Distal Radius Volar T Plate Versus Distal Clavicle Pre-Contoured Locking Plate in Neer 2b Distal Clavicle Fractur: A Randomized Controlled Trial
-
Amir Mehrvar
,
Reza Zandi
,
Mohammad Ali Okhovatpour
,
Shahab Sarlak
,
Mohammadreza Minator Sajjadi
,
Akbar Ehsani
,
Ahmadreza Ahmadi Abdashti
Abstract
Background: The purpose of the current study was to compare the clinical and radiographic outcomes of
distal radius volar T plate and pre-contoured locking plate in distal clavicle fracture.
Methods: A total of 60 patients with Neer 2b distal clavicle fracture were included in this study and
undergone open reduction and internal fixation between March 2019 and November 2020 via two different
plates; distal radius volar T plate and distal clavicle pre-contoured locking plate. All patients were followed
at least two years post-operative. Union rate, time to union, need to device removal, and Constant-Murley
score were assessed among them.
Results: In all patients, the bony union was achieved without wound-related complications. The mean time
to union in distal radius volar T plate group was 3.30.6 and 3.60.7 in the pre-contoured locking plate (p
=0.14). The mean Constant-Murley score was 93.12.2 and 92.1 2.5 in T plate group and pre-contoured
plate group, respectively (p =0.09). Five cases with T plate and eight cases with pre-contoured plated were
candidates for device removal (p =0.53).
Conclusion: Distal radius volar T plate could be a reasonable choice to manage Neer 2b distal clavicle
fracture as it restores functional range of motion with excellent bone union and without the necessity of
device removal, besides its economical price
1.Postacchini F, Gumina S, De Santis P, Albo F. Epidemiology of clavicle fractures. Journal of Shoulder and Elbow Surgery. 2002;11(5):452-6.
2.Robinson CM. Fractures of the clavicle in the adult: epidemiology and classification. The Journal of bone and joint surgery British volume. 1998;80(3):476-84.
3.Kihlström C, Möller M, Lönn K, Wolf O. Clavicle fractures: epidemiology, classification and treatment of 2 422 fractures in the Swedish Fracture Register; an observational study. BMC Musculoskeletal Disorders. 2017;18(1):82.
4.Edwards D, Kavanagh T, Flannery M. Fractures of the distal clavicle: a case for fixation. Injury. 1992;23(1):44-6.
5.Neer CS, II. FRACTURE OF THE DISTAL CLAVICLE WITH DETACHMENT OF THE CORACOCLAVICULAR LIGAMENTS IN ADULTS.Journal of Trauma and Acute Care Surgery. 1963;3(2).
6.Cho C-H, Kim B-S, Kim D-H, Choi C-H, Dan J, Lee H. Distal clavicle fractures: a new classification system. Orthopaedics & Traumatology: Surgery & Research. 2018;104(8):1231-5.
7.Levy GM, Pinto NE, Woods BJ, Hermans D, Duckworth DG. Operative management of an extra-lateral distal clavicle fracture pattern: a study of 48 patients and a proposed update to the modified Neer classification. Journal of Shoulder and Elbow Surgery. 2021;30(8):1931-7.
8.Anderson K. Evaluation and treatment of distal clavicle fractures. Clinics in sports medicine. 2003;22(2):319-26.
9.Eskola A, Vainionpää S, Myllynen P, Pätiälä H, Rokkanen P. Outcome of clavicular fracture in 89 patients. Archives of orthopaedic and traumatic surgery. 1986;105(6):337-8.
10.Badhe S, Lawrence T, Clark D. Tension band suturing for the treatment of displaced type 2 lateral and clavicle fractures. Archives of Orthopaedic and Trauma Surgery. 2007;127(1):25-8.
11.Flinkkilä T, Ristiniemi J, Lakovaara M, Hyvönen P, Leppilahti J. Hook-plate fixation of unstable lateral clavicle fractures: a report on 63 patients. Acta orthopaedica. 2006;77(4):644-9.
