Purpose: Injury to the clavicle is a rare cause of outlet syndrome. We report eight cases to determine the diagnostic and therapeutic features and report outcomes. Material and methods: This series of eight patients (five women and three men), mean age 48 years (11)70) sufferred from pain irradiating to the upper limb with paraesthesia in the ulnar teritorry of the hand together with diminished muscle force. The diagnosis was established 23.1 months (mean, range 1–10 years) after the initial comminutive mid-third fracture. The displaced bone which was treated orthopaedically. Standard x-rays revealed: four deformed calluses, two atrophic nonunions, one fracture with a vertical fragment (rapid osteosynthesis performed to avoid acute plexus compression) and finally one resection of the mid third (secondary to osteitis). The electromyogram confirmed the diagnosis, generally with compression of a secondary anteromedial trunk. 3D reconstruction scans (measurement of the costo-cleidal space) were obtained. Results: Pain disappeared the day after surgery as did the paraesthesia in seven out of eight patients. The clavicle healed in 13 to 18 months. Discussion: Different mechanisms can cause compression of the brachial plexus after displaced comminutive fracture of the clavicle. Different therapeutic modalities have been proposed. The outlet syndrome should be considered following displaced fractures of the mid third of the clavicle in patients presenting pain irradiating to the upper limb. The diagnosis is confirmed by electromyography. Proper analysis of the clavicle is obtained with 3D CT scan allowing adapted surgical treatment

Introduction: Pathological fracture of the clavicle is not such a rare condition. By definition the fracture occurs either without or with minimal trauma. We present a case of pathological fracture where there was a definite history of trauma; clouding the true malignant diagnosis. Case Report: A 73 year old man first presented to the Accident & Emergency Dept. of our hospital with a history of having fallen on to his left shoulder after throwing a piece of concrete, and to have developed swelling and pain around the shoulder immediately following the fall. On examination the main findings were swelling and bony tenderness over the proximal clavicle and inability to use his left shoulder due to pain. X-ray showed a fracture at the junction between the proximal 1/3 and distal 2/3 of the left clavicle, and he was given a broad arm sling for support and a one week appointment for review in the fracture clinic. Two clinic appointments later he was still complaining of pain. X-rays taken at that time showed what appeared to be some evidence of callus formation at the fracture site. Six weeks later he had clinical and radiological signs of what appeared to be “huge callus formation”. He was given a 3 month appointment for what was expected to be a final review. Before his next fracture clinic appointment, however, he became jaundiced and complained about this to his GP who felt it was obstructive jaundice and referred him to the physicians who admitted him to the hospital, and began to investigate him as to the cause of the jaundice. These investigations included an Ultrasound Scan of the abdomen which showed a bulky head of pancreas with biliary and pancreatic ductal dilatation; and a CT scan of the upper abdomen which showed the presence of a cystic mass within the caudate lobe of the liver. Soft tissue vascular encasement around the portal vein and hepatic artery were reported as in keeping with malignant infiltration. Extensive tumour was present within the retroperitoneum involving local vascular structures. He came down to the fracture clinic for his next clinic appointment from the ward. At this point he was very ill, deeply jaundiced and frail. The swelling of the clavicle was the size of a large orange, firm to touch with dilated veins. X-ray at this point showed complete radiological destruction of the medial 1/3 of the left clavicle. At this point palliative care was the mainstay of his management. A week later the chest x-ray report came back as showing collapse of the left upper lobe with whiteout appearance and bulky hilum indicating an underlying bronchogenic carcinoma. Three days later, almost 5 months after initial presentation following a fall, this patient finally succumbed to his disease. Conclusion: This patient presented with a simple fracture and was given the standard treatment for the condition. However because his treatment was compartmentalized, i.e., orthopaedics treating the orthopaedic condition, radiology doing x-rays, and physicians managing the jaundice; it took some months before the different pieces of the jig-saw puzzle were put together and the malignant diagnosis arrived at

