• Athlete
• Clavicle
• Fracture
• Injury
• Return to play
• Sport

• CRIF clavicle
• Clavicle
• ORIF clavicle
• Plating fixation
• Titanium elastic nail

• Humans
• Clavicle/injuries
• Clavicle/surgery
• Bone Plates
• Male
• Fractures, Bone/surgery
• Female
• Retrospective Studies
• Fracture Fixation, Intramedullary/methods
• Fracture Fixation, Intramedullary/instrumentation
• Adult
• Middle Aged
• Bone Nails
• Treatment Outcome
• Fracture Fixation, Internal/methods
• Fracture Fixation, Internal/instrumentation
• Young Adult
• Postoperative Complications
• Aged

• child and adolescent
• clavicle fractures
• family medicine
• orif
• pediatric fractures

• Clavicle
• Fracture
• Fracture non-union
• Postoperative complications
• Subclavian artery
• Subclavian vein

• brachial plexus
• clavicle
• fracture
• subclavian vessels
• thoracic outlet syndrome

• clavicle fracture
• conservative treatment
• motion analysis
• range of motion
• scapula

• clavicle fractures
• complication
• constant-murley score
• functional and radiological outcome
• locking compression plating

• Anterior plating
• Clavicle fracture
• Distal clavicle plating
• Superior plating
• Surgical management

• clavicular fracture
• dual plating
• dual-plate fixation
• midshaft
• reoperation

• Humans
• Reoperation/adverse effects
• Cohort Studies
• Retrospective Studies
• Clavicle/surgery
• Clavicle/injuries
• Fractures, Bone/surgery
• Fracture Fixation, Internal/adverse effects
• Fracture Fixation, Internal/methods
• Postoperative Complications/etiology
• Bone Plates/adverse effects
• Treatment Outcome

• clavicle fracture
• displacement
• non-operative
• shortening

• Clavicle
• Clavicle fracture
• Most cited articles
• Top 50 influential

• Humans
• Clavicle/surgery
• Fracture Healing
• Treatment Outcome
• Fractures, Bone/surgery
• Fracture Fixation/methods

• clavicle
• clavicle reconstruction
• fracture repair bone graft
• iliac crest bone graft
• nonunion fracture

• adolescent
• clavicle fracture
• functional outcomes
• trauma
• upper extremity

• Clavicle
• Cohort Studies
• Cost of Illness
• Fractures, Bone
• Postoperative Complications
• Reoperation
• United Kingdom

Midshaft clavicle fractures are the most common fracture of the clavicle accounting for 80% of all clavicle fractures. Traditionally, midshaft clavicle fractures are treated with conservative treatment even when prominent displacement is observed; however, recent studies revealed that nonunion or malunion rate may be higher with conservative treatment. Moreover, recent studies have shown better functional results and patient satisfaction with surgical treatment. This review article provides a review of clavicle anatomy, describes the current clavicle fracture classification system, and outlines various treatment options including current surgical options for clavicle fracture in adults.

• Adult
• Clavicle
• Shaft
• Shoulder
• Treatments

• Clavicle malunion
• orthopedic surgery
• trauma

• clavicle fracture
• locater
• motion analysis
• range of motion
• scapula

• 3-D image
• 3D
• Clavicle
• Fracture
• Malunion
• Printing
• Traumatology

• Fracture
• Front page
• Nonunion
• SCI-EXPANDED
• Scientometrics

• Bibliometrics
• Databases, Factual
• Humans

• clavicle midshaft fracture
• multicentric study
• superior plate of the clavicle

• Bone graft
• Clavicle fracture
• Clavicle nonunion
• Clinical results
• Osteosynthesis
• Radiological results

Absence of cortical alignment in wedge-shaped and multifragmentary fractures (Fx) results in decreased fixation stability. The aim of this study was to compare the outcome using 2.0- vs. 3.5-mm screws for open reduction and internal fixation (ORIF) in dislocated, wedge-shaped or fragmentary midshaft clavicle fractures.

Patients suffering from AO/OTA 15 2.A-C midshaft clavicle fractures were operatively treated between 2008 and 2018. 2.0- or 3.5-mm cortical screws were used to restore anatomic alignment in dislocated, wedge-shaped and fragmentary clavicle fractures. Data of radiologic outcome were collected until fracture consolidation was identified.