12.Kalamaras M, Cutbush K, Robinson M. A method for internal fixation of unstable distal clavicle fractures: early observations using a new technique. Journal of shoulder and elbow surgery. 2008;17(1):60-2.
13.Kashii M, Inui H, Yamamoto K. Surgical treatment of distal clavicle fractures using the clavicular
hook plate. Clinical Orthopaedics and Related Research (1976-2007). 2006;447:158-64.
14.Nourissat G, Kakuda C, Dumontier C, Sautet A, Doursounian L. Arthroscopic stabilization of Neer type 2 fracture of the distal part of the clavicle. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2007;23(6):674. e1-. e4.
15.Flinkkilä T, Ristiniemi J, Hyvönen P, Hämäläinen M. Surgical treatment of unstable fractures of the distal clavicle: a comparative study of Kirschner wire and clavicular hook plate fixation. Acta Orthopaedica Scandinavica. 2002;73(1):50-3.
16.Sambandam B, Gupta R, Kumar S, Maini L. Fracture of distal end clavicle: a review. Journal of clinical Orthopaedics and Trauma. 2014;5(2):65-73.
17. Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987(214):160-4.
18. Herrmann S, Schmidmaier G, Greiner S. Stabilisation of vertical unstable distal clavicular fractures (Neer 2b) using locking T-plates and suture anchors. Injury. 2009;40(3):236-9.
19. Panagopoulos A, Solou K, Tatani I, Triantafyllopoulos IK, Lakoumentas J, Kouzelis A, et al. What is the optimal surgical treatment for Neer type IIB (IIC) distal clavicle fractures? A systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research. 2022;17(1):1-14.
20. Yu C, Sun Y-h, Zhao C-q, Shi D-w, Wang Y. Treatment of distal clavicle fracture with distal radius volar locking compression plate. Chinese Journal of Traumatology. 2009;12(05):299-301.
21. Daglar B, Delialioglu O, Minareci E, Tasbas B, Bayrakci K, Gunel U. An alternative fixation method for the treatment of unstable distal clavicle fractures: locked distal radius plate. Acta Orthopaedica et Traumatologica Turcica. 2009;43(4):324-30.
22. Abdeldayem A, Nafea W, Eid A. Treatment of unstable distal third clavicular fracture with locked distal radius plate. Journal of Orthopaedics. 2013;10(4):168-71.
23. Schliemann B, Roßlenbroich SB, Schneider KN, Petersen W, Raschke MJ, Weimann A. Surgical treatment of vertically unstable lateral clavicle fractures (Neer 2b) with locked plate fixation and coracoclavicular ligament reconstruction. Archives of orthopaedic and trauma surgery. 2013;133(7):935-9.
24. Martetschläger F, Kraus TM, Schiele CS, Sandmann G, Siebenlist S, Braun KF, et al. Treatment for unstable distal clavicle fractures (Neer 2) with locking T-plate and additional PDS cerclage. Knee Surgery, Sports Traumatology, Arthroscopy. 2013;21(5):1189-94.
25. Hohmann E, Hansen T, Tetsworth K. Treatment of Neer type II fractures of the lateral clavicle using distal radius locking plates combined with TightRope augmentation of the coraco-clavicular ligaments. Archives of Orthopaedic and Trauma Surgery. 2012;132(10):1415-21.
26. Teimouri M, Ravanbod H, Farrokhzad A, Sabaghi J, Mirghaderi SP. Comparison of hook plate versus T-plate in the treatment of Neer type II distal clavicle fractures: a prospective matched comparative cohort study. Journal of Orthopaedic Surgery and Research. 2022;17(1):369.
27. Erdle B, Izadpanah K, Jaeger M, Jensen P, Konstantinidis L, Zwingmann J, et al. Comparative analysis of locking plate versus hook plate osteosynthesis of Neer type IIB lateral clavicle fractures. Archives of orthopaedic and trauma surgery. 2017;137(5):651-62.
