Aims. Distal third
Background. A number of studies have described the epidemiological characteristics of
Twenty fresh-frozen
Purpose. In a previously published multicenter randomized clinical trial it was shown that young patients (16–60 years-old) with displaced mid-shaft
Purpose: To document outcomes and patient satisfaction in relation to the incision used following
In Neer type II (Robinson type 3B) fractures
of the distal clavicle the medial fragment is detached from the coracoclavicular
ligaments and displaced upwards, whereas the lateral fragment, which
is usually small, maintains its position. Several fixation techniques
have been suggested to treat this fracture. The aim of this study
was to assess the outcome of patients with type II distal clavicle
fractures treated with coracoclavicular suture fixation using three
loops of Ethibond. This prospective study included 14 patients with
Neer type II fractures treated with open reduction and coracoclavicular
fixation. Ethibond sutures were passed under the coracoid and around
the clavicle (UCAC loop) without making any drill holes in the proximal
or distal fragments. There were 11 men and three women with a mean
age of 34.57 years (29 to 41). Patients were followed for a mean
of 24.64 months (14 to 31) and evaluated radiologically and clinically
using the Constant score. Fracture union was obtained in 13 patients at
a mean of 18.23 weeks (13 to 23) and the mean Constant score was
96.07 (91 to 100). One patient developed an asymptomatic fibrous
nonunion at one year. This study suggests that open reduction and
internal fixation of unstable distal
Purpose. Plating remains the most widely employed method for the fixation of displaced diaphyseal
Aims. The aim of this study was to compare biomechanical properties of pre-contoured plate fixation using different screw fixation modes in a mid-shaft
Purpose. The evolution of locked anatomical clavicular plating in combination with evidence to suggest that fixation of
Despite the vast quantities of published artificial intelligence (AI) algorithms that target trauma and orthopaedic applications, very few progress to inform clinical practice. One key reason for this is the lack of a clear pathway from development to deployment. In order to assist with this process, we have developed the Clinical Practice Integration of Artificial Intelligence (CPI-AI) framework – a five-stage approach to the clinical practice adoption of AI in the setting of trauma and orthopaedics, based on the IDEAL principles ( Cite this article:
Background. This is a continued assessment of the effectiveness of a locked intramedullary device in the treatment of acute
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
This study investigated the anatomical relationship between the clavicle and its adjacent vascular structures, in order to define safe zones, in terms of distance and direction, for drilling of the clavicle during osteosynthesis using a plate and screws following a fracture. We used reconstructed three-dimensional CT arteriograms of the head, neck and shoulder region. The results have enabled us to divide the clavicle into three zones based on the proximity and relationship of the vascular structures adjacent to it. The results show that at the medial end of the clavicle the subclavian vessels are situated behind it, with the vein intimately related to it. In some scans the vein was opposed to the posterior cortex of the clavicle. At the middle one-third of the clavicle the artery and vein are a mean of 17.02 mm (5.4 to 26.8) and 12.45 mm (5 to 26.1) from the clavicle, respectively, and at a mean angle of 50° (12 to 80) and 70° (38 to 100), respectively, to the horizontal. At the lateral end of the clavicle the artery and vein are at mean distances of 63.4 mm (46.8 to 96.5) and 75.67 mm (50 to 109), respectively. An appreciation of the information gathered from this study will help minimise the risk of inadvertent iatrogenic vascular injury during plating of the clavicle.
This prospective evaluation of early experience using this technique. Patients with fracture of the distal clavicle were surgically treated with clavicular hook plate fixation. They were reviewed clinically and radiographically by one observer. 12 patients, 7 male, 5 female, were treated in our unit. Mean age (34.7) range 25–60 years. 10 were the results of low velocity injury. 9 were treated within one week of injury. 3 were treated at 13, 14 and 16 weeks post injury. Mean hospital stay 2.7 range 2–5 days. All patients healed, 10 within 12 weeks. All resumed full activity by 24 weeks. 2 had superficial wound infection, treated successfully with oral antibiotics without implant removal. One had a seroma, which resolved spontaneously. One patient developed limitation of movement at 20 weeks ultrasound confirmed impingement. Plate was removed and patient regained full range of movement after six weeks. No implant fracture or loosening was observed. Based on experience to date the clavicular hook plate is a safe and reliable method of fixation. Relatively simple implant with good results. Allows early mobilisation and has little complication.
