Fractures of the clavicle are relatively common, occurring mostly in younger patients and have historically been managed non-operatively. Recent studies have shown an advantage to surgical reduction and stabilisation of clavicle fractures with significant displacement. Currently, fracture displacement is measured using simple anterior-posterior two-dimensional x-rays of the clavicle. Since displacement can occur in all three-dimensions, however, evaluation of the amount displacement can be difficult and inaccurate. The purpose of this study was to determine the view that provides the most accurate assessment. Nine CT scans of acute displaced clavicle fractures were analysed with AmiraDEV5.2.2 Imaging software. Measurements for degrees of shortening and fracture displacement of the fracture clavicle were taken. Using a segmentation and manipulation module (ITK toolkit), five digitally reconstructed radiographs (DRRs) mimicking antero-posterior x-rays were created for every CT, with each differing by projection angle (ranging from 20° upwards tilt to 20° downwards tilt). Measurements were taken on each DRR using landmarks of entire clavicle length, distance from vertebrae to fracture (medial fragment length), distance from fracture to acromium (lateral fragment length), and horizontal shortening, and then compared to the true measurement obtained from the original CT. For all 9 samples, after comparing the measurements of clavicle fracture displacement in each 2D image, we found that an AP view with a 20° downward tilt yielded displacement measurements closest to the 3D (“gold standard”) measurements. The results agree with previous data collected from cadaveric specimens using physical X-ray film images. DDRs enable creation of multiple standard AP radiographs from which accurate tilt can be measured. The large deviation in measurements on different DRR projections motivates consideration of standardising X-ray projections. A uniform procedure would allow one to correctly evaluate the displacement of clavicular fractures if fracture displacement information is to be utilized in motivating surgical decision-making

Purpose: The purpose of this study is to evaluate the biomechanical properties and the stability between locking clavicle plate, dynamic compression plate and external fixation systems on an unstable displaced fracture model under torsional and 3 point bending loading.

Materials and Methods: Forty eight human adult formalin fixed clavicles were paired according to their BMD (DEXA) homogeneously into three groups; Group 1: Locking clavicle plate, Group 2: Dynamic compression plate and Group 3: External fixator. Each specimen was then osteotomized in the midshaft; and a 5mm bone segment was removed in order to stimulate a displaced fracture model. Biomechanical tests were applied in a cyclic loading model in MTS, Bionix 2. Torsional and three point bending forces were performed for 1000 cycles in all subgroups, stiffness was recorded at 10 cycles (initial) and periodic every 100 cyclic intervals. Failure load and moment were obtained after 1000 cycles. Initial stiffness, failure loads and the percentage of initial stiffness for each subgroup were compared across each group. One-way ANOVA and Bonferoni post- hoc tests were utilized to determine which were significantly different from one another with the significance level set as p< 0.05.

Results: The mean initial stiffness(Nmm/deg) - mean failure moments(Nmm) for torsional tests were 703.2 – 7671.7 (locking plate), 448.1 – 4370.3 (compression plate), 365.2 – 2999.7 (ex-fix) and the mean initial stiffness(Nmm) – mean failure loads(N) for bending tests were 32.6 – 213.2 (locking plate), 23.4 – 131.1 (compression plate), 20.6 – 102.7 (ex-fix) respectively. ANOVA test confirmed an overall significant difference between the three constructs in terms of both failure loads and a significant difference only between locking plate and others in terms of initial stiffness. At all cyclic intervals after 100 cycles there was significant difference of percentage of initial stiffness between locking plate and others in bending and torsion. There was a significant difference between compression plate and ex-fix after 700 cycles in torsional group and no difference found in bending group between (any of) them at any cyclic interval.

Conclusions: Locking anatomic clavicle plate is significantly more stable than unlocked dynamic compression plate and external fixator under torsional and bending cyclic loading in an unstable displaced fracture or non-union clavicle model.