28. Abe S, Koizumi K, Murase T, Kuriyama K. Comparing the locking screw direction of three locking plates for lateral clavicle fractures: a simulation study. BMC Musculoskeletal Disorders. 2021;22(1):812.
29. Fox HM, Ramsey DC, Thompson AR, Hoekstra CJ, Mirarchi AJ, Nazir OF. Neer type-II distal
clavicle fractures: a cost-effectiveness analysis of fixation techniques. JBJS. 2020;102(3):254-61.
2.Robinson CM. Fractures of the clavicle in the adult: epidemiology and classification. The Journal of bone and joint surgery British volume. 1998;80(3):476-84.
3.Kihlström C, Möller M, Lönn K, Wolf O. Clavicle fractures: epidemiology, classification and treatment of 2 422 fractures in the Swedish Fracture Register; an observational study. BMC Musculoskeletal Disorders. 2017;18(1):82.
4.Edwards D, Kavanagh T, Flannery M. Fractures of the distal clavicle: a case for fixation. Injury. 1992;23(1):44-6.
5.Neer CS, II. FRACTURE OF THE DISTAL CLAVICLE WITH DETACHMENT OF THE CORACOCLAVICULAR LIGAMENTS IN ADULTS.Journal of Trauma and Acute Care Surgery. 1963;3(2).
6.Cho C-H, Kim B-S, Kim D-H, Choi C-H, Dan J, Lee H. Distal clavicle fractures: a new classification system. Orthopaedics & Traumatology: Surgery & Research. 2018;104(8):1231-5.
7.Levy GM, Pinto NE, Woods BJ, Hermans D, Duckworth DG. Operative management of an extra-lateral distal clavicle fracture pattern: a study of 48 patients and a proposed update to the modified Neer classification. Journal of Shoulder and Elbow Surgery. 2021;30(8):1931-7.
8.Anderson K. Evaluation and treatment of distal clavicle fractures. Clinics in sports medicine. 2003;22(2):319-26.
9.Eskola A, Vainionpää S, Myllynen P, Pätiälä H, Rokkanen P. Outcome of clavicular fracture in 89 patients. Archives of orthopaedic and traumatic surgery. 1986;105(6):337-8.
10.Badhe S, Lawrence T, Clark D. Tension band suturing for the treatment of displaced type 2 lateral and clavicle fractures. Archives of Orthopaedic and Trauma Surgery. 2007;127(1):25-8.
11.Flinkkilä T, Ristiniemi J, Lakovaara M, Hyvönen P, Leppilahti J. Hook-plate fixation of unstable lateral clavicle fractures: a report on 63 patients. Acta orthopaedica. 2006;77(4):644-9.
12.Kalamaras M, Cutbush K, Robinson M. A method for internal fixation of unstable distal clavicle fractures: early observations using a new technique. Journal of shoulder and elbow surgery. 2008;17(1):60-2.
13.Kashii M, Inui H, Yamamoto K. Surgical treatment of distal clavicle fractures using the clavicular
hook plate. Clinical Orthopaedics and Related Research (1976-2007). 2006;447:158-64.
14.Nourissat G, Kakuda C, Dumontier C, Sautet A, Doursounian L. Arthroscopic stabilization of Neer type 2 fracture of the distal part of the clavicle. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2007;23(6):674. e1-. e4.
15.Flinkkilä T, Ristiniemi J, Hyvönen P, Hämäläinen M. Surgical treatment of unstable fractures of the distal clavicle: a comparative study of Kirschner wire and clavicular hook plate fixation. Acta Orthopaedica Scandinavica. 2002;73(1):50-3.
16.Sambandam B, Gupta R, Kumar S, Maini L. Fracture of distal end clavicle: a review. Journal of clinical Orthopaedics and Trauma. 2014;5(2):65-73.
17. Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987(214):160-4.
