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At least 235 records · Page 13Linked to original sources
PubMed2004

Osteolysis of the distal clavicle: serial improvement and normalization of acromioclavicular joint space with conservative care.

OBJECTIVE: To discuss a case of osteolysis of the distal clavicle (ODC) in a 29-year-old male chiropractic student who showed interval radiographic and clinical evidence of healing. CLINICAL FEATURES: The patient complained of intermittent left-sided shoulder pain of 8 months' duration that was exacerbated while performing spinal-manipulative procedures. A radiographic examination showed changes consistent with osteolysis involving the distal clavicle. INTERVENTION AND OUTCOME: A conservative treatment regimen of physiotherapy, nutritional supplementation, and activity modification resulted in an interval reduction in symptomatology and radiographic findings on serial examinations, ultimately resolving both abnormal clinical and radiographic findings after approximately 14 months of treatment. We specifically observed normalization of the acromioclavicular (AC) joint dimension. CONCLUSIONS: In contrast to the posttreatment radiographic outcome seen in our patient, ODC classically does not result in complete resolution of radiographic findings or normalization of AC joint dimension, and such radiographic normalization of joint space is currently not reported in the literature. This case report serves to document and to show this unique occurrence.

Acromioclavicular Joint↗
PubMedDate not supplied

Hook plate fixation for type II fractures of the lateral end of the clavicle.

Management of type II fractures of the lateral end of the clavicle is controversial. Different treatment options have been advocated with varying results. In this paper, we report the results of a group of 22 patients who underwent hook plate fixation for these fractures between 1997 and 2004. The mean follow-up was 39 months. There were 4 significant complications. Twenty-one patients regained their preinjury level of activity, and 19 patients were satisfied with their outcome. We recommend hook plate fixation as an acceptable alternative method for the treatment of type II fractures of the lateral end of the clavicle.

Adolescent↗
PubMed2006

[Aneurismal bone cyst of clavicle: A case report].

Aneurismal bone cyst is a rare tumour. The authors report an exceptional case in its clavicle localization. They review the diagnosis circumstances and treatment modalities of this pathology. The occurrence of the cyst is linked to vascular homodynamic disturbance and its discovery in a post-traumatic context has been assessed by the histology exam. Although numerous therapeutic trials, radical removal versus conservatory methods avoid relapse. Finally, resection of the clavicle leading to few functional consequences should be recommended for the cure of evoluted aneurismal bone cyst.

Adult↗
PubMed1999

Plate fixation of fresh displaced midshaft clavicle fractures.

From 1992-1994, we operated on 251 fresh completely displaced mid-third clavicle fractures in adults; 232 were followed up. The fractures were plated with a Mizuho C-type plate or an AO/ASIF 3.5 mm reconstruction plate. Comminuted fragments were reduced and wired (133 cases). There were 150 men and 82 women; the median age was 37.3 years (range 18-79). The mean follow-up was 4.4 years (range 3.0-5.9). The mean time to radiographic union was 10 weeks. Seven patients (3%) developed nonunion. Healing with angulation occurred in 14 patients. Deep infection developed in one patient, and superficial infection in four cases; 21 patients reported soreness with changes in the weather and activity; 28 patients had residual skin numbness caudal to the incision. No patient had shoulder droop, and none had impairment of range of motion or shoulder strength. None developed new or late neurovascular impairment; 171 patients eventually had the hardware removed at an average 401 days post operatively. Overall, 94% were satisfied with the procedure. For completely displaced clavicle fractures in adults, plating is a reliable procedure.

Adolescent↗
PubMed1998

Fracture of the clavicle in the newborn following normal labor and delivery.

OBJECTIVE: Earlier works have associated neonatal clavicular fracture (0.2-3.5% of all deliveries) with a range of procedural, fetal and maternal risk factors; more recent studies, however, have failed to firmly identify any one or a combination of them. In the present work we sought to determine possible ante/intra-partum risk factors for this condition. STUDY DESIGN: Using a retrospective case-controlled approach, we examined a series of maternal, fetal and pregnancy or delivery-related variables in 87 cases (out of 403) of fractured clavicle of the newborn diagnosed in our department from 1986 to 1994. All infants were delivered vaginally (in the occipito-anterior position) at term by a specialist obstetrician and underwent peripartum sonographic fetal weight estimation. All variables were compared with those of an equal number of infants born immediately before or after each affected infant and delivered by the same obstetrical team. RESULTS: Fractured clavicles were found in 1.65% of the total number of deliveries during the study period. Neonatal clavicular fracture was significantly and directly related to the duration of the second stage of labor, peripartum sonographic fetal weight estimation, and neonatal length, and inversely related to maternal height; nevertheless, all values in both the study and control groups were within normal range. Logistic regression analysis showed that these antenatal variables significantly affect the chances of clavicular fracture, but due to the high false-positive rate they cannot serve clinically as a comprehensive antenatal prediction index. CONCLUSIONS: The majority of clavicular fractures occur in normal newborns following normal labor and delivery. The risk factors we identified statistically do not offer a method for clinical prenatal prediction. This work provides statistical evidence of the nature of this complication of early newborn life.