Clavicular hook plates have been used over the last decade in the treatment of lateral clavicular fractures with good rates of union reported throughout the literature. Fewer studies have reported the functional outcome of these patients and some have reported potential soft tissue damage post plate removal. We aimed to review the functional outcomes alongside union rates in patients treated with hook plates for lateral clavicular fractures. In this retrospective case series, 21 patients with traumatic lateral third clavicular fractures were included. 15 had Neer type II fractures, 4 Neer type III fractures, 1 patient had a Neer type I fracture and 1 radiograph was not able to be classified. All patients were treated with clavicular hook plates at the same district general hospital by five experienced surgeons between March 2010 and February 2015 adhering to the same surgical protocol. All patients had standard physiotherapy and post operative follow up. Plates were removed when radiological union was achieved in all but one patient who had the plate removed before union was achieved due to prolonged non-union. Patients were followed up post plate removal and evaluated clinically using the Oxford Shoulder Score. Their post plate radiographs were assessed by an independent radiologist and bony union documented. 21 patients were included. Mean age was 40 (range 14–63) with a male:female ratio of 17:4. Mean follow up was 5 months post injury (1–26 months). The hook plate remained in situ for a mean time of 4.3 months (2–16 months). One patient developed a post-operative wound infection treated with antibiotics, 2 patients developed adhesive capsulitis, one patient had not achieved bony union prior to hook plate removal at 16 months, however did achieve union 2 months post plate removal, two patients required revision plating. All patients achieved bony union eventually with good alignment and no displacement of the acromioclavicular joint seen on the most recent post operative radiographs. Post plate removal Oxford Shoulder Scores indicated good shoulder function with a mean score of 41.5 (maximum score possible 48 and the range of scores for our cohort was 30–47). Our data would support the use of hook plates in the treatment of lateral clavicular fractures. All patients achieved union eventually with good alignment and this was reflected in the good functional outcome scores. This study is limited in its small cohort and short-term follow up. More research is required to examine the long term consequences of hook plate surgery in a larger patient population

Osteoarthritis (OA) is the most common disorder of the Sternoclavicular Joint (SCJ). In our case-control study, we evaluated the relationship between clavicular length and OA at the SCJ. CT scans of adults presenting to the Emergency Department of our hospital were examined to look for OA, defined as the presence of osteophytes, subchondral cysts, or cortical sclerosis at the SCJ. Medial-most and lateral-most points of the clavicle were marked on the slices passing through the SC and AC joints respectively. Using x, y, and z-axis coordinates from the DICOM metadata, clavicular length was calculated as the distance between these two points with 3D geometry. Preliminary data of 334 SCJs from 167 patients (64% males, 36% females) with a mean age of 48.5 ± 20.5 years were analysed. Multivariate regression models revealed that age and clavicular length were independent risk factors for OA while gender did not reach statistical significance. A 1mm increase in length was associated with 9% and 7% reduction in the odds of developing OA on the left and the right respectively. Comparing the mean clavicular length using t-test showed a significantly shorter clavicle in the group with OA (145.8 vs 152.7, p=0.0001, left and 144.2 vs 150.3, p=0.0007, right). Our data suggest that the risk of developing OA at the SCJ is higher for shorter clavicles. This could be of clinical relevance in cases of clavicular fracture where clavicular shortening might lead to a higher risk of developing OA. Biomechanical studies are needed to find out the mechanism of this effect

Introduction: Mid-shaft clavicular fractures that are displaced and shortened are often treated surgically. The standard technique in the past has been to use plate fixation. However, in the last five years intramedullary fixation has been popularised. To our knowledge no recent study has compared the outcomes of intramedullary pinning and plating of displaced mid-shaft clavicular fractures. Method: We retrospectively evaluated 40 patients with mid-shaft clavicular fractures. Twenty patients had plate fixation and twenty patients had intramedullary fixation for exactly the same fracture pattern. Each patient filled out a standardised questionnaire particular to clavicular fractures and was assessed using the Shoulder Score Index of the American Shoulder and Elbow Surgeons and the Constant Score. A physical examination was performed and individual radiographs were assessed to determine the state of union. Results: All fractures that were treated with intramedullary pin fixation went on to union within two to three months. There was one nonunion in the plate fixation group requiring revision surgery. The results revealed no significant difference in the functional outcome scores. There were however fewer complications, less scar related paraesthesia, shorter stay in hospital, and earlier mobilization in the group who underwent intramedullary pinning. Conclusions: Our results suggested that both techniques of intramedullary pinning and plating resulted in good long-term functional outcomes for patients with acute mid-shaft clavicular fractures. Intramedullary pinning, however, resulted in fewer short-term complications. From this study the method of fixation for mid-shaft clavicle fractures should be determined by the surgeon’s preference and expertise