Aims. The management of mid-shaft
Aims. Tobacco, in addition to being one of the greatest public health threats facing our world, is believed to have deleterious effects on bone metabolism and especially on bone healing. It has been described in the literature that patients who smoke are approximately twice as likely to develop a nonunion following a non-specific bone fracture. For
Aims. The aims of this network meta-analysis (NMA) were to examine nonunion rates and functional outcomes following various operative and nonoperative treatments for displaced mid-shaft
Aim. The number of operatively treated
Implant removal after clavicle plating is common. Low-profile dual mini-fragment plate constructs are considered safe for fixation of diaphyseal
The April 2023 Trauma Roundup. 360. looks at: Displaced femoral neck fractures in patients aged 55 to 70 years: internal fixation or total hip arthroplasty?; Tibial plateau fractures: continuous passive motion approves range of motion; Lisfranc fractures: to fuse or not to fuse, that is the question; Is hardware removal after
Abstract. Aim. The aim of this study was to present the results of treatment of displaced lateral
The December 2023 Shoulder & Elbow Roundup. 360. looks at:
Introduction. The Tour de France, commonly recognised and the hardest physical endurance event on the planet, is an iconic cycling competition with a history of ever impressive performances and increasingly notable injuries. This study aims to methodologically catalogue and analyse injuries sustained by professional riders over a span of six years and understand the operative workload created by this prestigious race. (2018–2023). Methods. Data was gathered from multiple publicly available sources, including pro-cycling stats, news articles, team press releases and independent medical reports. Each injury was categorized by year, rider, and injury type. Results. From 2018–2023, there was a significant diversity in both injured body part and mechanism of injury. Of the 124 recorded race ending incidents
The April 2024 Shoulder & Elbow Roundup. 360. looks at: Acute rehabilitation following traumatic anterior shoulder dislocation (ARTISAN): pragmatic, multicentre, randomized controlled trial; Prevalence and predisposing factors of neuropathic pain in patients with rotator cuff tears; Are two plates better than one? The
The aim of this study was to define the long-term outcome following adolescent
Operative management of
Recently, a new generation of superior clavicle plates was developed featuring the variable-angle locking technology for enhanced screw positioning and optimized plate-to-bone fit design. On the other hand, mini-fragment plates used in dual plating mode have demonstrated promising clinical results. However, these two bone-implant constructs have not been investigated biomechanically in a human cadaveric model. Therefore, the aim of the current study was to compare the biomechanical competence of single superior plating using the new generation plate versus dual plating with low-profile mini-fragment plates. Sixteen paired human cadaveric clavicles were assigned pairwise to two groups for instrumentation with either a 2.7 mm Variable Angle Locking Compression Plate placed superiorly (Group 1), or with one 2.5 mm anterior plate combined with one 2.0 mm superior matrix mandible plate (Group 2). An unstable
Aims. To evaluate if union of
A number of studies have described the epidemiological characteristics of
Abstract. Objectives.
