Operative treatment of midclavicular fractures in 62 elderly patients: knowles pin versus plate. Treatment of midclavicular nonunion: comparison of dynamic compression plating and low-contact dynamic compression plating techniques. A three-dimensional reconstruction plate for displaced midshaft fractures of the clavicle.
This prospective, randomized trial compared treatment with Knowles pins and plates in 62 elderly patients (>50 years) with midclavicular fractures. The clinical outcomes were evaluated at 30 months postoperatively. The mean shoulder score of the Knowles pinning was 85 points and the plating was 84 points (P=.7). Knowles pinning requires significantly shorter operative time (P<.001), smaller wound size (P<.001), shorter hospital stay P=.03), less meperidine use (P=.02), lower complication rate (P=0.04), and less symptomatic hardware (P=.015). If surgery of mid-third clavicular fractures is indicated, fixation with a Knowles pin has more advantages than plate fixation in elderly patients. In this study a comparison of patients with midclavicular nonunion, treated by a combination of internal fixation with dynamic compression plate (DCP) or low-contact DCP (LC-DCP) and application of autogenous corticocancellous chips or sculptured graft on nonunion areas, was performed. Time to union in the patients treated with LC-DCP fixation was shorter than in those treated with DCP fixation (P <.001). Union was obtained in all patients treated with LC-DCP fixation and in 87.5% of those treated with DCP fixation. All of those treated with LC-DCP fixation returned to their original jobs, whereas two patients treated with DCP fixation had to change jobs. According to the Disabilities of the Arm, Shoulder, and Hand functional score, at the last follow-up visit, functional outcomes of the patients treated with LC-DCP fixation were more satisfactory (P <.001). The addition of internal fixation of the clavicle with DCP or LC-DCP to application of autogenous corticocancellous chips, or sculptured graft on nonunion areas in patients with midclavicular nonunion, shortens the time to union, increases union rates, and provides satisfactory functional outcomes. This randomised study compared outcomes in patients with displaced fractures of the clavicle treated by open reduction and fixation by a reconstruction plate which was placed either superiorly or three-dimensionally. Between 2003 and 2006, 133 consecutive patients with a mean age of 44.2 years (18 to 60) with displaced midshaft fractures of the clavicle were allocated randomly to a three-dimensional (3D) (67 patients) or superior group (66). Outcome measures included the peri-operative outcome index, delayed union, revision surgery and symptoms beyond 16 weeks. CT was used to reconstruct an image of each affected clavicle and Photoshop 7.0 software employed to calculate the percentage of the clavicular cortical area in the sagittal plane. The patients were reviewed clinically and radiographically at four and 12 months after the operation. The superior plate group had a higher rate of delayed union and had more symptomatic patients than the 3D group (p < 0.05). The percentage comparisons of cortical bone area showed that cortical bone in the superior distal segment is thicker than in the inferior segment, it is also thicker in the anterior mid-section than in the posterior (p < 0.05). If fixation of midshaft fractures of the clavicle with a plate is indicated, a 3D reconstruction plate is better than one placed superiorly, because it is consistent with the stress distribution and shape of the clavicle.