 50 with acromioclavicular joint dislocations (dislocation group). There was no significant difference in the baseline data of gender, age, cause of injury, side of injury, time from injury to operation, and constituent ratio of osteoporosis patients between the two groups (P>0.05). The time to remove the internal fixators and the occurrence of complications were recorded. Before removing the internal fixator and at 3 months after removing, the visual analogue scale (VAS) score was used to evaluate the degree of pain, and the mobility of the shoulder joint in forward flexion, elevation, and abduction was measured. Before removing the internal fixators, the Constant-Murley score and the University of California, Los Angeles (UCLA) score were used to evaluate the function of the shoulder joint. X-ray films of the shoulder joint were taken during follow-up to observe the occurrence of subacromial osteolysis, acromioclavicular joint osteoarthritis, and distal clavicle bone atrophy. Subgroup comparison was conducted between patients with and without subacromial osteolysis in the two groups. Results All incisions healed by first intention in both groups. All patients were followed up 1-9 years, with a median of 5 years; the difference in follow-up time between the two groups was not significant (P>0.05). During follow-up, subacromial osteolysis occurred in 74 cases, including 41 cases of typeⅠand 33 cases of type Ⅱ, distal clavicle bone atrophy in 15 cases, and acromioclavicular joint osteoarthritis in 8 cases. There were significant differences in the removal time of internal fixators, the incidence of bone atrophy, and the incidence of osteoarthritis between the two groups (P<0.05). There was no significant difference in the incidence of subacromial osteolysis (P>0.05). Before removing the internal fixators, there was no significant difference in VAS score, UCLA score, and Constant-Murley score between the two groups (P>0.05), while there were significant differences in shoulder joint range of motion in all directions (P<0.05). After removing the internal fixators, only the difference in elevation was significant (P<0.05). Within the group comparison, the VAS score and mobility of shoulder joint in abduction and elevation after removing the internal fixators were significantly superior to those before removing (P<0.05). In the fracture and dislocation groups, there was only a significant difference in plate length between the subgroup with and without subacromial osteolysis (P<0.05), while there was no significant difference in the above other indicators (P>0.05). Conclusion Clavicular hook plate is a good choice for treating acromioclavicular dislocation or distal clavicle fractures, but the incidence of subacromial osteolysis is higher, and the degree of bone resorption is more severe in fracture patients. After removal of the internal fixator, the shoulder functions significantly improve. It is recommended to remove the internal fixator as soon as possible within the allowable range of the condition.
Objective To analyze the clinical effect of clavicular hook plate in treating Neer type Ⅱ fracture of distal clavicle. Methods From March 2004 to April 2006, 15 patients suffering from Neer type Ⅱ fracture of distal clavicle were treated with clavicular hook plate, including 12 males and 3 females with an average age of 39 years (range,17-69 years). All patients had acute injury,including accident injury (8 cases) and falling injury (7 cases). The results were assessed by the JOA method. Results The wounds healed by first intention. No early complications were found. All patients were followed up for an average of 16.4 months(range,9-34 months) .The mean JOA score was 93.1. Themean pain parameter was 28.0, the fuction was 18.8 and the range of motionwas 26.3. The X-ray films showed that bony union was obtained in all patients after 3.6 months, and the mean healing period was 3.9 months.No acromioclavicular subluxation and dislocation occurred. Conclusion The principal advantages of this method are reliable fixation and early rehabilitation. It is necessary to protect rotator cuff and tissues behind acromioclavicular joint and remove the plate as soon as possible after bony union.
Objective To summarize the method and effectiveness of open reduction and internal fixation in the treatment of 4 cases of bipolar clavicle dislocations. Methods Between June 2017 and June 2022, 4 patients with bipolar clavicle dislocations were admitted. There were 3 males and 1 female. The age ranged from 27 to 63 years, with an average age of 45 years. There were 2 cases of crushing injury of mine car, 1 case of traffic accident injury, and 1 case of heavy object injury. The time from injury to operation was 3-7 days, with an average of 5.0 days. The sternoclavicular joint dislocations were classified as Grade Ⅱ in 1 case and type Ⅲ in 3 cases, and anterior dislocation in 3 cases and posterior dislocation in 1 case. The acromioclavicular joint dislocations were classified as Tossy type Ⅱ in 2 cases and type Ⅲ in 2 cases. After open reduction, the sternoclavicular joint and acromioclavicular joint were fixed with lateral malleolus locking titanium plate and clavicular hook plate, respectively. ResultsAll operations were successfully completed without vascular or nerve injury. All incisions healed by first intention. All patients were followed up 12-18 months, with an average of 14 months. At last follow-up, the shoulder joint functions were rated as excellent in 3 cases and good in 1 case according to Rockwood score. During follow-up, there was no loosening of internal fixator or fracture. The internal fixators were removed in all patients at 5-7 months after operation (mean, 6 months), and no re-dislocation occurred after removal. Conclusion For bipolar clavicle dislocation, open reduction combined with lateral malleolus locking titanium plate fixation of the sternoclavicular joint and clavicle hook plate fixation of the acromioclavicular joint can achieve good effectiveness. It has the advantages of simple operation, high safety, firm fixation, and fewer complications, and the shoulder function recovers well.