Aim. Clavicular osteotomy was described as an adjunct to deltopectoral approach for improved exposure of the glenohumeral joint. This study aims to present contemporary outcomes and complications associated with the routine use of clavicular osteotomy by a single surgeon in a regional setting within New Zealand. Methods. A retrospective case series of patients who have undergone any shoulder arthroplasty for any indication between March 2017 to August 2022. This time period includes all patients who had clavicular osteotomy(OS) and patients over an equal time period prior to the routine use of osteotomy as a reference group (N-OS). Oxford Shoulder Score (OSS) and a Simple Shoulder Test (STT) were used to assess functional outcomes and were compared with the reported literature. Operative times and Complications were reviewed. Results. 66 patients were included in the study. 33 patients in the OS group and 33 in the N-OS group. No difference in age, sex, indications for operative intervention and the surgery provided was identified. No significant difference in operative time between groups (N-OS 121 minutes; OS 128 minutes). No clinically significant difference was identified in the OSS (N-OS; mean 38 vs OS 39) or the STT (N-OS 8.3 vs OS 9). The outcomes scores of both groups are in keeping with published literature. Two post operative
Abstract. Introduction. In our quality improvement project we implemented a novel pathway, performing acute fixation in mid-third
Neer Type-IIB lateral
Background. Clavicle development occurs before the age of 9 in females and 12 in males. Children below the age of 10 with displaced midshaft clavicle fractures recover well with conservative management. However adolescents are more demanding of function and satisfaction following
Aims. The aim of this study was to define the complications and long-term outcome following adolescent mid-shaft clavicular fracture. Methods. We retrospectively reviewed a consecutive series of 677 adolescent fractures in 671 patients presenting to our region (age 13 to 17 years) over a ten-year period (2009 to 2019). Long-term patient-reported outcomes (abbreviated version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) score and EuroQol five-dimension three-level (EQ-5D-3L) quality of life score) were undertaken at a mean of 6.4 years (1.2 to 11.3) following injury in severely displaced mid-shaft fractures (Edinburgh 2B) and angulated mid-shaft fractures (Edinburgh 2A2) at a minimum of one year post-injury. The median patient age was 14.8 years (interquartile range (IQR) 14.0 to 15.7) and 89% were male (n = 594/671). Results. The majority of fractures were mid-shaft (n = 606) with angulation (Edinburgh 2A2, n = 241/606, 39.8%) or displacement (Edinburgh 2B1/2, n = 263/606, 43.4%). Only 7% of the displaced mid-shaft fractures underwent acute fixation (n = 18/263). The incidence of refracture over ten years following nonoperative management of mid-shaft fractures was 3.2% (n = 19/588) and all united without surgery. Fracture type, severity of angulation, or displacement were not associated with refracture. One nonunion occurred following nonoperative management in a displaced mid-shaft fracture (0.4%, n = 1/245). Of the angulated fractures, 61 had angulation > 30°, of which 68.9% (n = 42/61) completed outcome scores with a median QuickDASH of 0.0 (IQR 0.0 to 0.6), EQ-5D-3L 1.0 (1.0 to 1.0), and 98% satisfaction with shoulder function. For the displaced fractures, 127 had displacement beyond one cortical width of bone for which completed outcome scores were provided in 72.4% (n = 92/127). Of these 15 had undergone acute fixation. Following nonoperative treatment, the median QuickDASH was 0.0 (IQR 0.0 to 2.3), EQ-5D-3L 1.0 (1.0 to 1.0), and satisfaction with shoulder function was 95%. There were no significant differences in the patients’ demography or functional outcomes between operative and nonoperative treatments. Conclusion. Nonoperative management of adolescent mid-shaft
Background. This is an epidemiological study of patients with middle third
Assess the outcome of plating of lateral end
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
We are presenting a prospective study of 25 patients with
To investigate the incidence of complications arising from
Fractures of the mid-shaft of the clavicle have been treated conservatively with excellent results regarding functional outcome. Indeed some studies have indicated that open reduction and internal fixation of mid-shaft
Although most uncomplicated paediatric fractures do not require routine long-term follow-up with an orthopaedic surgeon, practitioners with limited experience dealing with paediatrics fractures will often defer to a strategy of unnecessary frequent clinical and radiographic follow-up. Development of an evidence-based clinical care pathway may help reduce unnecessary radiation exposure to this patient population and reduce costs to patient families and the healthcare system. A retrospective analysis including patients who presented to SickKids hospital between October 2009 and October 2014 for management of
There is no clear consensus regarding the indications for surgical treatment of middle third
Background: We compared five classification systems for
Background: Distal third fractures account for 10 to 15% of all
Purpose. Open reduction and plate fixation of displaced mid-shaft
To assess patient following operative fixation of
Non-operative treatment of lateral