80 consecutive patients with a mean age of 44.5 ± 16.3 years, who were operatively treated for dislocated midshaft clavicle fractures were enrolled. 40 patients were treated using 2.0-mm and 40 patients using routine 3.5-mm cortical screws, respectively. Time to fracture consolidation was 12.8 ± 7.8 months. No mal- or non-unions occurred during routine follow-up until 18 months postoperatively.

Restoring anatomic alignment in wedge or fragmentary clavicle fractures can ultimately be addressed using cortical screw augmentation. Both groups showed comparable results with respect to fracture reduction, fixation and stability as well as time to consolidation of the fracture, while the 2.0-mm screw diameter was associated with easier handling of small Fx fragments.

• Alignment
• Clavicle
• Cortical
• Fracture
• Osteosynthesis
• Plate
• Screw

• Clavicle fractures
• Computed tomography
• Coracoid process
• Intramedullary device
• Medullary canal
• Morphometry

Peripheral nerve injury after shoulder trauma is an underestimated complication. The distribution of the affected nerves has been reported to be heterogeneous in previous studies. This study aimed to describe the distribution of peripheral nerve injuries in patients with a history of shoulder trauma who were referred to a tertiary care electrodiagnostic laboratory. A retrospective chart review was performed for all cases referred to a tertiary care electrodiagnostic laboratory between March 2012 and February 2020. The inclusion criteria were a history of shoulder trauma and electrodiagnostic evidence of nerve injury. Data on patient demographics, mechanism of injury, degree of weakness, clinical outcomes at the final follow-up, and electrodiagnostic results were retrieved from medical records. Fifty-six patients had peripheral nerve injuries after shoulder trauma. Overall, isolated axillary nerve injury was the most common. A brachial plexus lesion affecting the supraclavicular branches (pan-brachial plexus and upper trunk brachial plexus lesions) was the second most common injury. In cases of shoulder dislocation and proximal humerus fracture, isolated axillary nerve injury was the most common. Among acromioclavicular joint injuries and clavicular fractures, lower trunk brachial plexus injuries and ulnar neuropathy were more common than axillary nerve or upper trunk brachial plexus injuries. Patients with isolated axillary nerve lesions showed a relatively good recovery; those with pan-brachial plexus injuries showed a poor recovery. Our study demonstrated the distribution of peripheral nerve injuries remote from displaced bony structures. Mechanisms other than direct compression by displaced bony structures might be involved in nerve injuries associated with shoulder trauma. Electrodiagnostic tests are useful for determining the extent of nerve damage after shoulder trauma.

• axillary nerve
• brachial plexus injury
• clavicle fracture
• electrodiagnosis
• nerve injury
• proximal humerus fracture
• shoulder dislocation

• Clavicle fractures
• pseudoaneurysm
• subclavian artery

• figure-of-eight bandage
• midshaft clavicle fractures
• shortening and displacement

Radiographic measurements of shortening and vertical displacement in the fractured clavicle are subject to a variety of factors such as patient positioning and projection. The aims of this study were (1) to quantify differences in shortening and vertical displacement in varying patient positions and X-ray projections, (2) to identify the view and patient positioning indicating the largest amount of shortening and vertical displacement, and (3) to identify and quantify the inter- and intraobserver agreement.

A prospective clinical measurement study of 22 acute Robinson type 2B1 clavicle fractures was performed. Each patient underwent 8 consecutive standardized and calibrated X-rays in 1 setting.

In the upright patient position, the difference of absolute shortening was 4.5 mm (95% confidence interval [CI]: 3.0-5.9, P < .0001) larger than in the supine patient position. For vertical displacement, the odds of being scored a category higher in the upright patient position were 4.7 (95% CI: 2.2-9.8) times as large as the odds of being scored a category higher in supine position. The odds of being scored a category higher on the caudocranial projection were 5.9 (95% CI: 2.8-12.6) times as large as the odds of being scored a category higher on the craniocaudal projection.

Absolute shortening, relative shortening, and vertical displacement were found to be the greatest in the upright patient positioning with the arm protracted orientation on a 15° caudocranial projection. No statistically significant differences were found for a change in position of the arm between neutral and protracted.