Introduction. Sternoclavicular dislocations are well-known adult injuries. The same traumatism causes growth-plate fracture of the medial clavicle in children and young adults. At this location, the emergence of the secondary ossification center and its bony fusion are late. We report the results of 20 cases hospitalized in the Toulouse University Hospital Center that were treated surgically. Materials & Methods. 20 patients were treated between 1993 and 2007, 17 boys and 3 girls, 16 years old (6–20). The traumatism was always violent (rugby 75%). Two physeal fractures were anteriorly displaced, and 18 posteriorly. The follow-up is 64 month (8–174). Clinical, radiographic and therapeutic characteristics were assessed. The long-term results were analysed with: an algo-functional scale (Oxford shoulder score), the subjective Constant score, a functional disability scale (Shoulder simple test), a quality of life scale (DASH), and global indicators (SANE and global satisfaction). Results. all the patients were symptomatic before surgery: pains, oedema and partial functional impotence. Only 2 dysphagia, 1 dyspnea and 1 venous circulation alteration were observed. The first clinical and radiological examination, before CT scan, didn't diagnose the injury in 8 cases. The CT scan were realized for all the patients: it diagnosed the physeal fracture and showed 4 cases of vascular or respiratory compressions. There were 5 attempts of closed reduction, without success: all the patients were surgically-treated. The open reduction were completed by pinning (12 cases) or cerclage with absorbable suture (3 cases). Per-operatory findings lead to realize costo-clavicular repair plasties with the sub-clavicular muscle (3 cases) and/or capsular-ligamentous-perosteal selective plasties (13 cases). Two cases of broken Kirschner wires were noticed, without migration. Functional outcomes are largely good or excellent: STT 11,74/12 (10–12)–OSS 12,95/60 (12–19)–DASH 2,07/100 (0–17,6)–SANE 93,16% (60–100). Discussion and Conclusion. we present the largest case series in the literature. CT scanner is the essential element of the diagnostic process and may allow the distinction between true sterno-clavicular dislocation and displaced physeal fractures. This distinction is difficult at younger ages and is facilitated by the progression of ossification. Very good results were obtained, but classical pitfalls of treatment were found: instability after closed reduction, broken K-wires, recurrent anterior instability, inesthetic scars

Purpose. Plating remains the most widely employed method for the fixation of displaced diaphyseal clavicle fractures. The purpose of this study was to assess the efficacy and outcomes of diaphyseal clavicle fractures treated with intramedullary fixation using the Rockwood clavicle pin. Methods. We conducted a retrospective analysis of all diaphyseal clavicle fractures treated with intramedullary fixation using the Rockwood pin between February 2004 and March 2010. Sixty-eight procedures were carried out on 67 patients. Functional outcome was assessed using the Disability of the Arm, Shoulder and Hand (DASH) questionnaire and an overall patient satisfaction questionnaire. Results. There were 52 (77.6%) male and 15 (22.4%) female patients with an average age of 35.8 years. In 35 (51.5%) cases the injury was located on the dominant side. Fractures were classified according to the Edinburgh system with the commonest configuration being the Type 2B1 (47, 69.1%). The indications for fixation were; acute management of displaced fractures (56, 82.4%), delayed union (2, 2.9%), nonunion (8, 11.8%) and malunion (2, 2.9%). The average time to pin removal was 3.7 months and the average follow-up prior to discharge was 6.9 months. Sixty-six (97.1%) fractures united without consequence. Two (2.9%) cases of non-union were treated with repeat fixation using a contoured plate and bone graft. The most common problem encountered postoperatively was discomfort due to subcutaneous pin prominence posteriorly (12, 17.6%) which resolved following removal of the metalwork. The average DASH score was 6.04 (0–60) and 96.4% of patients rated their satisfaction with the procedure as good to excellent. Conclusion. Due to its minimally invasive technique, cosmetically favourable scar, preservation of periosteal tissue, avoidance of stress risers associated with screw removal and good clinical outcomes, the use of this device is the preferred method of treatment for displaced diaphyseal clavicle fractures in our hospital