Adult↗
PubMed2003

Evaluation and treatment of distal clavicle fractures.

Of all clavicle fractures, those involving the lateral aspect are the most controversial. These fractures, adjacent to the strong coracoclavicular ligaments, often create an imbalance of stability and motion between the proximal and distal fragment. There are many surgical options, but the complication rates of these procedures can be high. Although nonsurgical management results in relatively high nonunion rates, the subjective and functional outcome is usually quite good. The evaluation and controversies involving management of distal clavicle fractures are reviewed in this article.

Algorithms↗
PubMed1997

The SLAP lesion: a cause of failure after distal clavicle resection.

Persistent pain after distal claviculectomy (the Mumford procedure) has been attributed to both inadequate and excessive clavicle resection or incomplete supraspinatus outlet decompression with continued impingement. A retrospective review of twenty glenohumeral arthroscopies done in shoulders with a previous Mumford procedure disclosed 15 cases, (75%) of superior glenoid labrum, long head biceps tendon (SLAP) lesions. Most of the distal calvicle resections 13 out of 15 (86%) had been done for "acromioclavicular arthritis." These patients were young, with an average age of 37 years (range 20 to 50) and most, 14 out of 15, had pain attributable to a specific traumatic event. Most had deep pain referable to the bicipital groove with cross chest adduction of the shoulder with the elbow extended and forearm pronated (thumb down). The discomfort improved with the forearm supinated (thumb up). It is concluded the SLAP lesion to be part of the differential diagnosis of acromioclavicular joint disease. In younger patients with a traumatic history, glenohumeral arthroscopy should be used to rule out SLAP pathology and possibly prevent an unnecessary distal clavicle resection.

Acromioclavicular Joint↗
PubMed1999

Arthroscopic versus open distal clavicle resection: a biomechanical analysis on a cadaveric model.

A fresh cadaver shoulder model was used to evaluate the difference in joint laxity between arthroscopic and open distal clavicle resection procedures. Twelve shoulders were mounted in a load frame that allowed compressive loading of the distal clavicle into the acromion. Specimens were loaded to 100 N (20 N/sec) while load and deformation data were recorded for three conditions: (1) intact, (2) 5-mm closed resection, and (3) 10-mm open resection. The displacement at the 100-N load and the stiffness of the load/displacement curves were compared for the intact, arthroscopic, and open procedures. Significant differences (ANOVA, P< or =.05) in displacement and stiffness were observed between the intact joint and both surgically resected joints. No significant differences were observed between the two surgically resected joints. The amount of bone removed arthroscopically was sufficient to prevent further bony contact in the axially loaded acromioclavicular joint.

Acromioclavicular Joint↗
PubMedDate not supplied

Decortication and plate osteosynthesis for nonunion of the clavicle.

Between 1968 and 1995, 37 patients with ununited fractures of the clavicle were treated by decortication and plate osteosynthesis. Thirty-two (86%) were failures of union of fractures of the middle third. Thirty-four (92%) patients had post-traumatic nonunion or delayed union. Sixteen (43%) patients had undergone primary operative treatment. Autogenous cancellous bone graft was used in 24 (65%) patients with atrophic nonunion. Nine tricortical, iliac crest, intercalary grafts were used for segmental bone loss equal to or greater than 15 mm. At the end of treatment, union had been achieved in 35 (95%) cases. At a mean follow-up of 8.6 years (range 13 months to 17 years), 32 (86%) patients had no symptoms and had a full range of motion of the shoulder. Decortication with plate osteosynthesis is a reliable, durable technique for the management of symptomatic, ununited fractures of the clavicle.

Adolescent↗
PubMedDate not supplied

Clavicle malunion.

