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Objective To investigate the efficacy of Endobutton plate combined with high-strength suture Nice knot fixation in the treatment of distal clavicular fractures with coracoclavicular ligament injuries. Methods A retrospective analysis was performed on 43 patients who sustained distal clavicular fractures along with injuries to the coracoclavicular ligament. These patients were treated between January 2017 and December 2023. The fractures were classified according to the fixation method: high-strength Nice knot suture fixation (experimental group, n  = 23) and acromioclavicular Kirschner wire fixation (control group, n  = 20). The basic information of the two groups of patients, including age, gender, cause of injury, fracture classification, hospitalization duration, fracture healing time and complications, was collected and analyzed. The increase rate of coracoclavicular space on the affected side was collected and analyzed. The pain level of the affected shoulder was assessed using the visual analog scale (VAS). The shoulder joint function was assessed using the American Shoulder and Elbow Surgeons (ASES) scores and Constant-Murley scores before and after surgery. Results No significant differences were observed in the general demographic data, including age, gender, injury etiology, Craig classification, and hospitalization duration between the two groups ( p  > 0.05). Both groups were followed for a period ranging from 12 to 33 months, with an average follow-up of 20.53 ± 5.16 months. The bone healing time in the experimental group was significantly shorter than in the control group (12.82 ± 1.12 weeks vs. 17.25 ± 1.71 weeks, p  < 0.05). At the final follow-up, The increase rate of coracoclavicular space was (9.25 ± 2.53) % in the experimental group and (8.10 ± 2.53) % in the control group, which was not significantly different ( p  > 0.05). Both groups demonstrated significant improvements in VAS scores, Constant-Murley scores, and ASES scores post-operatively compared to pre-operative values ( p  < 0.05 ). One month after surgery, the Constant-Murley and ASES scores were significantly superior in the experimental group compared to the control group ( p  < 0.05). However, no statistical difference was observed three months post-surgery or during the final follow-up ( p  > 0.05). The control group reported one case of infection related to the Kirschner wire and one case of Kirschner wire displacement postoperatively. Conversely, no significant complications were reported in the experimental group. Conclusion In the management of distal clavicle fractures accompanied by coracoclavicular ligament injuries, particularly oblique fractures or those with butterfly-shaped fragments, the application of a high-strength Nice knot suture in conjunction with Endobutton plate fixation can effectively stabilize the fracture site. This approach not only mitigates complications associated with Kirschner wire fixation but also enhances fracture healing, leading to favorable postoperative outcomes.

Introduction The purpose of this prospective study was to report the outcomes of two different methods in CC and AC reconstruction for the treatment of AC separation using a tendon graft and knot-hiding titanium clavicular implant. Materials and methods Twenty-seven patients with Rockwood grade III and V acromioclavicular (AC) separations were randomized into two groups. The primary outcome was whether taking the tendon graft through the coracoid risked a fracture. The following were secondary outcomes: follow-up of clavicular wound healing and Nottingham Clavicle score, Constant score, and Simple Shoulder Test results obtained preoperatively and 24 months postoperatively. The anteroposterior radiographic change between the clavicular and coracoid cortexes and the clavicular tunnel diameter was measured postoperatively and 24 months postoperatively. General patient satisfaction with the outcome (poor, fair, good, or excellent) was assessed 2 years postoperatively. Results No coracoid fractures were detected. No issues in clavicular wound healing were detected. The mean Nottingham Clavicle score increased from a preoperative mean of 42.42 ± 13.42 to 95.31 ± 14.20 ( P  < 0.00). The Constant score increased from a preoperative mean of 50.81 ± 17.77 to 96.42 ± 11.51 ( P  < 0.001). The Simple Shoulder Test score increased from a preoperative mean of 7.50 ± 2.45 to 11.77 ± 1.18 ( P  < 0.001). The changes were significant. The coracoclavicular distance increased from 11.88 ± 4.00 to 14.19 ± 4.71 mm ( P  = 0.001), which was significant. The clavicular drill hole diameter increased from 5.5 to a mean of 8.00 ± 0.75 mm. General patient satisfaction was excellent. Conclusions There were no significant differences between the two groups. There were no implant related complications in the clavicular wound healing. The results support the notion that good results are achieved by reconstructing both the CC and AC ligaments with a tendon graft. Study registration This clinical trial was registered on Clinicaltrials.gov.

To compare the clinical efficacy of vertical double-plate fixation (combining a distal clavicle locking plate and a radial lateral plate) versus clavicular hook plate fixation for unstable distal clavicle fractures. A retrospective analysis was conducted on 37 patients with unstable distal clavicle fractures (Neer II/V) treated at our institution from May 2015 to May 2023. Twenty-one patients underwent open reduction and internal fixation with clavicular hook plates (16 Neer II, 5 Neer V), while 16 patients received vertical double-plate fixation (12 Neer II, 4 Neer V). Postoperative evaluations included: 1) radiographic assessment of fracture healing at 1, 2, 3, and 6 months; 2) Visual Analogue Scale (VAS) pain scores during passive shoulder mobilization at 1, 2, and 4 weeks; and 3) Constant-Murley shoulder function scores and complication rates (incision infection, nonunion, acromial osteolysis, impingement syndrome) at 3, 6 and 12 months. The clavicular hook plate group (mean age 47.96±17.01 years) and vertical double-plate group (mean age 49.47±15.33 years) showed comparable demographics. All patients achieved fracture union within 3–6 months, with no implant displacement. The vertical double-plate group demonstrated significantly lower VAS scores during early rehabilitation (4.6±1.09, 4.05±0.88, 2.8±1.0 vs. 7.25±1.16, 5.9±1.12, 4.75±0.71; P<0.05). At 3, 6 and 12 months, Constant-Murley scores were markedly higher in the vertical double-plate group (84.41±4.48, 92.25±2.47, 94.55 vs. 75.35±5.92, 83.4±3.87, 88.10±2.10; P<0.05). The clavicular hook plate group exhibited higher complication rates: 4 cases of impingement syndrome, 3 of acromial osteolysis, and 5 with limited shoulder mobility—all improving after implant removal. Both techniques effectively achieve fracture union for unstable distal clavicle fractures. However, vertical double-plate fixation offers superior pain control, facilitates earlier functional rehabilitation, improves shoulder functional recovery, and reduces postoperative complications, demonstrating enhanced clinical efficacy compared to hook plate fixation.