Sonographic callus may enable assessment of fracture healing. The aim of this study was to establish a reliable method for three-dimensional reconstruction of sonographic callus. Patients that underwent non-operative management of displaced midshaft clavicle fractures and intramedullary nailing of tibia fractures were prospectively recruited and followed to union. Ultrasound scanning was performed at periodical time points following injury. Infra-red tracking technology was used to map each image to a three-dimensional lattice. Criteria was fist established for two-dimensional bridging callus detection in a pilot study. Using echo intensity of the ultrasound image, semi-automated mapping was used to create an anatomic three-dimensional representation of fracture healing. Agreement on the presence of sonographic bridging callus was assessed using the kappa coefficient and intra-class-correlation (ICC) between observers. 112
Background: The aim of this study was to analyse mid-shaft
Purpose:. To review the union rates, outcomes and complications of angular stable plating of lateral third
Several recent studies have shown an increased incidence of symptomatic non-unions and malunions after non-operative treatment of displaced
Abstract. Objectives. We aimed to evaluate if union of
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
Introduction:
Background and Aims: Plate fixation of acute mid-shaft
In a decidedly upper limb themed series of reviews this edition of Cochrane Corner summarises four new and updated reviews published by the Cochrane Bone, Joint and Muscle Trauma Group over the last few months. The tenacious reviewers at the Cochrane collaboration have turned their beady eyes to conservative treatments for shoulder dislocations and
The aim of our study was to assess the use of the Clavicular Hook Plate in treating acromio–clavicular joint dislocations and fractures of the distal clavicle. The prospective study was carried out at two hospitals- a teaching hospital and a district general hospital. Between 2001 and 2004 a total of 37 patients with AC joint injuries and distal
Fractures of the lateral clavicle with complete displacement have a high non-union rate and are associated with poor functional outcomes following non-operative treatment. Various operative techniques are available but preliminary studies of open reduction and tunnelled suspensory device (ORTSD) fixation report good early functional outcomes with a low rate of complications. This study assesses the functional outcomes in a large series of patients treated using ORTSD. After surgical reconstruction in 67 patients, outcomes were assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and Oxford score at six weeks, and three, six and twelve months post-operatively. 55 of 64 surviving patients were contacted at a mean of 69 (27–120) months to complete DASH and Oxford scores, evaluate overall satisfaction, and document any complications. At one year post-operatively, the mean Oxford score was 46.4 and mean DASH score was 2.4 points (59/67 patients assessed). At a mean of 69 months after surgery, the mean Oxford score was 46.5 and mean DASH score was 2.2 (55 surviving and contactable patients). There were no significant differences between the one-year functional scores and those at the latest follow-up. Two patients developed symptomatic non-union requiring re-operation, and two developed an asymptomatic fibrous union not requiring surgery. The five-year survival when considering only obligate revision for implant-related complications was 97.0%. ORTSD fixation for isolated displaced lateral-end
To evaluate if clinical recovery following midshaft clavicle fracture is associated with nonunion and determine if this has superior predictive value compared to estimation at time of injury. A prospective study of all patients (≥16 years) who sustained a displaced midshaft clavicle fracture was performed. We assessed patient demographics, injury factors, functional scores and radiographic predictors with a standardized protocol at six-weeks. Conditional-stepwise regression was used to assess which factors independently predicted nonunion at six-months post-injury determined by CT. The nonunion predictor six-week model (NUP6) was compared against a previously validated model based on factors available at time of injury (NUP0-smoking, comminution and fracture displacement). 200 patients completed follow-up at six months. The nonunion rate was 14% (27/200). Of the functional scores, the QuickDASH had the highest accuracy on receiver-operator-characteristic (ROC) curve analysis with a 39.8 threshold, above which was associated with nonunion (Area Under Curve (AUC) 76.8%, p<0.001). On regression modelling QuickDASH ≥40 (p=0.001), no callus on radiograph (p=0.004) and fracture movement on examination (p=0.001) were significant predictors of nonunion. If none were present the predicted nonunion risk was 3%, found in 40% of the cohort (n=80/200). Conversely if two or more were present, found in 23.5% of the cohort, the predicted nonunion risk was 60%. The NUP6 model appeared to have superior accuracy when compared to the NUP0 model on ROC curve analysis (AUC 87.3% vs 64.8% respectively). Delayed assessment at six-weeks following displaced
When deciding on treatment for displaced mid-shaft
Introduction.
Introduction:. Displaced and shortened
Abstract. Background. Distal third
Distal
Purpose of study:. To assess the effectiveness of a novel locked intra-medullary device in the treatment of acute
We undertook a prospective randomised trial to determine the outcome of locked intramedullary fixation vs. plating of displaced shortened mid-shaft
Introduction.