To estimate the prevalence of clavicular fractures, number of cases required operative treatment, and whether removal of the implant is a frequent necessity. Between November 2005 and Nov 2007 all patients presenting in our institution with clavicular fractures were eligible for participation. Patients below 18 years of age, and pathological fractures were excluded. Retrospective review of clinical notes and radiographs. Demographic details, mode of injury, treatment protocol, operative procedures performed, time to union, complications post-surgery stabilization, and the number of cases that required implant removal were documented and analysed in a computerized database. The mean time of follow up was 24 weeks (12–48). Out of 16,280 adult fractures that presented to our institution, 200 (1.23%), (137 males) patients met the inclusion criteria with a mean age of 43 years (19–95) and a mean ISS of 9 (4–38). There were 4 of the medial, 153 of the middle and 43 of the lateral clavicle fractures (3 were open). 178 (89%) patients were treated non-operatively and 22 (11%) operatively. Indications for surgery included open fracture, bony spike/skin threatened, grossly displaced/comminuted fracture, polytrauma and non-union. Mean time to radiological union was 14 weeks (5–38 weeks). Out of the 200 patients 12 (6%) developed non-union. Out of the 22 operated patients, 7 (32%) required plate removal and 1 had screw removal. Indications for removal of implant included, periprosthetic fracture (1), prominent metal work through skin (3), pain in shoulder (2), pressure symptoms (1). Post removal of implant, 6 (75%) patients claimed improvement in symptoms. Functional outcome was excellent/good in 90% of cases. The incidence of clavicular fractures was 1.23%. A small number of patients (11%) required operative treatment out of which one third had metal work removal. The majority of clavicular fractures can be treated non-operative with good functional results

Purpose. The evolution of locked anatomical clavicular plating in combination with evidence to suggest that fixation of clavicle fractures yields better outcome to conservative treatments has led to an increasing trend towards operative management. There is no evidence however to compare early fixation with delayed reconstruction for symptomatic non- or mal-union. We hypothesize that early intervention yields better functional results to delayed fixation. Methods. Between August 2006 and May 2010, 97 patients were managed with operative fixation for their clavicular fracture. Sixty eight with initial fixation and 29 delayed fixation for clavicular non- or mal-union. Patients were prospectively followed up to radiographic union, and outcomes were measured with the Oxford Shoulder Score, QuickDASH, EQ5D and a patient interview. Mean follow-up was to 30 months. All patients were managed with Acumed anatomical clavicular plates. Results. The radiographic and clinical outcomes were available for all patients. Scores were available for 62 (62/97). There were no statistically significant differences in age (p>0.05), sex (p>0.05), energy of injury (p>0.05), number of open fractures (p>0.05) between the two groups. The mean quickDASH was 8.9 early, 9.1 delayed (p< 0.05), Oxford Shoulder score was 15.7 early, 16.1 delayed (p< 0.05). In the early fixation group 5 patients had wound healing complications, and 8 went on subsequently to have removal of prominent metalwork. In the delayed fixation group 2 had wound healing complications and 4 had removal of prominent metalwork. There were no statistically significant differences in the EQ5D quality of life questionnaire. Conclusion. There are no statistically significant differences in shoulder performance, wound or operative complications between early and delayed fixation of clavicular fractures. Our series does not support early fixation of clavicular fractures, as results for delayed intervention in those who become symptomatic appear comparable

Introduction. Clavicle fractures can cause pain and functional impairment if not managed appropriately. This paper evaluates the prevalence of clavicular fractures, estimates number of cases requiring operative treatment, whether removal of implant is a frequent necessity and compares the final functional outcome of the operative and non-operative group. Materials/Methods. Between November 2005 and November 2007 patients with clavicular fractures were eligible for participation. Patients below 18 years of age, and pathological fractures were excluded. Operative versus non-operative treatment, radiographic classification (Allman system), complications, implant removal, and functional outcome using the University of California Los Angeles (UCLA) shoulder scores were documented and analysed. Results. Out of 16,280 fractures presenting to our University Teaching Hospitals, 200 (1.23%) met the inclusion criteria. Twenty patients were lost due to natural attrition, 159 (88.3%) patients were treated non-operatively and 21 (11.7%) patients operated upon, over half for symptomatic non-union. All clavicles united post operatively. Eighty one conservatively managed undisplaced medial, middle and lateral end fractures had excellent mean UCLA shoulder scores. A statistical significance in UCLA scores (p<0.05) was noted between the operative and non-operative groups in mid shaft fractures. Under half (42.9%) required removal of metal implant sue to soft tissue irritation with complete resolution of symptoms. Conclusion. The incidence of clavicle fractures was 1.23%. A small number of patients (11.7%) required operative treatment. We recommend surgical management of symptomatic non-union and removal of metal implant for hard ware related symptoms

