Clavicle Plating System

Publication Excerpt

“Our study comparing the in-vitro biomechanical properties of a precontoured clavicle plate and 3.5-mm stainless steel LCDC plate using a cadaveric osteotomy model found no post-plating differences between the 2 plate types in the 4 modes tested. The precontoured clavicle plate may afford several potential advantages. It has the anatomic shape of the natural clavicle and, with available right and left clavicle fittings, may decrease operative time. With a lower profile and round ends, compared to the 3.5 mm LCDC plate, greater cosmesis and patient tolerance of the plate are possible. The lower modulus of elasticity of titanium compared to stainless steel may lead to less stress shielding. Further clinical investigations are necessary to evaluate the efficacy and any realized benefits of the Acumed clavicle plate.”

Journal Abstract

Recent attention has been focused on the operative treatment of mid-shaft fractures of the clavicle. This study compares the in-vitro biomechanical properties of a preformed titanium clavicle plate (Acumed) to a Synthes 3.5 mm limited-contact dynamic-compression (LCDC) plate using a cadaveric osteotomy model. An osteotomy was performed on 7 pairs of human clavicles and were randomly plated with either a Synthes 3.5 mm LCDC stainless steel plate or an Acumed titanium precontoured clavicle plate. After plating, specimens were tested on an EnduraTEC material testing apparatus for axial compression and tension strength, as well as torsional strength in compression and tension. Biomechanical test results for plated specimens are reported for the LCDC plate and the Acumed plate, and the 2 plates are compared. This exploratory study supports investigations with larger sample sizes to determine if the Acumed precontoured plate differs from the LCDC plate in biomechanical properties and the clinical implications of such differences.

Reference

Goswami T, Markert R, Anderson C, Sundaram S, Crosby L. Biomechanical evaluation of a pre-contoured clavicle plate. J Shoulder Elbow Surg. 2008;17(5):815-818.

Publication Excerpt

“Operative fixation of a displaced fracture of the clavicular shaft results in improved functional outcome and a lower rate of malunion and nonunion compared with nonoperative treatment at one year of follow-up. Hardware removal remains the most common reason for repeat intervention in the operative group. This study supports primary plate fixation of completely displaced midshaft clavicular fractures in active adult patients.”

Journal Abstract

Background
Recent studies have shown a high prevalence of symptomatic malunion and nonunion after nonoperative treatment of displaced midshaft clavicular fractures. We sought to compare patient-oriented outcome and complication rates following nonoperative treatment and those after plate fixation of displaced midshaft clavicular fractures.

Methods
In a multicenter, prospective clinical trial, 132 patients with a displaced midshaft fracture of the clavicle were randomized (by sealed envelope) to either operative treatment with plate fixation (sixty-seven patients) or nonoperative treatment with a sling (sixty-five patients). Outcome analysis included standard clinical follow-up and the Constant shoulder score, the Disabilities of the Arm, Shoulder and Hand (DASH) score, and plain radiographs. One hundred and eleven patients (sixty-two managed operatively and forty-nine managed nonoperatively) completed one year of follow-up. There were no differences between the two groups with respect to patient demographics, mechanism of injury, associated injuries, Injury Severity Score, or fracture pattern.

Results
Constant shoulder scores and DASH scores were significantly improved in the operative fixation group at all timepoints (p = 0.001 and p < 0.01, respectively). The mean time to radiographic union was 28.4 weeks in the nonoperative group compared with 16.4 weeks in the operative group (p = 0.001). There were two nonunions in the operative group compared with seven in the nonoperative group (p = 0.042). Symptomatic malunion developed in nine patients in the nonoperative group and in none in the operative group (p = 0.001). Most complications in the operative group were hardware-related (five patients had local irritation and/or prominence of the hardware, three had a wound infection, and one had mechanical failure). At one year after the injury, the patients in the operative group were more likely to be satisfied with the appearance of the shoulder (p = 0.001) and with the shoulder in general (p = 0.002) than were those in the nonoperative group.

Conclusions
Operative fixation of a displaced fracture of the clavicular shaft results in improved functional outcome and a lower rate of malunion and nonunion compared with nonoperative treatment at one year of follow-up. Hardware removal remains the most common reason for repeat intervention in the operative group. This study supports primary plate fixation of completely displaced midshaft clavicular fractures in active adult patients.

Reference

Altamimi S, McKee M, and the Canadian Orthopaedic Trauma Society. Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. J Bone Joint Surg Am: 2008;90: 1-8.

Publication Excerpt

"There are significant[ly] more bad fits with the straight plates compared to the precontoured plates in group A (p < 0.001), B (p = 0.004) and C (p < 0.001). There is no statistical difference between the number of bad fits between precontoured plates in group A (p = 1.000) and C (p = 0.695)."

Journal Abstract

Hardware prominence after plate fixation for clavicle fracture is a common complication. The aim of the study was to perform a 3D analysis of the prominence of different types of superior clavicle plates. An automated fitting of 3 straight and 10 precontoured plates was performed on 52 3D-CT-scan reconstructed cadaver clavicles. The mean and maximum bone-plate distance and maximum prominence was significant higher with the straight plates compared to the precontoured plates. The mean and maximum boneplate distance was significant[ly] higher with the precontoured DePuy Synthes plates compared to the precontoured Acumed plates but when evaluating the maximum prominence there was no significant difference between the most commonly used 8-holes plates. To conclude, precontoured plates of the clavicula diminish significantly hardware prominence. There exists a difference in hardware prominence between different brands of precontoured plates but this difference is limited and in most cases not significant.

Reference

Publication Excerpt

"CC fixation adds stability to type IIB distal clavicle fractures fixed with plate and screws when loaded to failure."

Journal Abstract

Purpose
The purpose of this study was to determine the effect of coracoclavicular (CC) fixation on biomechanical stability in type IIB distal clavicle fractures fixed with plate and screws.

Methods
Twelve fresh-frozen matched cadaveric specimens were used to create type IIB distal clavicle fractures. Dual-energy x-ray absorptiometry (DEXA) scans ensured similar bone quality. Group 1 (6 specimens) was stabilized with a superior precontoured distal clavicle locking plate and supplemental suture anchor CC fixation. Group 2 (6 specimens) followed the same construct without CC fixation. Each specimen was cyclically loaded in the coronal plane at 40 to 80 N for 17,500 cycles. Load-to-failure testing was performed on the specimens that did not fail cyclic loading. Outcome measures included mode of failure and the number of cycles or load required to create 10 mm of displacement in the construct.

Results
All specimens (12 of 12) completed cyclic testing without failure and underwent load-to-failure testing. Group 1 specimens failed at a mean of 808.5 N (range, 635.4 to 952.3 N), whereas group 2 specimens failed at a mean of 401.3 N (range, 283.6 to 656.0 N) (P=.005). Group 1 specimens failed by anchor pullout without coracoid fracture (4 of 6) and distal clavicle fracture fragment fragmentation (1 of 6); one specimen did not fail at the maximal load the materials testing machine was capable of exerting (1,000 N). Group 2 specimens failed by distal clavicle fracture fragment fragmentation (3 of 6) and acromioclavicular (AC) joint displacement (1 of 6); 2 specimens did not fail at the maximal load of the materials testing machine.

Conclusions
During cyclic loading, type IIB distal clavicle fractures with and without CC fixation remain stable. CC fixation adds stability to type IIB distal clavicle fractures fixed with plate and screws when loaded to failure.

Clinical Relevance
CC fixation for distal clavicle fractures is a useful adjunct to plate-and-screw fixation to augment stability of the fracture.

Reference

Publication Excerpt

"Use of an anatomical locking plate with CC augmentation has better functional and radiographic outcomes than treatment without CC augmentation. Therefore, a combination of anatomical locking plate and CC ligament augmentation is a reliable treatment option for unstable distal clavicle fractures."

Journal Abstract

Background
Surgical managements were recommended for unstable distal clavicle fracture owing to the high incidence of nonunion. The present study compared the efficacy of anatomical locking plate with versus without additional suture anchor fixation for the treatment of unstable Neer type II distal clavicle fractures.

Material/Methods
Between January 2013 to January 2015, 28 consecutive patients with unstable Neer type II fractures were treated by using anatomical locking plate with or without additional suture anchor fixation. The patients were divided into anatomical locking plate group (group A) and anatomical locking plate combined with suture anchor group (group B) according to the surgical method. The operative-related parameters such as operation time, blood loss, length of hospitalization, union time, functional outcomes (Constant score, UCLA score and DASH score) and CC distance were compared.

Results
The mean follow-up period of the 28 patients was 19.60 months (21.80 versus 18.39 months, respectively). No statistical differences in general and peri-operative parameters were found between 2 groups. The group B had significant higher Constant score than group A (P=0.004, 91.67 versus 83.10). While no statistical differences were reached in the UCLA score and DASH score between 2 groups (P=0.112 and 0.163, respectively). The group A had longer CC distance than group B (11.67 versus 8.94 mm), while no statistic difference was found (P=0.067).

Conclusions
For the treatment of acute unstable Neer type II distal clavicle fractures, both surgical methods could offer satisfactory outcome. However, anatomical locking plate combined with additional suture anchor fixation had a better functional and radiographic outcome than that without additional suture anchor fixation.

Reference