Vascular injuries during total hip arthroplasty (THA) are rare but when they occur, have serious consequences. These have traditionally been managed with open exploration and repair, but more recently there has been a trend towards percutaneous endovascular management.

We performed a systematic review of the literature to assess if this change in trend has led to an improvement in the overall reported rates of morbidity and mortality during the last 22 years in comparison with the reviews of the literature published previously.

We found a total of 61 articles describing 138 vascular injuries in 124 patients. Injuries because of a laceration were the most prevalent (n = 51, 44%) and the most common presenting feature, when recorded, was bleeding (n = 41, 53.3%). Delay in diagnosis was associated with the type of vascular lesion (p < 0.001) and the clinical presentation (p = 0.002).

Open exploration and repair was the most common form of management, however percutaneous endovascular intervention was used in one third of the injuries and more constantly during the last 13 years.

The main overall reported complications included death (n = 9, 7.3%), amputation (n = 2, 1.6%), and persistent ischaemia (n = 9, 7.3%). When compared with previous reviews there was a similar rate of mortality but lower rates of amputation and permanent disability, especially in patients managed by endovascular strategies.

Cite this article: Bone Joint J 2015;97-B:1447–55.

Introduction: Clavicle fractures represent 5% of fractures in adults and almost 44% of shoulder injuries and are usually treated none operatively with good results. However significantly displaced fractures can be associated with high non-union rate and there is a lack of consensus on when surgical treatment is indicated for such fractures. The aim of this study was to identify guidelines for surgical intervention, safer surgical approach and outcome of surgical intervention.

Method: A retrospective audit of all clavicle fractures managed surgically over past 5 years (March 2004 to 2009) in a district general hospital. Case notes were reviewed to study the surgical indication, surgical approach, patient satisfaction and oxford should score and need for metal work removal.

In all 35 patients (29 male) underwent surgery for significant fracture displacement with shortening, manual workers and keen sportsmen at the time of injury. The infraclavicular approach was used in 21 patients and 14 patients had direct incision approach. Radiological union was achieved in all patients after an average of 13.26(8–24) weeks. Six patients required plate removal at 6 months following surgery, infraclavicular (2 patients) & direct approach (4 patients). All patients returned to their original occupation at average 2.55 months. The Oxford Shoulder Score at 3 months after surgery was average 15 (range12–20) and all patients, except one, scored excellent on subjective scoring.

Conclusion: Our study showed excellent surgical outcome for displaced clavicle fractures in young and active patients and is supported by the high union rate, good oxford shoulder score, early return to work and high patient satisfaction scores. The infraclaviculr approach is a betterthan direct approach based on the low complication rate and less need for metal work removal.

Clavicle fracture account for about 44% of all adult fracture around the shoulder, although non-operative care results in high union rates for most, surgery is indicated in particular if displacement and/or shortening greater than 15–20 mm, lack of cortical apposition in young, healthy, active individual to yield the best clinical results in terms of alignment, union and early mobilisation.

We did a retrospective audit to define the guidelines for admission, safer surgical approach and functional outcome using oxford score for the period Jan2002–Jan2007.

This included 35pts, with Female: male ratio 1:2.5, Right: left side of 12:23, just over 50%were manual labours. Most common indication for surgery was displacement/shortening (16pts). 28 pts were operated within 4 weeks as acute admission.

Direct incision was used in 14pts and infraclavicular incision in 21pts.

Radiological union were seen in all pts on average 13.26 weeks (8 – 24wks). 10 patients had minor complications, 28% with direct incision and 19% with infraclavicular approach 29 patients went back to original work by 2.55 month, 5 excluded as 3 were at school, 2 unemployed and 1 did not mention. All patients had an oxford score of 12–20, showing satisfactory joint function.

Metal work were removed in 6 patients, 2 (9.5%) in infraclavicular and 4 (28%) in direct incision.

Conclusion: Our study included 35 patients, union were achieved in all with good functional results. 34 patients express to recommend surgical fixation to others. Infraclavicular approach was associated with less complication and less metal work removal.