Clavicle Fractures: Are You Kidding?!? Intermedullary Devices are - - PowerPoint PPT Presentation
Clavicle Fractures: Are You Kidding?!? Intermedullary Devices are Far Better, Much Safer and Get the Results - What are You Reading? Smoking? Carl J. Basamania, MD, FACS Orthopedic Physician Associates Swedish Orthopaedic Institute Seattle,
Orthopedic Physician Associates Swedish Orthopaedic Institute Seattle, Washington
Are you making the plate match the clavicle or the clavicle match the plate?
JBJS Case Connector, 2013 Mar 13;3(1):e24 1-4.
Author Source # of patients Technique Used Outcomes of Interest Failure rate Complication rate Comment Level of evidence Saha, et al Indian Journal of Orthopaedics 2014;48(6):587-593. 37 plate 34 IM TEN Anterosuperior locking plate Significantly shorter time to union, operative time and blood loss in IM group 0% IM group 3% in plate group Major complications: 14% plate vs 0% IM Minor complications: 16% plate vs 38% in IM group 11% infection rate in plate group 16% of plate patients rated their scar as ugly I Assobhi J Orthopaed Traumatol. 2011, 12:185–192 19 plate 19 IM TEN 3.5 recon plate Significantly shorter hospital stay, length of surgery, scar length and blood loss in IM group Nonunion: 5.3% plate 0% IM Major complication rate: 15.8% plate vs 0% IM Minor complication rate: 36.8% plate vs 21.1% IM 5.3% re-fracture rate in plate group after hardware removal vs 0% in IM group I Ferran, et al J Shoulder Elbow Surg. 2010, 19: 783-789 17 IM 15 plate Rockwood screw 3.5 LCDCP Mean Constant score: 92.1 IM vs 88.7 plate 0% both groups 24% in IM group vs 80% in plate group Hardware removal: 100% planned removal in IM group 53% due to irritation and infection in plate group I Bohme, et al Z Orthop Unfall. 2011, Jan;149(1):68-76. 20 IM 53 plate 47 nonop TEN DCP, recon or LCDCP 4% infection rate in plate group 0% nonunion in
15% IM 22% plate Both operative groups had better pain relief, function and cosmetic result compared to nonop II Chen, et al J Shoulder Elbow Surg. 2012, 21(4): 495-501 84 plate 57 IM TEN Reconstruction plates Significantly shorter time to union, operative time and less blood loss in IM group 2% IM 4% plate Infection: 2% IM 4% plate Hardware failure: 7%plate 5% IM 43% of plate group rated results as unsatisfactory compared to 14% in IM group III Wijdicks, et al International Orthopaedics (SICOT). 2012 36:2139–2145 43 plate 47 IM TEN Reconstruction and locking plates 7% refracture rate in plate group vs 0% IM 14% implant failure plate vs 2.1% IM 26% major complication plate vs 4% IM 12% major revision plate vs 2% IM III Wenninger, et al J Surgical Orthop Advances 22(1):77–81, 2013 29 plate 33 IM Rockwood screw 3.5 recon and precontoured plates majority of symptoms were from the pressure of body armor and rucksack wear during training 0% nonunions in both groups Complication rate: 31% plate vs 9% IM Active duty military population III Liu, et al Journal of Trauma Injury, Infection, and Critical Care 2010, 69(6):E82-E87 59 plate 51 IM TEN Straight and contoured superior plates Significantly shorter
stay, incision size and blood loss in IM group Nonnunion: 9.8% IM vs 10.2% plate Malunion: 7.8% IM vs 3.4% plate Complication rate: 39% IM vs 53% plate Wound complication rate: 5.9% IM vs 10.2% plate III Kleweno, et al J Shoulder Elbow Surg. 2011, 20, 1114-1117 18 IM 14 plate Rockwood screw 6 recon, 6 locking and 2 precontoured plates Average time to union: 8 months IM vs 17 months plate 0% IM group vs 7% plate 28% IM vs 36% plate 7% delayed union and 14% refracture rate in plate group vs 0% IM group III Thyagarajan, et al International J of Shoulder Surgery 2009;3(2):23-27 17 IM 17 plate 17 nonop Rockwood screw LCDCP plates IM group had 100% union by 8-12 weeks. All IM surgeries
Plate group all had 2-3 day hospital stay IM 0% Plate 6% nonunion Nonop 23.5% nonunion
IM:12% superficial wound Plate: 12 % implant failure 35% plate irritation 24% scar related pain All patients in IM group were satisfied with result. 35% of plate group had pain with activity. 12% of IM group had only mild pain III
Advanced Reconstruction: Shoulder 2, AAOS 2016
“Major re-intervention and re-fracture after implant removal occurred more frequently after plate fixation of non-comminuted, displaced midshaft clavicle fractures.”
– Hussain, N. et al. Intramedullary Nailing Versus Plate Fixation for the Treatment Displaced Midshaft Clavicular Fractures: A Systematic Review and Meta-Analysis. Sci. Rep. 6, 34912;doi:10.1038/srep34912 (2016).