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ORIGINAL ARTICLE
Year : 2017  |  Volume : 52  |  Issue : 3  |  Page : 208-214

Dual fixation of midshaft clavicle fractures in adults: intramedullary Kirschner wire with augmentative plate fixation


Department of Orthopaedic Surgery and Trauma Traumatology, Faculty of Medicine, El-Hadra University Hospital, Alexandria University, Alexandria, Egypt

Correspondence Address:
Bahaa A Motawea
Department of Orthopaedic Surgery and Trauma Traumatology, Faculty of Medicine, University of Alexandria, 16 Masged El-Quarawy Street, El-Mansheya
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/eoj.eoj_58_17

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Background The clavicle is one of the most commonly fractured bones in the body. In adults, clavicle fractures represent 2.6–5% of all fractures and 44% of all shoulder girdle injuries. Although fracture union usually occurs regardless of the treatment selected, controversy exists regarding optimal management. Although most clavicle fractures can be managed nonoperatively, still there has been debate on how to best treat displaced midshaft clavicular fractures. Without fixation, nonunion rates as high as 15–21% have been reported. Operative fixation for displaced midshaft fractures improve the functional outcomes and decrease nonunion rates. Operative management including open or closed reduction with plate fixation or intramedullary (IM) fixation results in improved outcomes and lower rates of nonunion compared with nonoperative management and is recommended for patients with multiple risk factors for nonunion, especially significant displacement or clavicle shortening. This study was conducted to assess the results and reliability of combined IM and plate fixation of displaced mid-clavicular fractures in adults. Patients and methods Thirty-three adult patients with comparable demographics having displaced mid-clavicular fracture were submitted to surgical fixation by both IM Kirschner wire and short small reconstruction plate. Results were assessed at the end of this period according to Constant and Murley Score (CMS). The CMS is a 100-point functional shoulder-assessment tool in which higher scores reflect increased function. Results At the end of the follow-up period, the mean score was 95.33±9.0. Thirty-two (97%) patients had excellent results, and only one (3%) patient had poor result. The mean final CMS for pain was 14.70±1.74. The mean final CMS for activity of daily living was 19.67±1.91. The mean final CMS for active forward flexion was 9.82±1.04 (145°–174°). The mean final CMS for active abduction was 9.82±1.04 (145°–174°). The mean final CMS for active external rotation was 9.88±0.70. The mean final CMS for active internal rotation was 9.88±0.70. The mean final CMS for strength was 23.88±2.36. Time of union in the studied patients ranged from 8 to 12 weeks, with a mean of 8.25±0.84 weeks. Conclusion Our research data suggest that a relatively new technique using IM Kirschner wire with augmentative anteroinferior short small fragment contoured reconstruction plate fixation is a suitable, reproducible, and effective alternative for surgical fixation of displaced midshaft clavicle fractures in adults and provides reliable functional results.


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