ORIF is the Gold Standard: Stop Guessing and Plate it! Michael D. - - PowerPoint PPT Presentation

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ORIF is the Gold Standard: Stop Guessing and Plate it! Michael D. - - PowerPoint PPT Presentation

Feb 11, 2024 22 likes •202 views

ORIF is the Gold Standard: Stop Guessing and Plate it! Michael D. McKee, MD, FRCS(C) Professor and Chair, Department of Orthopaedic Surgery University of Arizona, College of Medicine, Phoenix, AZ Disclosure Studies supported

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ORIF is the Gold Standard: Stop Guessing and Plate it!

  • Michael D. McKee, MD, FRCS(C)
  • Professor and Chair, Department of Orthopaedic Surgery
  • University of Arizona, College of Medicine, Phoenix, AZ
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Disclosure

  • Studies supported by:
  • OTA, COA, ASES
  • Zimmer Inc.
  • Stryker, Olympus Biotech, AO
  • I am a consultant for Stryker, Acumed,

Zimmer, ITS

  • Receive royalties from Stryker (plates),

LWW, Springer (publishers)

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1994

  • We will give you a

sling and everything should be fine.

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Clavicle nonunion

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Nonunion

Robinson 2014 1 94 36 98 54.5% 0.21 (0.01, 0.75) Ahrens 2017 1 131 16 123 24.4% 0.09 (0.01,0.62)

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RCT : Nonunion

Study Plate fixation Non-operative COTS n = 132 1% 18% Robinson n = 202 1% 28% Ahrens n = 302 1% 15%

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Nail versus Plate RCT

  • Plate fixation versus intramedullary nailing of

completely displaced midshaft fractures of the clavicle: a prospective RCT

  • Fuglesang HFS et. al. BJJ 2017
  • 123 patients, generally good results
  • Plate better early, IM nail less infection, OR time
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Fixing a Clavicle Fracture is a Finesse Operation With a Narrow Risk-Benefit Ratio

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Surgical Risk-Benefit Ratio

  • Life saving
  • Non-op Rx bad
  • Indestructible
  • Reconstruction

difficult

  • Ratio: ++++
  • Improves U/E function
  • Non-op Rx ok
  • Can fall apart
  • Reconstruction

reasonable

  • Ratio: +
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Conclusions - displaced midshaft fracture of the clavicle

  • With non-op care, nonunion risk is approximately 15%-20%
  • The nonunion rate following ORIF is 1-2 %
  • ORIF provides more rapid return to function / activity
  • ORIF is superior to non-operative care in select cases
  • Most patients do well with non-operative treatment,

but not all, and we continue to pursue prognostic factors