• Clavicle
• displacement
• fractures
• interrater agreement
• intrarater agreement
• radiological imaging
• shortening

• ABOS
• American Board of Orthopedic Surgery
• Clavicle fracture
• Complications
• Exam subspecialty
• Fellowship

• Biomechanical
• Clavicle
• Comminuted
• Fracture
• Internal fixation
• Orthogonal
• Segmental

• Biomechanical Phenomena
• Bone Plates
• Clavicle/injuries
• Clavicle/surgery
• Compressive Strength
• Fracture Fixation, Internal/instrumentation
• Fracture Fixation, Internal/methods
• Fractures, Comminuted/surgery
• Humans
• Models, Anatomic

• - Melbourne Orthopaedic Group Research Foundation

The majority of previous investigations on operative fixation of clavicle fractures have been related to the adult population, with occasional assessments of the younger, more commonly affected adolescent population. Despite limited prospective data for adolescents, the incidence of operative fixation of adolescent diaphyseal clavicle fractures has increased.

To detail the demographic features and descriptive epidemiology of a large pooled cohort of adolescent patients with diaphyseal clavicle fractures presenting to pediatric tertiary care centers in the United States through an observational, prospective, multicenter cohort study (Function after Adolescent Clavicle Trauma and Surgery [FACTS]).

Cross-sectional study; Level of evidence, 4.

Patients aged 10 to 18 years who were treated for a diaphyseal clavicle fracture between August 2013 and February 2016 at 1 of 8 geographically diverse, high-volume, tertiary care pediatric centers were screened. Treatment was rendered by any of the pediatric orthopaedic providers at each of the 8 institutions, which totaled more than 50 different providers. Age, sex, race, ethnicity, fracture laterality, hand dominance, mechanism of injury, injury activity, athletic participation, fracture characteristics, and treatment decisions were prospectively recorded in those who were eligible and consented to enroll.

A total of 545 patients were included in the cohort. The mean age of the study population was 14.1 ± 2.1 years, and 79% were male. Fractures occurred on the nondominant side (56%) more frequently than the dominant side (44%). Sport was the predominant activity during which the injury occurred (66%), followed by horseplay (12%) and biking (6%). The primary mechanism of injury was a direct blow/hit to the shoulder (60%). Overall, 54% were completely displaced fractures, defined as fractures with no anatomic cortical contact between fragments. Mean shortening within the completely displaced group was 21.9 mm when measuring the distance between fragment ends (end to end) and 12.4 mm when measuring the distance between the fragment end to the corresponding cortical defect (cortex to corresponding cortex) on the other fragment (ie, true shortening). Comminution was present in 18% of all fractures. While 83% of all clavicle fractures were treated nonoperatively, 32% of completely displaced fractures underwent open reduction and internal fixation.

Adolescent clavicle fractures occurred more commonly in male patients during sports, secondary to a direct blow to the shoulder, and on the nondominant side. Slightly more than half of these fractures were completely displaced, and approximately one-fifth were comminuted. Within this large cohort, approximately one-third of patients with completely displaced fractures underwent surgery, allowing for future prospective comparative analyses of radiographic, clinical, and functional outcomes.

• adolescent
• clavicle fixation
• clavicle fracture
• pediatric

• Clavicle
• fracture
• meta-analysis
• nonoperative
• operative
• systematic review

• 3D printing
• 3D model
• Deformity
• Malunion
• Osteotomy
• Pain

• clavicle
• fracture
• functional
• midshaft
• military
• operative
• outcomes

• Clavicle malunion
• Conservative treatment
• Functional outcome
• Midshaft clavicle fractures. level of evidence: III

• Clavicle fracture
• Clavicle non-union
• Lateral clavicle

• Clavicle fracture
• Mid-diaphyseal
• Midshaft clavicle
• Pediatrics
• Skeletally immature

This retrospective analysis was designed to compare the outcomes of mid-shaft clavicle fracture operative treatment using bridge combined fixation system (BCFS) versus clavicular locking plate (CLP).

Operative surgeries performed between January 2016 and July 2018 were included in the analysis. The surgical internal fixation implants were chosen according to surgeon preference and the choice of patients between the BCFS and CLP. Functional outcomes, fracture union, complications, pain, and patient satisfaction post-operation were assessed at a follow-up of 12 to 24 months.

