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Simple, minimally invasive surgical technique for treatment of type 2 fractures of the distal clavicle.

Neer type 2 fractures of the distal clavicle have a high rate of nonunion and delayed union. A simple, minimally invasive surgical technique using suture fixation is introduced. In this series 12 patients were treated with suture fixation of this fracture with absorbable suture material, resulting in union of all fractures. There was a rapid return to function and no complications. This technique allows simple, minimally invasive fixation with good fracture healing and early return to work and sports.

Adolescent↗

A simple technique for internal fixation of the clavicle. A long term evaluation.

A simple, effective technique for internal fixation of the clavicle with Knowles threaded pins is described in 11 patients with 1 to 21 year results. The method is applicable to fresh fractures of non-union and provides secure compression-fixation. The threads prevent migration of the pin, reduce the period of external immobilization, and obviate the need for removal of the pin.

Adult↗

Post-traumatic osteolysis of the distal clavicle.

Five cases of painful bone resorption from the distal clavicle following shoulder trauma are reported to demonstrate that the lesion is generally benign. Surgical excision is curative. The multiplicity of circumstances leading to clavicular osteolysis suggest that the balance between bone accretion and resorption is precarious in this region of the skeleton.

Acromioclavicular Joint↗

Post-traumatic osteolysis of the clavicle: MR features.

We present the magnetic resonance findings in a pathologically proven case of post-traumatic osteolysis of the distal clavicle. High signal intensity tissue centered on the acromioclavicular joint was seen on T2-weighted images, consistent with synovial proliferation.

Acromioclavicular Joint↗

Type II distal clavicle fractures: a retrospective review of surgical treatment.

We retrospectively reviewed cases of 19 of 35 patients who underwent operative treatment for type II fractures of the distal clavicle over 7 years. The average age was 21.5 years. There were 15 males. Ten of the fractures occurred in vehicular accidents and eight in sports. Ten of the fractures were comminuted. All fractures were closed. Thirteen patients were treated with transacromial Kirschner wires and six by other methods. There were 10 satisfactory and nine unsatisfactory results. All six nonunions and five of the six deep infections occurred in those treated with transacromial wires. Our results indicate that transacromial wire fixation may not be the treatment of choice for this uncommon fracture.

Adolescent↗

Midshaft clavicle nonunions treated with intramedullary Steinman pin fixation and onlay bone graft.

The current literature tends to favor rigid internal fixation with plates for symptomatic midclavicular nonunions. From 1985 to 1992, 14 patients with clavicular nonunions were treated by open reduction and intramedullary Steinman pin fixation with onlay iliac crest bone grafting. The average age of patients was 36 years (range 18-62). The majority of nonunions occurred after high-energy injuries to the clavicle. Three patients had failed previous plating and one initial fracture was pathological through irradiated bone. At an average follow-up of 4 years, all nonunions healed uneventfully and all were satisfied with the result of surgery. There were no infections or pin migrations. All hardware was removed at an average of 12.7 weeks (7-24 weeks). The most significant complications were two refractures occurring through osteopenic bone. We have found this technique to be as effective as plating procedures, yet it maintains the great advantage of ease of hardware removal. It allows early motion and has been useful in those whose previous plating procedures have failed.

Adolescent↗

Osteosynthesis of irreducible fractures of the clavicle with 2.7-MM ASIF plates.

Thirty-six patients with Allman group-2 fractures of the clavicle were treated by ORIF with 2.7-mm ASIF dynamic compression plates. The indications for surgery were an open fracture in one patient, ipsilateral fractures of the arm or the ribs in five patients, bilateral clavicular fractures in one patient, and an inability to reduce the fracture in all other patients. There were no instances of deep infection. One patient suffered a refracture after plate removal; three patients developed pseudarthrosis because plates that were too short were used. The total failure rate was 12%. It is concluded that the 2.7-mm DCP is the method of choice for internal fixation of midshaft clavicular fractures and that a minimum of three screws should be placed in each fragment.

Adolescent↗

Bone scans in condensing osteitis of the clavicle.

Two additional cases of condensing osteitis of the clavicle are reported. Technetium Tc 99m phosphate bone scans were positive in both cases. Clinical and roentgenographic manifestations may allow nonoperative diagnoses of this entity which mimics metastatic disease on bone scans.

Bone Neoplasms↗

Posttraumatic osteolysis of the clavicle.

Posttraumatic osteolysis of the distal clavicle should be considered when continued pain follows trauma. The osteolysis and accompanying symptoms can be partially alleviated by immobilization of the shoulder joint. The pathology is poorly understood, but synovial hyperplasia appears to play an integral part in the resorptive process.

Accidents, Traffic↗

New syndrome: clavicle hypoplasia, facial dysmorphism, severe myopia, single central incisor and peripheral neuropathy.

A new syndrome of unknown origin is reported, consisting of facial dysmorphism (upward slanted palpebral fissures, single superior central incisor, narrow, cylindrical nose with hypoplastic alae), bilateral agenesis of the clavicles, limited movements of elbow and fingers, calf atrophy and pes cavus with abolished reflexes (Charcot-Marie-Tooth syndrome, unspecified type).

Atrophy↗

A novel syndrome with dwarfism, poorly muscled build, absent clavicles, humeroradial fusion, slender bones, oligodactyly and micrognathia.

We report on a 15-year-old girl with severe pre- and post-natal growth retardation, poorly muscled build, micrognathia, ulnar ray oligodactyly, absent clavicles, abnormal scapulae, humeroradial fusion, hip dislocation, small iliac wings, slender tubular bones and normal intelligence. An extensive search has failed to ascribe this association to a known condition. This child shared some clinical and radiological features with the Yunis-Varon syndrome but the normal intelligence and the ulnar ray oligodactyly of our patient does not support this diagnosis.

Abnormalities, Multiple↗

CASE REPORTS: unusual lateral clavicle fracture dislocation: case reports and museum specimens.

We present two clinical cases and four museum specimens of a type of lateral clavicle fracture dislocation that has not been detailed in any of the commonly accepted classification systems. With this injury, the major clavicular element is displaced downward and backward into the supraspinatus outlet and may cause symptomatic impingement. A method for surgical correction is described.

Accidental Falls↗

Kingella kingae osteomyelitis of the clavicle.

Kingella kingae is the most recent addition to the list of etiologic agents causing osteomyelitis and septic arthritis in previously well children. A case is presented of a child with K. kingae osteomyelitis of the clavicle--an uncommon site of infection due to any organism. In the hope of facilitating the detection and treatment of this increasingly recognized pathogen, a brief discussion of its microbiologic characteristics and a summary of the patients reported to date with bone and joint infections due to this organism are included. To our knowledge, this is the first discussion of K. kingae in the orthopedic literature.

Bacterial Infections↗

Nontraumatic clavicle lesions in children.

Sixteen children (average age 7.4 years) with nontraumatic lesions of the clavicle were reviewed. There were six cases of neoplasms, six cases of infection, and four developmental anomalies. The patients with infections all had pain at presentation, with elevated white blood cell counts and erythrocyte sedimentation rates. Tissue biopsy was an important diagnostic tool.

Adolescent↗