Fracture of the clavicle is common and comprise 4% of all adult fractures. The incidence appears to be increasing owing to several factors, including the occurrence of many more high velocity vehicular injuries and an increase in popularity of contact sports. The most common side site for occurrence of fracture in clavicle is the middle third and the medial fractures are rare. We did our retrospective study during 2003–2005. We review 13 patients with fracture of the clavicle. There were 10 males and 3 females and 11 were left side and 2 were right side. Patients ages ranged between 15–49 years (average 29.6). The majority of fractures were caused by motorbike and quads bike accidents. 10 were classified as Neer type 1 (midshaft) and 3 were Neer type 1 (distal third). All these patients were treated with an Acumed congruent anatomical plate. The patients were followed up for 6 months to 1 years. Post-operatively patients were treated for 3 weeks in a sling, and then had physiotherapy for the next 3 weeks. All fractures were united by 7 weeks. Our complications were 1 superficial wound infection, 1 delayed union at 9 weeks, and 1 non union at 12 weeks. All patients had a full range of movement of the shoulder by the end of the 6. th. week. In the past fractures of the clavicle were treated conservatively. Currently patients want to mobilise their limbs early, and get back to work. The clinical results of the congruent anatomical plate appear to be good in terms of fracture union and early return to function in young patients. The principal advantage of this method of treatment is an anatomical reduction of the fracture and early rehabilitation with return to normal function

Fractures of the clavicle remain common in clinical practice. The main changes that have occurred in the last five years are in the indications for surgical intervention. The traditional indications remain. For example, complex cases such as compound fractures, those in which the skin is threatened, fractures of the clavicle associated with a floating shoulder, fractures of the clavicle associated with vascular injury and unstable lateral clavicle fractures. Fractures of the middle 1/3 of the clavicle with displacement of greater than 2 cm have been identified as having a poorer outcome based on patient related factors. In adults these fractures are now recommended for surgical stabilisation. A number of surgical techniques have been described including internal fixation with plates and intramedullary pins. It is the author's preference to use plate fixation as it provides stable fixation of the clavicle including rotational control. Although there are some authors that do recommend pin fixation, insertion of these pins can be technically demanding and there is a risk of displacement of undisplaced fragments. The intramedullary pins do not provide rotational control of the fracture. When performing internal fixation of clavicle fractures it is important to be aware of the risk of major neurovascular compromise. In the second quarter (from the medial edge of the clavicle) the major neurovascular structures are at risk and care is required to ensure that drills and screws do not penetrate the inferior cortex of the clavicle and violate these neurovascular structures. Adolescents with fractures of the clavicle are often managed without surgical intervention even if there is significant displacement. However, further work is required to identify the natural history of this group. Non-union of the clavicle is a relatively uncommon event. For those patients who have a persistent symptomatic non-union, surgical stabilisation and bone grafting is recommended

The December 2012 Shoulder & Elbow Roundup. 360. looks at: whether allograft is biomechanically superior in large Hill-Sachs defects; glenoid bone loss in shoulder dislocators; repairing irreparable cuff tears; acromioclavicular joint injuries; whether more radiographs equals more surgery; whether reverse TSR is cheaper than hemiarthroplasty; autologous chondrocyte implantation in the shoulder; and fracture of the clavicle

Introduction: Distal third fractures of the clavicle account for approximately 10–15% of clavicle fractures. Non union rates following conservative management can be as high as 30%. Many techniques have been described, including external fixation, k-wire fixation, and most recently, hook plate fixation. Non-absorbable sutures, and slings have also been utilised. All of these techniques are associated with complications. In addition, Hook plates require a second operation to remove the plate. This study reports the results of a simple technique using a PDS loop in the fixation of Neer type 2 fractures of the clavicle, performed in our institution. Methods: Twelve patients with Neer type 2 fractures operated by a single surgeon over three years were included in the study. The mean age was 45 (14 to 63). There were 7 male and 5 female patients. Standard postoperative protocols were followed in all patients. A 1.5 PDS cord looped around the coracoid was used to hold the reduced medial clavicular shaft fragment. Patients were followed up postoperatively at two, six and twelve weeks. Final outcomes were assessed using radiographs and the Oxford and DASH scoring systems at twelve months. Results: Ten fractures united within twelve weeks. All of these patients returned to their pre-injury activity level. There were two non unions, both in non compliant patients. One of these non unions remained asymptomatic and one patient was lost to follow up. The mean Oxford score at 12 months was 14.25 (range 12 to 16) and the mean DASH score was 5 (4–7). Conclusion: We conclude that this technique is safe, simple and cost effective. It achieves high rates of union without the need for implant removal. As with other techniques, proper patient selection is essential. We recommend this technique as an excellent treatment option when dealing with these notoriously difficult fractures