The clavicle fracture that has united with deformity or shortening may have an adverse effect on normal shoulder girdle function. We report on 4 patients in whom a malunited fracture of the clavicle was believed to be a contributing factor to shoulder girdle dysfunction. In each patient, the functional status of the involved limb was improved after corrective osteotomy at the site of deformity, realignment, and plate fixation.

Adult↗
PubMed2000

Parosteal fasciitis of the clavicle.

A rare case of parosteal fasciitis arising from the periosteum of the left clavicle in a 27-year-old woman is reported. Magnetic resonance imaging demonstrated the lesion surrounding the periosteum of the clavicle. The lesion was iso-intense with muscle on T(1)-weighted images and hyperintense on T(2)-weighted images. At surgery, the lesion was discovered to be densely adherent with the periosteum, and excised along with the periosteum. Histopathological examination revealed the proliferation of myofibroblasts in a vague storiform or short fascicular pattern. A large amount of extravasated erythrocytes, and a few lymphocytes were present in the matrix. There were some foci of abundant myxoid materials. Immunohistochemical study showed the cells to be positive for vimentin, alpha-smooth muscle actin and HHF35, but negative for desmin. There was no local recurrence at a 6 months postoperative follow up.

Actins↗
PubMed1996

[Osteolysis of the lateral clavicle after Tossy II injury in ice hockey players].

Injuries of the acromioclavicular joint in hockey mainly occur after trauma directly to the shoulder joint. E.g. at a fall against the border, onto the ground or in case of a body check. Tossy-III-lesions lead directly to surgery meanwhile type Tossy-II-lesions are mainly treated conservatively. Despite healing of the acromioclavicular ligaments often acromioclavicular joint pain remains despite conservative treatment because of discuss lesions or a osteolysis of the lateral end of the clavicle. The resection of the lateral end of the clavicle with certain pain relief, very good functional results and quick full level participation in hockey has been shown as the method of choice in our patients.

Acromioclavicular Joint↗
PubMed2002

Surgical treatment of unstable fractures of the distal clavicle: a comparative study of Kirschner wire and clavicular hook plate fixation.

During 1988-1999 39 unstable fractures of the distal clavicle (Neer 2) were operated on in Oulu University Hospital. Kirschner wire (K-wire) fixation was used in 22 cases and a clavicular hook plate in 17. Shoulder symptoms and function were assessed using self-administered questionnaires devised by L'Insalata et al. (1997), and Constant scoring. Mean follow-up was 6.2 years in the K-wire fixation group and 2.0 years in the clavicular hook plate one. The mean L'Insalata scores were 91 in both groups (92% and 93% of the contralateral side) and the mean Constant scores 84 (95% and 90 (96%) for K-wire fixation and the clavicular hook plate, respectively. Complications commonly occurred with K-wires, which migrated in 12 cases, resulting in loss of reduction in 7 and infection in 3, and 2 cases of non-union. In the clavicular hook plate group, there was 1 complication, a fracture of the clavicle, and 2 cases of non-union. We conclude that shoulder symptoms were reduced and function restored to an adequate level by both methods, but complications were unacceptably frequent when K-wires were used. The clavicular hook plate was better in this respect and it is therefore recommended.

Adolescent↗
PubMedDate not supplied

Non-union of the clavicle in a child. A case report.

A case of symptomatic non-union of the clavicle occurred in a 12-year-old boy. Differential diagnosis roentgenographic and histologic observations, including the results of resection of the non-union site and stablization of the proximal clavicle using the coraco-acromial ligament demonstrated that this rare condition can be restored to full asymptomatic function without any internal metallic fixation devices.

Child↗
PubMed1989

Ipsilateral sternoclavicular dislocation and clavicle fracture.

A case of ipsilateral distal clavicle fracture and sternoclavicular joint dislocation is reported. This combination of injuries results from two separate forces in sequence. Closed reduction of the dislocation was possible only after open reduction and internal fixation of the clavicle fracture was performed, because of the inability to manipulate the free-floating segment. Patients should be carefully examined for associated brachial plexus injuries.

Adult↗
PubMed1996

Ipsilateral sternoclavicular joint dislocation and clavicle fracture.

A case of an ipsilateral sternoclavicular (SC) joint dislocation and clavicle fracture is reported. Two hours postinjury an open reduction and internal fixation of the fractured clavicle was performed using a Kirschner wire plus a stainless steel cerclage wire. This was followed by a surgical repair of the SC joint capsule. The Kirschner wire and cerclage wires were removed 10 months later. The patient had complete recovery of shoulder function.

Adult↗