Arun Sam, T (2012) Prospective analysis of functional outcome of clavicle fractures treated by Plate Osteosynthesis. Masters thesis, Madurai Medical College, Madurai.
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Abstract
INTRODUCTION: Clavicular fractures are common injuries, accounting for 2.6% of all fractures. Fractures of the middle third (or midshaft) account for approximately 80% of all clavicular fractures. The traditional view that the vast majority of clavicular fractures heal with good functional outcomes following non-operative treatment is no longer valid. Recent studies have identified a higher rate of nonunion and specific deficits of shoulder function in subgroups of patients with this injuries. These fractures should therefore be viewed in the spectrum of injuries with diverse functional outcomes, each requiring careful assessment and individualized treatment and when indicated these fractures should be treated by primary operative fixation. AIM OF THE STUDY: The aim of the study is to “prospectively analyse the functional outcome of clavicle fractures treated by Plate Osteosynthesis” in terms of complications and functional outcome in indicated cases. MATERIALS AND METHODS: Study is conducted in Madurai Medical College and Government Rajaji Hospital on 20 patients with displaced/comminuted midshaft clavicle fractures from May 2010 to Dec 2011. All the patients were treated by open reduction and internal fixation with 3.5 reconstruction plate and screws. Inclusion Criteria - Patients were included in the study if they had (1) a completely displaced (>2cms) mid shaft fracture of the clavicle (derived by clinical measurement), (2) a comminuted middle third fracture of the clavicle with inferior cortical defect, (3) a clavicle fracture associated with scapular neck fracture (floating shoulder), (4) painful non-union, (5) an age between sixteen and sixty years, (6) no medical contraindications to general anesthesia, and (7) informed consent. Exclusion Criteria - Patients were excluded from the study if they had (1) an age of less than sixteen years or greater than sixty years, (2) a fracture in the proximal or distal third of the clavicle, (3) Pathological fractures, (4) Undisplaced or minimally displaced clavicle fractures. A sling was used for comfort for seven to ten days, and then active range-ofmotion exercises were allowed. When fracture union (defined as radiographic union with no pain or motion with manual stressing of the fracture) was evident, typically at six weeks, overhead abduction and strengthening were allowed, with a return to full activities at three months. RESULTS: Of the twenty patients (19 male and 1 female and most of them aged below 30 years) studied between May 2010 and Dec 2011, all had primary plate fixation except the one with painful non-union for whom plate osteosynthesis with bone grafting was done. Three patients were lost to follow-up and remaining 17 patients had a mean of 15.5 months follow-up. All seventeen patients had fracture union in a mean of 16 weeks. Most of the patients (82%) had constant shoulder score above 90 with an excellent grade except for three patients. Of these, two of them had wound infection and function improved after implant removal; and one patient was a 60 year old lady who developed shoulder stiffness due to improper follow-up and physiotherapy. CONCLUSION: The traditional view that the vast majority of clavicular fractures heal with good functional outcomes following nonoperative treatment is no longer valid. Recent studies have identified a higher rate of non-union, late neurovascular compromise and specific deficits of shoulder function in subgroups of patients with these injuries who are treated by conservative means. Internal fixation by plate osteosynthesis has the advantage of early pain resolution, early return of shoulder function and potentially early return to work. The encountered complications in our study were similar to other recent studies. Clavicle fractures should therefore be viewed as a spectrum of injuries with diverse functional outcomes, each requiring careful assessment and individualized treatment, and plate osteosynthesis should be preferred for the treatment of indicated middle-third clavicle fractures in active individuals.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Prospective analysis ; functional outcome ; clavicle fractures treatement ; plate osteosynthesis. |
| Subjects: | MEDICAL > Orthopaedics |
| Depositing User: | Subramani R |
| Date Deposited: | 16 Sep 2017 16:03 |
| Last Modified: | 17 Sep 2017 07:02 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/2949 |
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