Introduction: The combined fractures of the clavicle (or A-C dislocation) and the scapular neck are complex injuries related to high energy trauma. Their management varies depending on the degree of instability and the presence of neurovascular complications. We evaluated the results of the treatment given to this rare injury. Material and Method: During a five year period (1997–2001) we treated 12 patients with floating shoulder. The injury was in all cases the result of severe road traffic accident. Nine patients were males and three females with age ranging from 20 to 51 years. Seven patients had injured the right shoulder, the remaining five having injured the left one. Eight patients had additional injuries (chest in four, head in two, fracture of the T4 with complete paraplegia in one, chest and abdominal in one). Three patients had neurovascular complications and were operated upon. Two of them with vascular injury were operated ungently and had arterial graft and stabilization of the clavicle or the A-C joint with tension band. The third patient with only neurological injury (axillary and suprascapular nerves) had similar stabilization of his clavicle. The remaining nine patients with minor displacement of the fractures and stable shoulder girdle were managed conservatively. Results: We reexamined eleven patients. The mean follow-up period was 19 months (8–56 months). In nine patients-including the three operated-the fractures had healed in satisfactory position. In the remaining two the fracture of the scapular neck was malunited, resulting in loss of shoulder normal configuration and restriction of shoulder elevation. In two of the operated patients the coexistence of neurological injury resulted in poor functional outcome. The third one-with the axillary and suprascapular nerve injury-improved in relation to the axillary nerve within six months from the injury and had a fairly useful upper extremity. In the Constant-Murley scale the score ranged from 28–89 points (average 67 points). Conclusion: In conclusion, fractures of the clavicle (or A-C dislocations) and the scapular neck are injuries of high energy and are usually encountered in multiplez injured patients. Severe displacement is usually related to instability of the shoulder girdle and neurovascular injuries; urgent operation is then necessary and the final result is often poor. In cases of severe displacement the stabilization of only the clavicle is not sufficient and open reduction and internal fixation of the scapular neck is recommended

Neer type 2 fractures of the distal third of the clavicle have a non union rate of 22-35% after conservative treatment. Open reduction and internal fixation has been recommended by most authors but there is no consensus about the best method of internal fixation. We retrospectively assessed the union and shoulder function following Hook plate fixation in 18 patients with Neer type 2 fractures of lateral end clavicle with more then a six month follow up after surgery. There were 14 males with a mean follow-up of 25.89 months (6-48 months) and the average age was 40.33 years (22-62 range). Fifteen had acute fractures and the rest were non unions. Complications included two non unions, one following a deep infection. There were no iatrogenic fractures. Acromial osteolysis was seen in five patients who had their plates in situ. The average pain score at rest was 1 (0-4) and the average pain score on abduction was 2.2 (0-5). The average Constant score was 88.5 (63-100). Patients were asked to rate their shoulder function; three said their shoulder was normal, eleven said it was nearly normal and one rated it as not normal. Hook plate fixation appears to be a valuable method of stabilising Neer type 2 fractures of the clavicle resulting in high union rates and good shoulder function. These plates need to be removed after union to prevent acromial osteolysis

Aims

To evaluate whether low-intensity pulsed ultrasound (LIPUS) accelerates bone healing at osteotomy sites and promotes functional recovery after open-wedge high tibial osteotomy (OWHTO).