Two hundred and seventeen (217) patients, aged 21–79 years, were operated, 87 using BCFS and 130 using CLP. The operation time of the BCFS group was significantly less than the CLP group (P<0.01). We also found that BCFS group had higher degree of satisfaction (100% vs. 97%, P<0.03) and less VAS scale (0.25±0.18 vs. 0.35±0.21, P<0.001) compared with the CLP group, but the significance could only be obtained during the follow-up at 3 months after surgery. No significant differences were observed between the 2 groups when compared for fracture unions, functional scores, or complications.

BCFS significantly reduced the operation time when compared with CLP. No significant differences were observed for functional outcomes, including fracture union and complications, and there was less pain and higher patient satisfaction. Both methods appeared to be safe in terms of complications. However, the effectiveness and safety of BCFS in treating comminuted multi-fragmentary mid-shaft clavicle fractures (AO/OTA 15-2C classification) need further confirmation.

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 clavicular fractures are common fractures and generally treated conservatively. Among the surgical options, plate fixation is the most popular and has been biomechanically and clinically proven in numerous studies. However, implant failures caused by plate deformations or breakage still occur in up to 16.7% of cases, and recent studies showed that screw holes above fracture zone (SHFZ) might be the at-risk location. Using finite element analysis, this study aimed to test the biomechanical property of the superior clavicle locking plate (SCLP) with and without SHFZ in comminuted midshaft clavicular fracture.

Finite element models of comminuted midshaft clavicular fracture fixed with standard 8-hole titanium SCLP with screw holes (SHFZ plate) and without screw holes above fracture zone (No-SHFZ plate) were built. Both groups were tested under three different loading models (100-N cantilever bending, 100-N axial compression, and 1-Nm torsion). The average peak stress on medial clavicle, fracture zone, and lateral clavicle, and the peak stress on each screw hole (or the same position in the No-SHFZ plate) were measured and compared.

The highest average peak stress on the fracture zone was higher than those on medial and lateral clavicles under all loading conditions in both plates. However, the No-SHFZ plate significantly reduced the average peak stress value on the fracture zone, compared to the SHFZ plate (45.0% reduction in cantilever bending, 52.2% reduction in axial compression, and 54.9% reduction in axial torsion). The peak stress value on the maximal stress point in the SHFZ and No-SHFZ plates with cantilever bending, axial compression, and torsion loads were 1257.10 MPa vs. 647.21 MPa, 186.42 MPa vs. 131.63 MPa, and 111.86 MPa vs. 82.41 MPa, respectively.

The weakest link of the SCLP construct in comminuted midshaft clavicular fracture fixation is the SHFZ, especially in the cantilever bending load. Additionally, the biomechanical property of the SCLP without SHFZ model (No-SHFZ plate) is superior to the standard SCLP model (SHFZ plate), with a significantly lower peak stress on the SHFZ location in all loading conditions. We recommend a new SCLP design with SHFZ to prevent implant failure and improve surgical outcomes.

• Implant failure
• Midshaft clavicular fracture
• Peak stress
• Plate fixation
• Screw hole
• Superior clavicle locking plate

• clavicle fracture
• evidence-based guidelines
• practice patterns

• Adult
• Age Factors
• Clavicle/injuries
• Controlled Before-After Studies
• Diaphyses/injuries
• Female
• Fracture Fixation, Internal/statistics & numerical data
• Fracture Fixation, Internal/trends
• Fractures, Bone/surgery
• Humans
• Injury Severity Score
• Male
• Middle Aged
• Open Fracture Reduction/statistics & numerical data
• Open Fracture Reduction/trends
• Practice Patterns, Physicians'/statistics & numerical data
• Practice Patterns, Physicians'/trends
• Randomized Controlled Trials as Topic
• Retrospective Studies
• Trauma Centers
• Young Adult

• Clavicle fractures
• Conventional open plating
• Locking compression plate
• Minimally invasive plate osteosynthesis (MIPO)

