2018, Number 3
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Acta Ortop Mex 2018; 32 (3)
Complex fractures of the clavicle’s lateral third
Morales-Villanueva J, Tamayo-Pacho F, Pineda-Castro OP
Language: Spanish
References: 22
Page: 140-144
PDF size: 187.10 Kb.
ABSTRACT
Background: Fractures of the lateral third of the clavicle represent 18% of all clavicle fractures. Even though non-displaced fractures can be managed conservatively, displaced fractures have a non-union percentage of 30%. Multiple approaches have been proposed to manage the displaced fractures. The objective of this study was to record the prevalence of fractures of the lateral third of the clavicle with involvement of the clavicular-acromial joint, as well as to briefly review the treatment performed in our center and compare it with the current literature.
Material and methods: Retrospective, cross-sectional, descriptive and observational study, which consisted in a review of the records of patients with a diagnosis of fracture of the lateral third of the clavicle with an injury to the clavicular-acromial joint.
Results: Lateral third fractures accounted for 24% of all clavicle fractures. Distribution by sex: 10: 2, men: women. Left shoulder predominance, 8:4. The predominant maneuvers were anatomical plate for the lateral third of the clavicle (50% of the cases), coracoclavicular cerclage technique plus resection of the lateral third of the clavicle (25%), plate hook (8.3%), Mumford combined with Waever/Dunn (8.3%), anchor plus Kirschner rods (8.3%).
Discussion: The choice of the appropriate treatment will depend on the type of fracture and specific characteristics of each patient. We suggest the use of the coracoclavicular cerclage technique in cases in which the lateral fragment is multifragmented, irreducible or smaller in size than its osteosynthesis would allow, performing plasty of clavicular and coracoclavicular ligaments.
REFERENCES
Ávila LJ, Moros MS, Jacobo EO, García-Polín LC, García RC, Del Olmo HT. Fracturas de clavícula distal. Rev Esp Artrosc Cir Articul. 2015; 22(1): 49-53.
Fukuda K, Craig EV, An KN, Cofield RH, Chao EY. Biomechanical study of the ligamentous system of the acromioclavicular joint. J Bone Joint Surg Am. 1986; 68(3): 434-40.
Debski RE, Parsons IM 4th, Woo SL, Fu FH. Effect of capsular injury on acromioclavicular joint mechanics. J Bone Joint Surg Am. 2001; 83-A(9): 1344-51.
Checchia SL, Doneux P, Miyazaki AN, Carvalho LA, Caneca Jr OA. Fraturas da clavícula distal: tratamento e resultados. Rev Bras Ortop. 1996; 31(10): 838-42.
Checchia SL, Doneux P, Miyazaki AN, Fregoneze M, Silva LA. Treatment of distal clavicle fractures using an arthroscopic technique. J Shoulder Elbow Surg. 2008; 17(3): 395-8.
Edwards DJ, Kavanagh TG, Flannery MC. Fractures of the distal clavicle: a case for fixation. Injury. 1992; 23(1): 44-6.
Jupiter JB, Leffert RD. Non-union of the clavicle. Associated complications and surgical management. J Bone Joint Surg Am. 1987; 69(5): 753-60.
Craig E. Fractures of the clavicle. In: Rockwood CA, Matsen FA. The shoulder. Philadelphia, PA: Saunders; 1990. pp. 367-412.
Loriaut P, Moreau PE, Dallaudiere B, Pelissier A, Duc Vu H, Massin P, et al. Outcome of arthroscopic treatment for displaced lateral clavicle fractures using a double button device. Knee Surg Sports Traumatol Arthrosc. 2015; 23(5): 1429-33.
Sajid S, Fawdington R, Sinha M. Locking plates for displaced fractures of the lateral end of clavicle: Potential pitfalls. Int J Shoulder Surg. 2012; 6(4): 126-9.
Naoki MA, Andrade SL, Do Val SG, Checchia SL, Cavadinha SH, Schneider CV. Evaluation of the results from surgical treatment of fractures of the lateral extremity of the clavicle, using the double ligature technique. Rev Bras Ortop. 2015; 50(2): 142-7.
Fann CY, Chiu FY, Chuang TY, Chen CM, Chen TH. Transacromial Knowles pin in the treatment of Neer type 2 distal clavicle fractures. A prospective evaluation of 32 cases. J Trauma. 2004; 56: 1102-5.
Good DW, Lui DF, Leonard M, Morris S, McElwain JP. Clavicle hook plate fixation for displaced lateral-third clavicle fractures (Neer type II): a function al outcome study. J Shoulder Elbow Surg. 2012; 21(8): 1045-8.
Neer CS. Fractures. In: Neer CS, editor. Shoulder reconstruction. Philadelphia: Saunders; 1990. pp. 403-12.
Oh JH, Kim SH, Lee JH, Shin SH, Gong HS. Treatment of distal clavicle fracture: a systematic review of treatment modalities in 425 fractures. Arch Orthop Trauma Surg. 2011; 131(4): 525-33.
Keifer H, Claes I, Burri C, Holzworth J. The stabilizing effect of various implants on the torn acromioclavicular joint. A biomechanical study. Arch Orthop Trauma Surg. 1986; 106(1): 42-6.
Souza VJ, De Andrade RP, Jacques GL, Abreu MT, Correa FM, De Araujo ID. Fractures of the distal clavicle: comparison between two surgical treatment methods. Rev Bras Ortop. 2015; 50(2): 136-41
Morales A. Resultados funcionales en la luxación acromioclavicular tipo III con técnica de Waeber-Dunn vs. Waeber-Dunn modificada. Tesis para obtener el título de Médico Especialista en Ortopedia y Traumatología. Universidad Nacional Autónoma de México; 2007.
Beirer M, Siebenlist S, Crönlein M, Postl L, Huber-Wagner S, Biberthaler P, et al. Clinical and radiological outcome following treatment of displaced lateral clavicle fractures using a locking compression plate with lateral extension: a prospective study. BMC Musculoskeletal Disord. 2014; 15: 380.
Del Gordo DR, Acuña PJ, Torres CE. Tratamiento quirúrgico de las fracturas laterales de clavícula. Un nuevo concepto. Med UNAB. 2014; 17(2): 91-8.
Soliman O, Koptan W, Zarad A. Under-coracoid-around-clavicle (UCAC) loop in type II distal clavicle fractures. Bone Joint J. 2013; 95B: 983-7.
Kenyon P, Morgan BW, Webb M, Ebreo D, Wheelton A, Ravenscroft M. Open reduction and fixation of displaced lateral clavicle fractures using the minimally invasive acromioclavicular joint reconstruction (MINAR) technique: a case series review. Shoulder Elbow. 2015; 7(1): 13-7.