Clinical and radiological outcome following treatment of displaced lateral clavicle fractures using a locking compression plate with lateral extension: a prospective study

Marc Beirer, Sebastian Siebenlist, Moritz Crönlein, Lukas Postl, Stefan Huber-Wagner, Peter Biberthaler, Chlodwig Kirchhoff, Marc Beirer, Sebastian Siebenlist, Moritz Crönlein, Lukas Postl, Stefan Huber-Wagner, Peter Biberthaler, Chlodwig Kirchhoff

Abstract

Background: Treatment of lateral fractures of the clavicle is challenging and has been controversially discussed for a long time due to high non-union rates in non-operative treatment and high complication rates in surgical treatment. Acromioclavicular joint instability due to the injury of the closely neighbored coraco-clavicular ligaments can result in a cranialization of the medial clavicle shaft. A recently developed implant showed a promising functional outcome in a small collective of patients.

Methods: In this prospective study, 20 patients with a mean age of 40.7 ± 11.3 years with a dislocated fracture of the lateral clavicle (Jäger&Breitner I-III, Neer I-III) were enrolled. All patients were surgically treated using the locking compression plate (LCP) for the superior anterior clavicle (Synthes®). Functional outcome was recorded using the Munich Shoulder Questionnaire (MSQ) allowing for qualitative self-assessment of the Shoulder Pain and Disability Index (SPADI), of the Disability of the Arm, Shoulder and Hand (DASH) score and of the Constant Score. Acromioclavicular joint stability was evaluated using the Taft-Score.

Results: The mean follow-up was 14.2 ± 4.0 months. The mean MSQ was 87.0 ± 7.4 points, the mean SPADI 91.1 ± 11.3 points, the mean DASH score 7.6 ± 7.3 points and the mean normative age- and sex-specific Constant Score 85.6 ± 8.0 points. The mean Taft Score resulted in 10.7 ± 1.0 points. The mean Taft Score in lateral clavicular fractures with fracture gap between the coracoclavicular ligaments in combination with a rupture of the conoid ligament (J&B II a, Neer II B; n =11) was with 10.3 ± 0.9 points significantly lower than the mean Taft Score of all other types of lateral clavicle fractures (J&B I, II b, III; n =9) which resulted in 11.3 ± 0.9 points (p<0.05).

Conclusions: The Synthes® LCP superior anterior clavicle plate allows for a safe stabilization and good functional outcome with high patient satisfaction in fractures of the lateral clavicle. However, in fractures type Jäger&Breitner II a, Neer II B a significant acromioclavicular joint instability was observed and additional reconstruction of the coracoclavicular ligaments should be performed.

Trial registration: ClinicalTrials.gov NCT02256059. Registered 02 October 2014.

Figures

Figure 1
Figure 1
Patient reported outcomes (Munich Shoulder Questionnaire (MSQ), Shoulder Pain and Disability Index (SPADI), Disability of the Arm, Shoulder and Hand (DASH) score, relative constant score) at a mean follow-up of 14 months. Data are given as vertical boxplots (median: horizontal boxline; 25–75% interquartile ranges; standard deviations: horizontal line).
Figure 2
Figure 2
Mean Taft Score of lateral clavicle fractures Jäger&Breitner (J&B) II a (Neer II B) versus J&B I, II b and III at a mean follow-up of 14 months. Data are given as vertical boxplots (median: horizontal boxline; 25–75% interquartile ranges). *p < 0.05 group J&B II a (Neer II B) vs. group J&B I, II b, III; Wilcoxon rank-sum test.
Figure 3
Figure 3
Radiological outcome of a lateral clavicle fracture J&B II a (Neer II B). a preoperative; b postoperative; c 1-year follow-up; d after plate removal.
Figure 4
Figure 4
Radiological outcome of a lateral clavicle fracture J&B II b. a preoperative; b postoperative; c 1-year follow-up; d after plate removal.