18. Herrmann S, Schmidmaier G, Greiner S. Stabilisation of vertical unstable distal clavicular fractures (Neer 2b) using locking T-plates and suture anchors. Injury. 2009;40(3):236-9.
19. Panagopoulos A, Solou K, Tatani I, Triantafyllopoulos IK, Lakoumentas J, Kouzelis A, et al. What is the optimal surgical treatment for Neer type IIB (IIC) distal clavicle fractures? A systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research. 2022;17(1):1-14.
20. Yu C, Sun Y-h, Zhao C-q, Shi D-w, Wang Y. Treatment of distal clavicle fracture with distal radius volar locking compression plate. Chinese Journal of Traumatology. 2009;12(05):299-301.
21. Daglar B, Delialioglu O, Minareci E, Tasbas B, Bayrakci K, Gunel U. An alternative fixation method for the treatment of unstable distal clavicle fractures: locked distal radius plate. Acta Orthopaedica et Traumatologica Turcica. 2009;43(4):324-30.
22. Abdeldayem A, Nafea W, Eid A. Treatment of unstable distal third clavicular fracture with locked distal radius plate. Journal of Orthopaedics. 2013;10(4):168-71.
23. Schliemann B, Roßlenbroich SB, Schneider KN, Petersen W, Raschke MJ, Weimann A. Surgical treatment of vertically unstable lateral clavicle fractures (Neer 2b) with locked plate fixation and coracoclavicular ligament reconstruction. Archives of orthopaedic and trauma surgery. 2013;133(7):935-9.
24. Martetschläger F, Kraus TM, Schiele CS, Sandmann G, Siebenlist S, Braun KF, et al. Treatment for unstable distal clavicle fractures (Neer 2) with locking T-plate and additional PDS cerclage. Knee Surgery, Sports Traumatology, Arthroscopy. 2013;21(5):1189-94.
25. Hohmann E, Hansen T, Tetsworth K. Treatment of Neer type II fractures of the lateral clavicle using distal radius locking plates combined with TightRope augmentation of the coraco-clavicular ligaments. Archives of Orthopaedic and Trauma Surgery. 2012;132(10):1415-21.
26. Teimouri M, Ravanbod H, Farrokhzad A, Sabaghi J, Mirghaderi SP. Comparison of hook plate versus T-plate in the treatment of Neer type II distal clavicle fractures: a prospective matched comparative cohort study. Journal of Orthopaedic Surgery and Research. 2022;17(1):369.
27. Erdle B, Izadpanah K, Jaeger M, Jensen P, Konstantinidis L, Zwingmann J, et al. Comparative analysis of locking plate versus hook plate osteosynthesis of Neer type IIB lateral clavicle fractures. Archives of orthopaedic and trauma surgery. 2017;137(5):651-62.
28. Abe S, Koizumi K, Murase T, Kuriyama K. Comparing the locking screw direction of three locking plates for lateral clavicle fractures: a simulation study. BMC Musculoskeletal Disorders. 2021;22(1):812.
29. Fox HM, Ramsey DC, Thompson AR, Hoekstra CJ, Mirarchi AJ, Nazir OF. Neer type-II distal
clavicle fractures: a cost-effectiveness analysis of fixation techniques. JBJS. 2020;102(3):254-61.
| Files | ||
| Issue | Vol 10 No 1 (2024) | |
| Section | Research Articles | |
| DOI | https://doi.org/10.18502/jost.v10i1.14961 | |
| Keywords | ||
| Clavicle Bone Fractures Fracture Healing Treatment | ||
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How to Cite
1.
Mehrvar A, Zandi R, Okhovatpour MA, Sarlak S, Minator Sajjadi M, Ehsani A, Ahmadi Abdashti A. Distal Radius Volar T Plate Versus Distal Clavicle Pre-Contoured Locking Plate in Neer 2b Distal Clavicle Fractur: A Randomized Controlled Trial. J Orthop Spine Trauma. 2024;10(1):1-4.