Aims. Distal third clavicle (DTC) fractures are increasing in incidence. Due to their instability and nonunion risk, they prove difficult to treat. Several different operative options for DTC fixation are reported but current evidence suggests variability in operative fixation. Given the lack of consensus, our objective was to determine the current epidemiological trends in DTC as well as their management within the UK. Methods. A multicentre retrospective cohort collaborative study was conducted. All patients over the age of 18 with an isolated DTC fracture in 2019 were included. Demographic variables were recorded: age; sex; side of injury; mechanism of injury; modified Neer classification grading; operative technique; fracture union; complications; and subsequent procedures. Baseline characteristics were described for demographic variables. Categorical variables were expressed as frequencies and percentages. Results. A total of 859 patients from 18 different NHS trusts (15 trauma units and three major trauma centres) were included. The mean age was 57 years (18 to 99). Overall, 56% of patients (n = 481) were male. The most common mechanisms of injury were simple fall (57%; n = 487) and high-energy fall (29%; n = 248); 87% (n = 748) were treated conservatively and 54% (n = 463) were Neer type I fractures. Overall, 32% of fractures (n = 275) were type II (22% type IIa (n = 192); 10% type IIb (n = 83)). With regards to operative management, 89% of patients (n = 748) who underwent an operation were under the age of 60. The main fixation methods were: hook plate (n = 47); locking plate (n = 34); tightrope (n = 5); and locking plate and tight rope (n = 7). Conclusion. Our study is the largest epidemiological review of DTC fractures in the UK. It is also the first to review the practice of DTC fixation. Most fractures are being treated nonoperatively. However, younger patients, suffering a higher-energy mechanism of injury, are more likely to undergo surgery. Hook plates are the predominantly used fixation method followed by locking plate. The literature is sparse on the best method of fixation for optimal outcomes for these patients. To answer this, a pragmatic RCT to determine optimal fixation method is required. Cite this article: Bone Jt Open 2022;3(12):953–959

Aims. The management of mid-shaft clavicle fractures (MSCFs) has evolved over the last three decades. Controversy exists over which specific fracture patterns to treat and when. This review aims to synthesize the literature in order to formulate an appropriate management algorithm for these injuries in both adolescents and adults. Methods. This is a systematic review of clinical studies comparing the outcomes of operative and nonoperative treatments for MSCFs in the past 15 years. The literature was searched using, PubMed, Google scholar, OVID Medline, and Embase. All databases were searched with identical search terms: mid-shaft clavicle fractures (± fixation) (± nonoperative). Results. Using the search criteria identified, 247 studies were deemed eligible. Following initial screening, 220 studies were excluded on the basis that they were duplicates and/or irrelevant to the research question being posed. A total of 27 full-text articles remained and were included in the final review. The majority of the meta-analyses draw the same conclusions, which are that operatively treated fractures have lower nonunion and malunion rates but that, in those fractures which unite (either operative or nonoperative), the functional outcomes are the same at six months. Conclusion. With regard to the adolescent population, the existing body of evidence is insufficient to support the use of routine operative management. Regarding adult fractures, the key to identifying patients who benefit from operative management lies in the identification of risk factors for nonunion. We present an algorithm that can be used to guide both the patient and the surgeon in a joint decision-making process, in order to optimize patient satisfaction and outcomes. Cite this article: Bone Jt Open 2022;3(11):850–858

Purpose. There is increasing evidence that primary fixation of displaced mid-shaft fractures of the clavicle results in superior short-term outcomes when compared to traditional non-operative methods. However, the results from published studies are limited to relatively short-term (one year or less) follow-up. Accurate data of longer follow-up is important for a number of reasons, including patient prognostication, counseling and care, the design of future trials, and the economic analysis of treatment. The purpose of this paper was to examine the results of the two year follow up of patients enrolled in a previously published randomized clinical trial of operative versus non-operative treatment of displaced fractures of the clavicle. Method. Using a comprehensive and standard assessment that included DASH (Disabilities of the Arm, Shoulder and Hand) and CSS (Constant Shoulder Scores) scores, we evaluated ninety-five patients of the original cohort of one hundred and thirty-two patients at two years following their injury. Results. Statistical analysis performed on the two year follow up data revealed that DASH and CSS scores remained essentially unchanged at two years post-injury compared to one year post-injury for both operative and non-operative groups (p>0.05). Additionally, outcome scores in the operative group remained superior to the non-operative group (DASH operative 4 +/− 7 versus DASH non-operative 11 +/− 20, p<0.014, CSS operative 97 +/− 4 versus CSS non-operative 92 +/− 14, p<0.012) at two years post-injury. Conclusion. The improvement in outcome seen with primary fixation of displaced clavicle fractures persists at two years but does not differ significantly from values seen after one year of follow-up, suggesting that clinically a steady state has been reached whereby outcome is unlikely to change with time. This has clinical, economic, and research implications