Brachial plexus compression is a rare complication of displaced clavicle fractures, with few reports existing in the literature. Neurologic symptoms can present immediately after the injury or in a delayed fashion months later. Following polytrauma, two patients presented with displaced middle-third left clavicle fractures initially treated conservatively at other institutions. Both patients developed neurologic symptoms in the left upper extremity consistent with brachial plexus compression. Magnetic resonance imaging and electrodiagnostic testing were used to help confirm the diagnosis of thoracic outlet syndrome/brachial plexopathy, and both patients underwent open reduction internal fixation with dual plating, local bone grafting and brachial plexus decompression. Both patients experienced successful relief of neurologic symptoms postoperatively. The purpose of this case series is to report on a rare complication of delayed- and non-united clavicle fractures and describe successful treatment with a novel fracture fixation construct.

• Brachial plexus compression
• Clavicle fracture
• Clavicle nonunion
• Dual-plating
• Thoracic outlet syndrome

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

Medial third clavicle fractures are rare injuries, with limited information available on their characteristics or treatment results.

We performed a systematic review according to PRISMA guidelines to evaluate the demographics, clinical profile, management and treatment outcome. Electronic searches of the MEDLINE, EMBASE and Cochrane databases were performed.

Seventeen studies were included, consisting of 7 case series and 10 case reports. Two hundred twenty fractures were identified. Seventy-eight percent of fractures occurred in men with mean age of 48 years (16–94 years). Road traffic accident was the most common mechanism of injury (64%). Associated injuries occurred in 81% of patients, with thoracic trauma being the most common (47%). The most common fracture type was extra-articular, with no or minimal displacement (60%). In 9% of patients the fracture was segmental. One hundred ninety-one patients received nonoperative treatment. Twenty-nine patients were treated operatively. The overall nonunion rate was 5% (7/137). The nonunion rate following nonoperative management was 4.6% (5/108). The functional result following nonoperative treatment indicated overall “good” functional outcome. There was no report of catastrophic intraoperative complication amongst patients undergoing surgical fixation.

Medial third clavicle fractures represent a distinct subgroup of clavicle fractures. Nonoperative treatment of these fracture seems to result in high union rate and overall favourable functional outcome. Further high-quality research in this area is warranted to investigate the outcomes and indication for nonoperative versus operative management of these fractures.

IV.

• Medial clavicle fracture
• Nonunion
• Open reduction internal fixation
• Systematic review

• Clavicle
• fracture
• internal fixation
• pneumothorax

A method of closed reduction and internal fixation with cannulated screws was proposed as a surgical treatment of midshaft clavicle fractures. However, there are no mechanical studies about the cannulated screw used in the fixation of midshaft clavicle fracture. We conducted this study to compare the construct bending stiffness of a fixation midshaft clavicle fracture with a Knowles pin, cannulated screw and reconstruction plate. In addition, purchase lengths of both intramedullary devices were measured.

After transverse osteotomy over the midpoint for fracture simulation, eighteen synthetic clavicles were assigned to 3 groups and fixed with reconstruction plate, Knowles pin or cannulated screw. Purchase length was defined as the engaged length of the intramedullary portion of the two intramedullary devices Stiffness, yield load and maximum load of the cantilever bending test were calculated of each tested synthetic bones.

The Knowles pin group had a significantly longer average intramedullary purchase length compared with that of the cannulated screw group. The construct stiffness in the reconstruction plate group (5.6 ± 0.9 N/mm) was higher than that of the intramedullary devices; the Knowles pin group (3.1 ± 0.6 N/mm) provided a greater construct stiffness than did the cannulated screw group (1.7 ± 0.4 N/mm) (p = 0.007). The cannulated screw group had the lowest yield and maximum load compared with the reconstruction plate and Knowles pin groups. Both the reconstruction plate and Knowles pin failed at the implant-bone interface. However, the cannulated screw group failed at the osteotomy site with broken implants.

This study suggests that fixation of midshaft clavicle fractures with cannulated screws may lead to early failure due to inadequate mechanical strength. Ideal intramedullary clavicle devices should supply adequate intramedullary purchase lengths and mechanical strength.

• Cannulated screw
• Intramedullary device
• Midshaft clavicle fracture

• Clavicle
• fracture
• imaging
• interobserver agreement
• shortening
• treatment strategy

• clavicle fracture
• conservative management
• plate fixation
• randomized control trial