Purpose. Intramedullary fixation of
Introduction. The treatment of
This multi-centre single-blind randomised control trial compared outcomes in patients with acute displaced mid-shaft
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
Rates of operative fixation for
Introduction: This study was performed to assess the incidence of generalized ligament laxity in patients presented with 1st time anterior shoulder dislocation. Patients and Methods: Prospective data was collected for patients presented with 1st time anterior shoulder dislocation and
The aim of this study was to assess the outcome of a pre-contoured anatomic plate in the treatment of midshaft clavicle fractures. We treated thirty patients consecutively for middle third
Purpose: To determine any relation between scapular fracture, severity of chest injury and mortality in patients with multiple injuries. Patients and Methods: We reviewed 621 consecutive patients admitted over a five year period (1995–1999) with multiple injuries. All had an associated chest injury. Such details were recorded and analyzed as – mechanism of injury, ISS, AIS for chest, GCS, ICU stay, total hospital stay, operations performed, presence or absence of scapular fracture, complications and mortality. Patients with chest injury but without scapula fracture formed the control group of the study. Results: Out of 621 patients with multiple injuries (mean ISS 27.5), 79 (17 women) (12.72%) – group 1 were identified with scapular fractures. 542 (122 women) patients with chest injury but no scapular fracture formed the control group – group 2. The mean age of group 1 was 42 years versus 40 years of group 1 and the mean ISS was 27.12 (SD 15.13) and 28. 41 (SD 14.21) in group 1 and group 2 respectively (p value >
0.05). In group 1 the chest AIS was 3.46 (SD 1.10) and 3.18 (SD 1.06) in group 2 (p value <
0.05).The most common associated chest injury in group 1 was pneumothorax (28%) followed by pulmonary contusion (15.2%) whereas in group 2 it was likewise pneumothorax (20%) followed by pulmonary contusion (21%). There were 8 (10.1%) flail segments in the scapula group, versus 50 flail segments (9%) in the non scapula group. In group 1 there was an incidence of 3.8 % associated thoracic vertebral fractures compared to 8.3% in group 2. 2.6 % of patients in group 1 had major vessel injury or cardiac laceration as compared to 3 % in group 2. There were 4 brachial plexus injuries in group 1 (5.1%) versus nil in group 2. In group 1, 32 (40.5%) patients had sustained associated abdominal injuries mean AIS 3.1 versus 190 (34.6%) in group 2 with a mean AIS of 2.9. In the scapula group there were 31
Last decade, a shift towards operative treatment of midshaft clavicle fractures has been observed [T. Huttunen et al., Injury, 2013]. Current fracture fixation plates are however suboptimal, leading to reoperation rates up to 53% [J. G. Wijdicks et al., Arch. Orthop. Trauma Surg, 2012]. Plate irritation, potentially caused by a bad geometric fit and plate prominence, has been found to be the most important factor for reoperation [B. D. Ashman et a.l, Injury, 2014]. Therefore, thin plate implants that do not interfere with muscle attachment sites (MAS) would be beneficial in reducing plate irritation. However, little is known about the clavicle MAS variation. The goal of this study was therefore to assess their variability by morphing the MAS to an average clavicle. 14 Cadaveric clavicles were dissected by a medical doctor (MH), laser scanned (Nikon, LC60dx) and a photogrammetry was created with Agisoft photoscan (Agisoft, Russia). Subsequently a CT-scan of these bones was acquired and segmented in Mimics (Materialise, Belgium). The segmented bone was aligned with the laser scan and MAS were indicated in 3-matic (Materialise, Belgium). Next, a statistical shape model (SSM) of the 14 segmented clavicles was created. The average clavicle from the SSM was then registered to all original clavicle meshes. This registration assures correspondences between source and target mesh. Hence, MAS of individual muscles of all 14 bones were indicated on the average clavicle. Mean area is 602 mm. 2. ± 137 mm. 2. for the deltoid muscle, 1022 mm. 2. ±207 mm. 2. for the trapezius muscle, and 683 mm. 2. ± 132 mm. 2. for the pectoralis major muscle. The sternocleidomastoid muscle has a mean area of 513 mm. 2. ± 190 mm. 2. and the subclavius muscle had the smallest mean area of 451 mm. 2. ± 162 mm. 2. Visualization of all MAS on the average clavicle resulted in 72% coverage of the surface, visualizing only each muscle's largest MAS led to 52% coverage. The large differences in MAS surface areas, as shown by the standard deviation, already indicate their variability. Difference between coverage by all MAS and only the largest, shows that MAS location varies strongly as well. Therefore, design of generic plates that do not interfere with individual MAS is challenging. Hence, patient-specific