Thoracic Outlet Syndrome (TOS) is a complex of symptoms representing neurovascular compression in the supraclavicular area and shoulder girdle. Arterial thoracic outlet syndrome represents only 1% of all TOS's. We present two cases of arterial TOS's following internal fixation of clavicular fractures. Two cases of clavicular fractures managed with internal fixation and subsequently diagnosed with symptomatic, position dependent arterial occlusion are presented. The first case of a 16-year-old male treated with an intramedullary compression screw. He developed symptoms and was diagnosed with TOS using dynamic duplex examination performed by a vascular surgeon. Revision surgery was planned to decompress the subclavian artery from the hypertrophic callus at the fracture site. Before this could be performed the patient re-fractured his clavicle and bent the intramedullary screw. This resulted in resolution of the TOS symptoms. Following this second injury the patient went on to unite the fracture. The second case was of a 48-year-old male. He was initially treated non- operatively until the patient reported sensory and motor disturbances involving the hand and forearm. Excess callus was excised and the fracture was fixed using a locking plate. The symptoms improved, but worsened again eight weeks post operatively. Angiogram revealed vascular occlusion on arm abduction. Repeat surgery was performed in conjunction with a vascular surgeon. The plate was removed, vascular structures were released from fibrous tissue in the region of the fracture, and the posterior edge of the clavicle was debrided with a burr to reduce future impingement on vascular structures. Post operatively the TOS symptoms did not recur. Arterial thoracic outlet syndrome is an uncommon complication of trauma involving the clavicle. It can present in the presence or absence of surgical intervention, but can require surgical intervention to resolve

Distal clavicle fractures associated with coracoclavicular ligament disruption are potentially unstable. 1. Internal fixation of these fractures is often inadequate due to two anatomical problems:. Inadequate distal fragment size and. Displacement and instability consequent to ligament disruption. We hypothesize that a contour-matched locking plate coupled with a coracoclavicular ligament repair device would provide a potentially safe and minimally invasive method for adequate fixation. Between 2006 and 2008, 5 patients were surgically treated for non-comminuted distal clavicular fractures associated with coracoclavicular ligament disruption. The surgical technique consisted of. neutralization of muscular forces on the proximal fragment by using a minimally invasive ligament repair device (TightRope. ™. , Arthrex, FL), and. Internal fixation using a contour-matched locking plate (Distal radial locking plate, Synthes). Technical tips to optimize this new procedure are presented. Outcome measures consisted of. Constant shoulder score. Radiographic union. The retrospective follow-up period varied from 8 weeks to 24 months. A statistically significant improvement in the Constant score was observed in every patient. All patients progressed to satisfactory bony union. Plate removal was not necessary in any patient. Potential complications include screw penetration of the acromioclavicular joint, acromioclavicular ligament disruption, and distal fragment comminution. A contour-matched locking plate coupled with a coracoclavicular ligament repair device is a new lesser invasive and safe anatomical approach for achieving fixation adequacy in a highly unstable but non-comminuted distal clavicular fracture subgroup. We recommend strict adherence to the guidelines presented (technical tips) to achieve an optimal result

Aim:We present our experience and the results of the treatment on 36 patients with fracture of the distal end of the clavicle (Grade II type 2) by open reduction of the fracture. Method: 25 men and 11 women were treated operatively for unstable (grade II, type 2) clavicular fracture from 1999 to 2002. The average age was 27.2 years (range, eighteen to thirty- þve years). The operations were performed under general anaesthesia. By the proper procedure the clavicle and the base of the coracoid was exposed. A 3.5mm hole was drilled, and a screw is introduced through the clavicle into the coracoid. The torn ends of the coracoclavicular ligaments are tagged with sutures. Six to nine weeks postoperatively the screw was removed. Results: All patients were reviewed radiologically and clinically after on average interval of 16 months. The healing of the fractures occurs about 8 weeks later. All patients were restored to the pre Ð injury level function with no pain or abnormal motion. Conclusions: Internal þxation with Boswarth screw and repair of the coracoclavicular ligament is an effective operation for Grade II type 2 unstable clavicular fractures specially for young and athletic patients

