• Bone infection
• Clavicle nonunion
• Iliac graft
• Masquelet technique
• Osteosynthesis infection

• Bone defect
• Clavicle
• Free fibular vascularised graft
• Management
• Non-union

• Humans
• Fibula/transplantation
• Treatment Outcome
• Clavicle/surgery
• Fractures, Bone/complications
• Osteomyelitis/surgery
• Bone Transplantation/methods
• Synostosis/etiology

• Acromioclavicular joint
• Biomechanics
• Conoid
• Coracoclavicular ligaments
• Posterior rotation
• Trapezoid

• Humans
• Acromioclavicular Joint
• Biomechanical Phenomena
• Upper Extremity
• Clavicle
• Muscles

• acromioclavicular joint
• biomechanics
• dynamic stabilizer
• shoulder
• trapezius

Midshaft clavicle fracture shortening measurement is a reported key element for indication to surgical management and reporting of clinical trials. Determination of pre-fracture clavicle length for shortening measurement remains an unresolved issue. The purpose of the study was to assess accuracy of a novel technique of three-dimensional reconstruction and virtual reposition of bone fragments (3D-VR) for determination of pre-fracture clavicle length and measurement of shortening.

Accuracy of 3D-VR measurements was assessed using 5 synthetic bone clavicle fracture models. Measurements were compared between caliper and 3D-VR technique measurements. Correlation between 3D-VR and 2D measurements on standard radiographs was assessed on a cohort of 20 midshaft fractures. Four different methods for 2D measurements were assessed.

Mean difference between caliper measurements and 3D-VR was 0.74 mm (95CI = − 2.51;3.98) (p = 0.56) on synthetic fracture models. Mean differences between 3D-VR and standard radiograph shortening measurement methods were 11.95 mm (95CI = 7.44;16.46) for method 1 (Jeray et al.) and 9.28 mm (95CI = 4.77;13.79) for method 2 (Smekal et al.) (p < 0.05). Differences were − 1.02 mm (95CI = − 5.53;3.48) for method 3 (Silva et al.) and − 2.04 mm (95CI = − 6.55;2.47) for method 4 (own method). Interobserver correlation ranged between 0.85 and 0.99. A false positive threshold of 20 mm was measured by the two observers in 25% of the case according to method of method 1, 30–35% with method 2, 15% with method 3 et al. and 5–10% with the method 4.

3D VR is accurate in measuring midshaft clavicle fracture length and shortening. Two dimensional measurements may be used for approximation of clavicular shortening.

• 3D analysis
• Clavicle fracture
• Computed tomography
• Shortening

• children
• clavicle
• diagnosis
• fracture
• pediatric
• pseudarthrosis
• treatment

• Acromioclavicular Joint/physiology
• Adult
• Biomechanical Phenomena/physiology
• Data Analysis
• Female
• Humans
• Male
• Movement/physiology
• Range of Motion, Articular/physiology
• Rotation
• Scapula/physiology
• Shoulder/physiology
• Shoulder Impingement Syndrome/physiopathology
• Shoulder Pain/physiopathology
• Sternoclavicular Joint/physiology
• Thorax/physiology

• P41 EB027061 NIBIB NIH HHS
• F31 HD087069 NICHD NIH HHS
• UL1 TR002494 NCATS NIH HHS
• T32 AR050938 NIAMS NIH HHS
• L30 HD089226 NICHD NIH HHS
• P41 EB015894 NIBIB NIH HHS
• NIH

Background: Clavicle fractures are common injuries in adults, especially due to sport activities or road traffic accidents. Most lesions occur at the level of the middle-third presenting some degree of displacement often. Traditionally, non-surgical management was considered the first treatment option for the most clavicle fractures. Nowadays, various authors suggest early surgical fixation of displaced midshaft fractures. The aim of this study is to compare surgical versus non-surgical treatment and to evaluate the outcomes and the incidence of complications following to both treatment options. Matherial and methods: 87 patients with 2 displaced clavicle fractures fragments (AO 15.2A) were included in the retrospective study, evaluating the clinical and functional outcomes and the complication rate with a follow-up average of 48 months. Results: The risk of nonunion resulted lower in the surgically treated patients. The Constant Score after 1 year was slightly better after the plate fixation (94,36 vs 91,36), while the DASH score resulted better in the conservatively treated patients (3,86 vs 4,63). The delay or revision surgery rates were similar for both groups and most of the complications were associated with the conservative treatment. Conclusions: According to our results, the plate fixation does not lead to better clinical and functional outcomes, instead it reduces the risk of nonunion. We suggest to tailor the treatment patient-by-patient considering the functional demand, patient’s comorbidity and nonunion risk factor. (www.actabiomedica.it)