Traumatic central cord syndrome (CCS) typically follows a hyperextension injury and results in motor impairment affecting the upper limbs more than the lower, with occasional sensory impairment and urinary retention. Current evidence on mortality and long-term outcomes is limited. The primary aim of this study was to assess the five-year mortality of CCS, and to determine any difference in mortality between management groups or age. Patients aged ≥ 18 years with a traumatic CCS between January 2012 and December 2017 in Wales were identified. Patient demographics and data about injury, management, and outcome were collected. Statistical analysis was performed to assess mortality and between-group differences.Aims
Methods
The aim of this systematic review and meta-analysis was to gather epidemiological information on selected musculoskeletal injuries and to provide pooled injury-specific incidence rates. PubMed (National Library of Medicine) and Scopus (Elsevier) databases were searched. Articles were eligible for inclusion if they reported incidence rate (or count with population at risk), contained data on adult population, and were written in English language. The number of cases and population at risk were collected, and the pooled incidence rates (per 100,000 person-years) with 95% confidence intervals (CIs) were calculated by using either a fixed or random effects model.Aims
Methods
There remains a lack of consensus regarding the management of chronic anterior sternoclavicular joint (SCJ) instability. This study aimed to assess whether a standardized treatment algorithm (incorporating physiotherapy and surgery and based on the presence of trauma) could successfully guide management and reduce the number needing surgery. Patients with chronic anterior SCJ instability managed between April 2007 and April 2019 with a standardized treatment algorithm were divided into non-traumatic (offered physiotherapy) and traumatic (offered surgery) groups and evaluated at discharge. Subsequently, midterm outcomes were assessed via a postal questionnaire with a subjective SCJ stability score, Oxford Shoulder Instability Score (OSIS, adapted for the SCJ), and pain visual analogue scale (VAS), with analysis on an intention-to-treat basis.Aims
Methods
We present a complete audit cycle of Emergency Department management of paediatric
Introduction. Plate fixations have been recommended for dislocated
Purpose. The aim of this study was to report the outcomes of a series of patients with
Michael Robinson has been a Consultant Orthopaedic Surgeon and Senior Lecturer in the Department of Orthopaedics and Traumatology in Edinburgh, Scotland, United Kingdom for 10 years. His special interests include the treatment of proximal humeral and
Non-union has traditionally been considered a rare complication following the non-operative management of
Background. Non-union has traditionally been considered a rare complication following the non-operative management of
We report the results of anterior plate fixation for symptomatic, mid-shaft clavicle non-union. The superior surface is most commonly used for plate fixation. To the best of our knowledge, there are no clinical reports where anterior plate fixation of the clavicle was used. We included 12 consecutive patients, with symptomatic mid-shaft clavicular non-union, aged between 23 and 56 years during a four-year period (1998-2002). The injury was secondary to RTA in 6 cases, sports-related in 5 and skiing in one. In three patients, the non-union was secondary to superior plating using one third tubular plate, in acute fractures. The most common complaint was anterior shoulder pain (12 cases) followed by brachialgia (4 patients). The operation was performed through an anterior approach. A 3.5mm reconstruction plate was contoured and fixed onto the anterior surface of the clavicle. Bone graft was used in all cases. The average follow up was 22 months. All 12 patients achieved union at an average union time of seventeen weeks. Compared to superior plating, anterior plating has the distinct advantage that the longer screws can be used (as the clavicle is a flat bone, and the AP diameter is larger compared to superoinferior diameter) thus improving the stability of fixation. Our results show that anterior clavicle fixation is safe and effective in achieving union, even in cases following failed superior plate fixation. We therefore recommend anterior plate fixation and bone grafting in symptomatic nonunions of mid third
Introduction. The treatment of Neer type 2 lateral end
Introduction. The Constant Score (CS) and the Oxford Shoulder Score (OSS) are shoulder scoring systems routinely used in the UK. Patients with Acromio-Clavicular Joint (ACJ) and Sterno-Clavicular Joint (SCJ) injuries and those with
Michael Robinson has been a Consultant Orthopaedic Surgeon and Senior Lecturer in the Department of Orthopaedics and Traumatology in Edinburgh, Scotland, United Kingdom for 10 years. His special interests include the treatment of proximal humeral and