Aim: To determine the accuracy of the posterior-to-anterior (PA) 15 degrees caudad view of the clavicle to assess amount of shortening of clavicular fractures. Method: The first stage of the study involved taking x-rays of an adult skeleton, centred on the clavicle. The projections included the standard anterior-to-posterior (AP) 15 degrees cephalad view, and the PA 15 degrees caudad view. Additional images were taken in the 15 degrees caudad view with a series of oblique rotational views, and oblique images in the vertical plane. Metal markers were placed on the clavicle at 10mm intervals. The clavicular length and the interval between markers were measured on the x rays.The second stage of the study involved obtaining the PA 15 degrees caudad x-ray on 50 patients with clavicular fractures. The non injured clavicle was also x-rayed. The lengths of the non injured clavicle and the lengths of the fragments of the fractured clavicle were recorded. Results: The length of the clavicle of the skeleton in the AP standard image was 149mm. The length in the PA 15 degrees caudad image was 130mm, with a maximum of 4mm variation on the oblique views up to 30 degrees. The true length was 124mm.Forty-five fractures were diaphyseal, and five were outer third fractures. There was less than 5mm measured difference in the length of injured and non injured clavicle in 38 out of 45 patients with diaphyseal fractures (84%). Conclusions: The PA 15 degrees caudad clavicular x-ray provided a more accurate assessment of clavicular shortening than the standard AP view, and was well tolerated by the patients

Traditionally midshaft clavicle fractures have been treated conservatively. It is recognized that displaced and shortened fractures may be better treated operatively. In particular, patients with greater than 20 mm of shortening and 100 percent displacement have a symptomatic non union rate of 30 percent. The standard technique used previously has been via plate fixation with LC-DCP or DCP. However in the last 5 years intramedullary fixation has been popularized. “Rockwood intramedulary clavicular pin” remedies the past treatment issues including poor blood supply, painful prominent hardware and stress raiser related to removal of metal work. Aim: The aim of this study was to assess the functional outcome following intramedullary fixation of clavicle using Rockwood pin. Method: We retrospectively evaluated 17 patients with displaced and shortened mid-shaft clavicular fractures who underwent intramedullary pinning using Rock-wood pins. Each patient was assessed using the ASES, Constant and SF36 scoring system. A physical examination was performed and individual radiographs were assessed to determine union. Results: The mean age of the patients was 28 (range 15–56). All patients went into union within 2 to 4 months. They had a shorter stay in hospital, earlier mobilization and no scar related paraesthesia. The average ASES score 98.2 (range 92–100) and constant 95.3 (range 89–100). Summary: Displaced and shortened mid clavicular fractures require operative fixation. Plates and screws on the clavicle requires significant soft tissue stripping leading to compromised blood supply to the bone and multiple bi-cortical screws act as stress raisers. Previous intra-medullary devices presented with the problem of pin migration. Rockwood pins are designed with a differential pitch which leads to compression at the fracture site and prevent pin migration. From this study we now recommend the use of the Rockwood Pin for the management of displaced mid-shaft clavicle fractures

Background. Level 1 studies for fracture management of upper extremity fractures remains rare. The influence of these studies on management trends has yet to be evaluated. The purpose of this study was to examine alterations in national trends managing mid-shaft clavicle and intra-articular distal humerus fractures (DHF) surrounding recent Level 1 publications. Methods. We retrospectively reviewed a comprehensive Medicare (2005–2012) and Humana (2007–2014) patient population database within the PearlDiver supercomputer (Warsaw, IN, USA) for DHF and mid-shaft clavicle fractures, respectively. Non-operative management and open reduction internal fixation (ORIF) were reviewed for mid-shaft clavicle fractures. ORIF and total elbow arthroplasty (TEA) were reviewed for DHF. Total use and annual utilization rates were investigated using age limits defined in the original Level 1 studies. Results. A total of 4,929 clavicle patients between 15 and 59 years, and 106,535 DHF patients greater than 65 years of age were coded. There was no significant change in annual volume of mid-shaft clavicle fractures and DHF coded (p=0.078 and p=0.614, respectively). Among clavicle patients there was a significant increase in ORIF utilization following the publication of the Level 1 study (p=0.002), and a strong, positive correlation was evident (p=0.007). No significant change in annual TEA (p=0.515) utilization for DHF was seen. Conclusion. A significant increase in the utilization of ORIF for clavicular fractures was observed following the publication of supporting Level 1 evidence. This was not observed following similar evidence in managing DHF, as no increase in utilization of TEA was observed