Introduction and Aims: Acromioclavicular dislocations and fractures of the distal clavicle present a challenging problem for the treating surgeon. The use of a new specifically designed implant was investigated. A hooked-shaped plate with fixation to the distal clavicle and ‘hook’ placement under the posterior acromion was used. Method: The procedure was carried out on eight patients. In five patients the injury was a fractured distal clavicle. In three cases an acromioclavicular dislocation was treated. In all cases the time to returning to a functional capacity was analysed. The eventual functional result was indexed from the time of fracture union or complete stabilisation of the dislocations. Results: All five fractures went on to anatomical union. The three dislocations were all stabilised with no instability or subluxation. In two cases patients complained of impingement symptoms with decreased overhead functional capacity. In both cases the patients regained a full and pain-free range of movement after removal of the implant. Conclusion: This new implant provides an acceptable alternative in the management of distal clavicle fractures and acromioclavicular dislocations. The complication of impingement is encountered, but this appears to be treatable by removal of the implant after fracture union or joint stabilisation

Non-operative treatment of lateral clavicle fractures presents a difficult problem. A high incidence of non-union, residual pain and shoulder girdle instability has been reported. A variety of fixation techniques have been described but the complication rates of these procedures can be high. This retrospective review describes the use of distal radius locking plates for fixation of lateral unstable clavicle fractures. From January 2006 until December 2007 23 patients (17 males, 5 females; mean age 31 yrs (12–70) presented to our service. 2 patients sustained type 1, 16 patients type 2, 2 patients type 4 and 3 patients type 5 fractures (Neer classification). Patients were reviewed clinically, radiographically and with Constant score assessment. Union was acchieved at a mean follow up of 7.2 weeks. The mean Constant score at 6 months was 84, the mean DASH score 27.7. The following complications were seen during the follow-up period: 1 superficial infection settling with oral antibiotics and 1 non-union in a type 5 fracture requiring bone grafting. Clavicle fractures of the lateral aspect are controversial. The mechanism of injury often results in ruptures of the adjacent coracoclavicular ligaments and create instability and increased motion between the proximal and distal fragment. The result of this series of cases are encouraging and we recommend the use of distal radius locking plates to treat unstable lateral clavicle fractures. However a larger study is needed to further evaluate mid- and long-term shoulder function

Acromioclavicular (AC) joint dislocations and fractures of the distal clavicle present challenging problems for the treating surgeon. We treated eight patients using a hook-shaped plate fixed to the distal clavicle and ‘hooked’ under the posterior acromion. In five patients the injury was a fractured distal clavicle and in three an AC joint dislocation. We analysed the time taken to achieve a functional capacity. The eventual functional result was indexed from the time of fracture union or complete stabilisation of the dislocations. All five fractures went on to anatomical union. The three dislocations were all stabilised with no instability or sub-luxation. Two patients complained of impingement symptoms and decreased overhead functional capacity. After the implant was removed, both patients regained a full range of pain-free movement. This is a small study with limited follow-up. However, the results suggest that this new implant provides an acceptable alternative in the management of distal clavicle fractures and AC joint dislocations. The complication of impingement can be treated by removal of the implant after union or stabilisation has been achieved