• Midshaft
• clavicle
• displaced
• fracture
• outcome
• shortening
• shoulder function, nonunion

• Atrophic nonunion
• clavicular midshaft
• hyaluronic acid-based mesh

Posterior instability of the shoulder is a rare condition and represents about 10% of shoulder instability. It has become more frequently recognized in the last year, even though it is more difficult to diagnose than anterior shoulder instability. As this form of shoulder pathology is somewhat rare, biomechanical knowledge is limited. The purpose of our study was to perform an extensive literature search, including PubMed and Medline, and to give an overview of the current knowledge on the biomechanics of posterior shoulder instability. The PubMed/Medline databases were utilized, and all articles related to posterior shoulder instability and biomechanics were included to form a comprehensive compilation of current knowledge. A total of 93 articles were deemed relevant according to our inclusion and exclusion criteria. As expected with any newly acknowledged pathology, biomechanical studies on posterior shoulder instability remain limited in the literature. Current biomechanical models are performed in a static manner, which limits their translation for explaining a dynamic pathology. Newer models should incorporate dynamic stabilization of both the rotator cuff and scapulothoracic joint. There is a current lack of knowledge with regards to the pathomechanism of posterior shoulder instability, with no consensus on appropriate treatment regimens. Further investigation is therefore required at both basic science and clinical levels.

• Posterior shoulder instability
• Anatomy
• Shoulder complex
• Scapula
• Humerus
• Glenohumeral

• Clavicle/diagnostic imaging
• Clavicle/injuries
• Female
• Fracture Fixation/adverse effects
• Fracture Fixation/methods
• Fracture Healing/physiology
• Fractures, Bone/diagnostic imaging
• Fractures, Bone/surgery
• Fractures, Malunited/diagnostic imaging
• Fractures, Malunited/surgery
• Humans
• Imaging, Three-Dimensional
• Male
• Osteotomy/methods
• Prognosis
• Reoperation/methods
• Risk Assessment
• Tomography, X-Ray Computed/methods
• Treatment Outcome

• Clavicular fracture
• hook plate
• plate fixation
• reconstruction plate
• tension band wire
• titanium elastic nail

• Bone Nails
• Bone Plates
• Bone Wires
• Clavicle/injuries
• Fracture Fixation, Internal/methods
• Fractures, Bone/surgery
• Humans
• Immobilization/methods
• Injury Severity Score
• Randomized Controlled Trials as Topic
• Shoulder/physiopathology
• Treatment Outcome

• 3D scanning
• Clavicle
• Forensic anthropology population data
• Sexual dimorphism
• Spanish population
• Volume

• Paradoxical breathing
• Respiratory function
• Sarcoma
• Shoulder function
• Sternectomy

• Activities of Daily Living
• Adult
• Aged
• Bone Neoplasms/surgery
• Female
• Forced Expiratory Volume
• Humans
• Male
• Middle Aged
• Postoperative Period
• Prostheses and Implants/adverse effects
• Plastic Surgery Procedures/adverse effects
• Sarcoma/pathology
• Sarcoma/surgery
• Shoulder/physiopathology
• Soft Tissue Neoplasms/surgery
• Spirometry
• Sternum/surgery
• Surgical Flaps
• Surgical Mesh/adverse effects
• Thoracic Wall/surgery
• Treatment Outcome
• Vital Capacity

• Clavicle
• delay
• fracture
• function
• mid-third
• outcome
• scapular

• Clavicle
• Resection
• Scapula
• Shoulder girdle