Clavicle fractures represent 45% of all shoulder girdle injuries. Although clavicle fractures are usually readily recognisable and unite uneventfully with treatment, they can be associated with difficult early and late complications. Fractures of the middle third of the clavicle represent 80% of all clavicular fractures. Traditionally clavicle fractures are treated conservatively, with surgical treatment reported as being associated with an increased rate of complications. Indications for primary open fixation include significant displacement, fracture comminution and tenting of the skin, threatening its integrity which fail to respond to closed reduction. What constitutes significant displacement, is usually not defined; nor is consideration for open reduction of displaced fractures, which are not comminuted and do not threaten the integrity of the overlying skin. This paper reports on the technique indications and use of the “Rockwood Intramedullary Clavicle Pin” and the results achieved using this technique

Surgical options in the treatment of acute acromio-clavicular joint (Rockwood Type III and IV) dislocations are many and controversial. We evaluated our technique using TIGHTROPE connecting the base of the coracoid to the proximal fragment of the clavicle. Between March 2006 and December 2006, ten young and active adult patients with acute ACJ dislocations were treated with arthroscopically assisted ARTHREX TIGHTROPE fixation. The dislocation was reduced with traction and manual reduction with the patient in beach-chair position. The base of the coracoid was identified and isolated using a radiofrequency ablator placed through the anterior portal while visualizing through the lateral portal. An ACL guide was placed percutaneously supero-medial to the coracoid over the distal with the inferior end of the ACL guide placed through a posterior portal, approximated against the prepared base of the coracoid. The Arthrex Tightrope braided fibre-wire was introduced through the pre-drilled distal clavicle passed to the base of the coracoid and manually tensioned to achieve stable reduction. Standard rehabilitation protocol was utilised as for internal fixation of distal clavicular fractures. Patients were evaluated clinically using Constant Score, which ranged from 75 to 83 and radiologically at 6 weeks and 3 months. We present the functional results and the technical difficulties faced highlighting on the probable reasons for failure of fixation in two of our early patients who had revision fixations. We also describe the additional intra-operative techniques used in the last few patients to prevent such complications and achieve a secure reduction. We conclude that Arthroscopic Reconstruction of dislocated Acromio-Clavicular joint using TIGHTROPE may require additional repair of the ligaments in carefully selected patients to prevent failure of fixation

Introduction: Primary surgical treatment has been recommended for unstable clavicular fractures if consequences of non-union or malunion have to be avoided. A prospective study was undertaken to evaluate the results of a conservative treatment of very unstable fractures of the middle third of the clavicle, with emphasis to very early mobilization. Material: Patients to be included in the study had to met the following criteria: 1) Fractures of the middle third of the clavicle, severely displaced or comminuted, 2) Closed injuries, 3) No neurovascular complications, 4) No pneumothorax or hae-mothorax and 5) No other injury in the ipsilateral upper extremity. Twenty-three patients with an average age of 24 years included in the study. Each patient evaluated with AP and 45-degree cephalad-tilted views. All patients treated with an arm sling and strongly instructed for early mobilization. All patients were evaluated in a weekly interval and assessed with the American Shoulder and Elbow Surgeonñs shoulder evaluation form. Results: The average follow up was 21.4 months. All fractures were consolidated and all malunited; but no patient had residual symptoms or functional impairment of the limb. On patient developed mild hypesthesia in the ulnar nerve territory. Conclusion: The extremely encouraging results of our study, within the bounds of the above-mentioned follow up, indicate that conservative treatment with very early mobilization may be considered as a valid therapy. However it is a concern the functional result in a longer follow up as well as the cosmetic result

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

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. Materials: 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: 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. Conclusions: 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

Aim: To compare and evaluate results following fixation of displaced clavicle fracture using three different plates. Methods: Between 1994 and 2001, forty patients with displaced midclavicular fracture were plated with three different type of implants. The mean age of the patients was thirty-four years. Reconstruction Plate was used in twenty, 3.5 mm DCP in ten and 3.5mm LCDCP in ten. Twenty-eight fractures were multifragmentary. The interfragmentary screw technique was used in fifteen cases and one patient required bone grafting. Evaluation: In this retrospective study, the patients’ shoulder function, rate of fracture union, and complications between the three different types of plate were evaluated and compared. Results: Patients whose fracture was treated with DCP or LCDCP all achieved union within three months. One LCDCP lifted laterally after the patient went back to manual work within two weeks. Of the patients whose fracture was treated with reconstruction plate (20), only twelve united uneventfully within three months. Eight complications were recorded. Delayed union occurred in three, loss of fixation in two and the plate bent in the remaining three. All the complications were observed in multifragmentary fractures. Conclusion: The more malleable reconstruction plate appeared to deform under load when used in the fixation of displaced multifragmentary clavicular fracture. We recommend the stronger LCDCP in this situation