Purpose: In a prospective randomized clinical trial, we have previously reported the “limb-specific” results comparing operative (plate fixation) versus non-operative (sling) treatment for completely displaced fractures of the shaft of the clavicle. We also sought to determine the effect that a fracture of the shaft of the clavicle had on general health status, as measured by the SF-36 General Health Status instrument. We then evaluated the effects of different treatment methods (operative versus non-operative), on general health scores. Method: We performed a multi-center, randomized clinical trial of operative versus non-operative treatment of completely displaced clavicular shaft fractures in 111 patients. In addition to radiographic, surgeon-based, and limb-specific data we prospectively gathered SF-36 questionnaires at baseline, and at 6 weeks and 3, 6, 12, and 24 months post-injury. Results: Results: Both groups had SF-36 scores equivalent to or slightly superior to population norms at baseline. A clavicular shaft fracture had a significant negative effect on SF-36 scores (especially the physical components) in both groups at 6 weeks (p< 0.01) and 3 months (p< 0.01). There was a statistically greater decrease in Physical Component Scores (PCS) in the non-operative group compared to the operative group (P< 0.05). At 6 months, scores had returned to pre-operative levels in the operative group, but remained significantly decreased in the non-operative group (p=0.04). This difference persisted at the one and two year points. Conclusion: A displaced fracture of the clavicular shaft has a clinically significant negative effect on general health status scores. This effect can be mitigated by primary operative fixation, which restores scores to normal levels by six months post-injury. Patients treated non-operatively for a displaced fracture of the shaft of the clavicle demonstrated lower PCS scores at two years post-injury. This information is useful in counseling patients with regards to treatment options following displaced fractures of the clavicle shaft

Assess the outcome of plating of lateral end clavicle fractures. Lateral end clavicle fractures can be treated both conservatively and surgically. Different surgical methods are available to stabilize lateral end clavicle fractures. We treated 15 lateral end clavicle fractures with plate fixations (4 AO ‘T’ plate and 11 ACUMED lateral clavicle plate) from September 2002 to December 2005. There were 12 males and 3 females and the mean age was 33.12 year (range 23–61). 3 were done for non-union and 13 for acute fractures. 2 non-unions were treated with AO ‘T’ plate and 1 with ACUMED lateral clavicle plate. 1 patient with non-union had bone grafting at the time of the procedure. Acute fractures were stabilized with in 3 weeks from the time of the injury. All fractures were Type 2 according to Neer classification of lateral end clavicle fractures. The cause of the injury was, simple fall (3), fall from pushbike (3), assault (3), sports/skate-board (3), and RTA (3). The senior author operated on all patients. The arm was immobilized in a sling for six weeks post operatively. The follow up ranged between 5 months to 36 months All but one fracture healed. 1 ‘T’ and 1 ACUMED plate was removed 7 months after the index procedure after fracture consolidation. There was no superficial or deep infection. Patients were assessed clinically with Constant and DASH scores; patient satisfaction with the procedure was also recorded and union assessed radiologically.. Lateral end clavicle fractures pose a challenge due to the small size of the distal fragment. In our experience plating of these fractures give satisfactory results. Oblique fracture patterns result in better fixation and union rates. The plate design and advantages of the ACUMED contoured distal clavicle plates are further discussed in the paper

Introduction and Aims: The clavicle has several important functions each of which may be affected after fracture and malunion of the bone. The aim is to establish any association between shortening of the clavicle, following successful conservative management and clinical outcome. Method: 132 patients with history of an acute fracture of the clavicle were reviewed. None of them had previous pathology affecting shoulder function, prior to injury. Men accounted 93 with average age 25.4 years, and women 39 with average age 34.2 years. All underwent conservative management with standard protocols and the fracture was united. The length and relative shortening of the united clavicle were assessed on a standardised posteroanterior chest x-ray. Intra- and Inter-observer reliability of measurements were assessed. Clinical outcome was evaluated with the Constant score. Mean follow-up was 30 months. Results: Clavicular shortening following fracture union was 11.4 mm on average (range 3–25 mm), and was encountered in 120 patients. Intra- and inter-observer variability of measurements were not significant. Fracture healing time averaged 10 weeks (range 6–20 weeks) and 5.3% of patients presented delayed union. Thirty-four patients (25.8%) were unsatisfied with the result. The mean Constant score was 84 (range 62–100). Forty patients were having pain, and 21 had shoulder function impairment. Shortening > 14mm was statistically associated with unsatisfactory results. Conclusion: Clavicle is an important element in the integral functional mobility of the shoulder and malunion after fracture could lead to unsatisfactory results. We describe a simple, reliable method of Clavicular length-shortening evaluation and we report the results following successful conservative management. Identification of those patients likely to have poor results after conservative treatment, would give the opportunity for alternative treatment modalities. Further prospective randomised trials are necessary