References

    1. Nowak J, Mallmin H, Larsson S. The aetiology and epidemiology of clavicular fractures. A prospective study during a two-year period in Uppsala, Sweden. Injury. 2000;31(5):353–358. doi: 10.1016/S0020-1383(99)00312-5.
    1. Donnelly TD, Macfarlane RJ, Nagy MT, Ralte P, Waseem M. Fractures of the clavicle: an overview. Open Orthop J. 2013;7:329–333. doi: 10.2174/1874325001307010329.
    1. Oh JH, Kim SH, Lee JH, Shin SH, Gong HS. Treatment of distal clavicle fracture: a systematic review of treatment modalities in 425 fractures. Arch Orthop Trauma Surg. 2011;131(4):525–533. doi: 10.1007/s00402-010-1196-y.
    1. Good DW, Lui DF, Leonard M, Morris S, McElwain JP. Clavicle hook plate fixation for displaced lateral-third clavicle fractures (Neer type II): a functional outcome study. J Shoulder Elbow Surg. 2012;21(8):1045–1048. doi: 10.1016/j.jse.2011.07.020.
    1. Tiren D, Vroemen JP. Superior clavicle plate with lateral extension for displaced lateral clavicle fractures: a prospective study. J Orthop Traumatol. 2013;14(2):115–120. doi: 10.1007/s10195-013-0228-0.
    1. Schliemann B, Rosslenbroich SB, Schneider KN, Petersen W, Raschke MJ, Weimann A. Surgical treatment of vertically unstable lateral clavicle fractures (Neer 2b) with locked plate fixation and coracoclavicular ligament reconstruction. Arch Orthop Trauma Surg. 2013;133(7):935–939. doi: 10.1007/s00402-013-1737-2.
    1. Kirchhoff C, Banke IJ, Beirer M, Imhoff AB, Biberthaler P. Operative management of clavicular non-union: Iliac crest bone graft and anatomic locking compression plate. Oper Orthop Traumatol. 2013;25(5):483–498. doi: 10.1007/s00064-013-0257-0.
    1. Neer CS., 2nd Fractures of the distal third of the clavicle. Clin Orthop Relat Res. 1968;58:43–50.
    1. Seppel G, Lenich A, Imhoff AB. Distal clavicle fracture. Oper Orthop Traumatol. 2014;26(3):254–262. doi: 10.1007/s00064-013-0280-1.
    1. Taft TN, Wilson FC, Oglesby JW. Dislocation of the acromioclavicular joint. An end-result study. J Bone J Surg Am Vol. 1987;6(7):1045–1051.
    1. Jager M, Breitner S. Therapy related classification of lateral clavicular fracture. Unfallheilkunde. 1984;87(11):467–473.
    1. Schmidutz F, Beirer M, Braunstein V, Bogner V, Wiedemann E, Biberthaler P. The Munich Shoulder Questionnaire (MSQ): development and validation of an effective patient-reported tool for outcome measurement and patient safety in shoulder surgery. Patient Saf Surg. 2012;6(1):9. doi: 10.1186/1754-9493-6-9.
    1. Biberthaler P, Beirer M, Kirchhoff S, Braunstein V, Wiedemann E, Kirchhoff C. Significant benefit for older patients after arthroscopic subacromial decompression: a long-term follow-up study. Int Orthop. 2013;37(3):457–462. doi: 10.1007/s00264-012-1760-x.
    1. Yian EH, Ramappa AJ, Arneberg O, Gerber C. The Constant score in normal shoulders. J Shoulder Elbow Surg. 2005;14(2):128–133. doi: 10.1016/j.jse.2004.07.003.
    1. Khan LA, Bradnock TJ, Scott C, Robinson CM. Fractures of the clavicle. J Bone Joint Surg Am. 2009;91(2):447–460. doi: 10.2106/JBJS.H.00034.
    1. Robinson CM, Cairns DA. Primary nonoperative treatment of displaced lateral fractures of the clavicle. J Bone Joint Surg Am. 2004;86-A(4):778–782.
    1. Hohmann E, Hansen T, Tetsworth K. Treatment of Neer type II fractures of the lateral clavicle using distal radius locking plates combined with TightRope augmentation of the coraco-clavicular ligaments. Arch Orthop Trauma Surg. 2012;132(10):1415–1421. doi: 10.1007/s00402-012-1570-z.
    1. Bhatia DN, Page RS. Surgical treatment of lateral clavicle fractures associated with complete coracoclavicular ligament disruption: clinico-radiological outcomes of acromioclavicular joint sparing and spanning implants. Int J Shoulder Surg. 2012;6(4):116–120. doi: 10.4103/0973-6042.106224.
    1. Herrmann S, Schmidmaier G, Greiner S. Stabilisation of vertical unstable distal clavicular fractures (Neer 2b) using locking T-plates and suture anchors. Injury. 2009;40(3):236–239. doi: 10.1016/j.injury.2008.07.021.
    1. Richards RH, Palmer JD, Clarke NM. Observations on removal of metal implants. Injury. 1992;23(1):25–28. doi: 10.1016/0020-1383(92)90120-H.
    1. Sanderson PL, Ryan W, Turner PG. Complications of metalwork removal. Injury. 1992;23(1):29–30. doi: 10.1016/0020-1383(92)90121-8.
    1. Jamil W, Allami M, Choudhury MZ, Mann C, Bagga T, Roberts A. Do orthopaedic surgeons need a policy on the removal of metalwork? A descriptive national survey of practicing surgeons in the United Kingdom. Injury. 2008;39(3):362–367. doi: 10.1016/j.injury.2007.10.028.
    1. Hanschen M, Biberthaler P. Mono- versus polyaxial locking plates. Unfallchirurg. 2013;116(8):733–741. doi: 10.1007/s00113-013-2451-9.
    1. Trompetter R, Seekamp A. Clavicle fractures. Unfallchirurg. 2008;111(1):27–38. doi: 10.1007/s00113-007-1384-6.
    1. Martetschlager F, Kraus TM, Schiele CS, Sandmann G, Siebenlist S, Braun KF, Stockle U, Freude T, Neumaier M. Treatment for unstable distal clavicle fractures (Neer 2) with locking T-plate and additional PDS cerclage. Knee Surg Sports Traumatol Arthrosc. 2013;21(5):1189–1194. doi: 10.1007/s00167-012-2089-0.
    1. Loriaut P, Moreau PE, Dallaudiere B, Pelissier A, Vu HD, Massin P, Boyer P. Knee Surg Sports Traumatol Arthrosc. 2013. Outcome of arthroscopic treatment for displaced lateral clavicle fractures using a double button device.
    1. Takase K, Kono R, Yamamoto K. Arthroscopic stabilization for Neer type 2 fracture of the distal clavicle fracture. Arch Orthop Trauma Surg. 2012;132(3):399–403. doi: 10.1007/s00402-011-1455-6.
    1. Rieser GR, Edwards K, Gould GC, Markert RJ, Goswami T, Rubino LJ. Distal-third clavicle fracture fixation: a biomechanical evaluation of fixation. J Shoulder Elbow Surg. 2013;22(6):848–855. doi: 10.1016/j.jse.2012.08.022.
Pre-publication history
    1. The pre-publication history for this paper can be accessed here:

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren