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Anterior Versus Superior Plating Of Fresh Displaced Midshaft Clavicular Fractures

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Author(s): Santosh Venkatachalam*,Chellappan K Sivaji**,Allison Shipton***,Greg J Packer#

Journal: Journal of Orthopaedics
ISSN 0972-978X

Volume: 4;
Issue: 4;
Date: 2007;
Original page

Keywords: Anterior plating | superior plating | fractures | Clavicle

ABSTRACT
Clavicle fractures are common in young active adults. They constitute 2.6% of all adult fractures [1] of which 80% occur in the midshaft of the clavicle [2]. Fractures of the middle third of the clavicle show a rotatory posterosuperior angular displacement of the medial fragment whereby the trapezuis muscle is penetrated and soft tissue interposition prevents fragments from contaction each other. Also, overlap in multiple fragment fractures results in a shortening of the shoulder girdle at the fracture site which leads to poor cosmetic and functional results [3]. In an Allman I [4] fracture, the distal fragment is pulled distally and medially due to the influence of the weight of the upper extremity and the pectorals major muscle, while the proximal fragment is elevated due to the force of the sternocleidomastoid. The incidence of non-union in midclavicular fractures is usually quoted as being 0.1-0.8% [5] with non-operative treatment. More recent data, based on detailed classification of fractures, suggest that the incidence of non union in displaced midshaft clavicular fractures is between 10-15% especially in those with an initial shortening of >20 mm [6]. This resulted in unsatisfactory patient outcome in 31% of the study group treated with non operative treatment [7]. There have been many papers published on treatment of established malunion of clavicular fractures and their complications [8]. Previously this was described only as a cosmetic deformity. Malunion with shortening and rotational deformity does not remodel in adults. This can be debilitating for the patient and challenging for the surgeon. Emphasis in literature has been more on non union until Eskola [3] reported that patients with a shortening of greater than 15 mm had statistically significantly more pain. Recent papers have analysed the results of plating of fresh clavicle fractures [9, 10]. The purpose of this study was to compare the results of anterior versus superior plating of freshly displaced clavicular fractures with an initial shortening of >20mm
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