Background Thoracic outlet syndrome can develop following the malunion of a clavicle midshaft fracture. To date, thoracic outlet syndrome complicated by clavicle malunion is typically treated with either first rib resection or corrective clavicle osteotomy; however, there have been no reports of these two procedures being performed simultaneously using the same approach. We present the first documented case of thoracic outlet syndrome caused by clavicle malunion treated by simultaneous first rib resection and corrective clavicle osteotomy through a single infraclavicular approach. Case presentation A 46-year-old woman presented with numbness and muscle weakness in the left upper limb, which worsened with 90º abduction external rotation of the shoulder joint. She had a history of conservative treatment for a left clavicle midshaft fracture 21 years earlier. Magnetic resonance imaging taken with upper extremity elevation revealed stenosis of the left subclavian artery at the costoclavicular space. Three-dimensional clavicle symmetry plane demonstrated that the distal fragment of the left clavicle displaced inferiorly and malunited, and left scapular depressed and retracted. The distance between the left clavicle and the first rib was up to 7 mm shorter than that on the right side. She was diagnosed with left arterial thoracic outlet syndrome caused by clavicle malunion. Using an infraclavicular approach, we performed the first rib resection and clavicle osteotomy. We inserted the first rib bone graft into the osteotomy site and performed the plate fixation. Her symptoms had resolved by two years postoperatively. Conclusions The present case provides new information on the surgical procedure of thoracic outlet syndrome due to clavicle malunion. In our patient, the inferior displacement of malunited clavicle and the associated scapular malposition may cause narrowing of the costoclavicular space, resulting in the development of thoracic outlet syndrome. The present case demonstrates that the infraclavicular approach enables the simultaneous first rib resection and corrective clavicle osteotomy and provides reliable decompression of the costoclavicular space. Clinical trial number Not applicable.

Background Studies comparing plate with intramedullary nail fixation of displaced midshaft clavicle fractures show faster recovery in the plate group and implant-related complications in both groups after short-term followup (6 or 12 months). Knowledge of disability, complications, and removal rates beyond the first postoperative year will help surgeons in making a decision regarding optimal implant choice. However, comparative studies with followup beyond the first year or two are scarce. Questions/purposes We asked: (1) Does plate fixation or intramedullary nail fixation for displaced midshaft clavicle fractures result in less disability? (2) Which type of fixation, plate or intramedullary, is more frequently associated with implant-related irritation and implant removal? (3) Is plate or intramedullary fixation associated with postoperative complications beyond the first postoperative year? Methods Between January 2011 and August 2012, patients with displaced midshaft clavicle fractures were enrolled and randomized to plate or intramedullary nail fixation. A total of 58 patients with plate and 62 patients with intramedullary nails initially were enrolled. Minimum followup was 30 months (mean, 39 months; range, 30–51 months). Two patients (3%) with plate fixation and two patients (3%) with intramedullary nails were lost to followup. The QuickDASH was obtained at final followup and compared between patients who had plate fixation and those who had intramedullary nail fixation. Postoperative complications measured include infection, implant-related irritation, implant failure, nonunion, and refracture after implant removal. Indications for implant removal included implant-related irritation, implant failure, nonunion, patient’s wish, or surgeon’s preference. Results Between patients with plate versus intramedullary nail fixation, there were no differences in QuickDASH scores (plate, 1.8 ± 3.6; intramedullary nail, 1.8 ± 7.2; mean difference, −0.7; 95% CI, −2.2 to 2.04; p = 0.95). The proportion of patients having implant-related irritation was not different (39 of 56 [70%] versus 41 of 62 [66%]; relative risk, 1.05; 95% CI, 0.82–1.35; p = 0.683). Intramedullary fixation was associated with a higher likelihood of implant removal (51 of 62 [82%] versus 28 of 56 [50%]; relative risk, 1.65; 95% CI, 1.24–2.19; p < 0.001). Among the removed implants more plates than intramedullary nails were removed after the 1-year followup (12 of 28 [43%] versus six of 51 [12%]; p = 0.002). There were no infections, implant breakage, nonunions, or refractures between the 1-year and final followup in either group. Conclusions After a mean followup of 39 months, disability scores were excellent. Major complications did not occur after the 1-year followup. A frequent and bothersome problem after both surgical treatments is implant-related irritation, resulting in high rates of implant removal, after 1 year. Future research could focus on analyzing risk factors for implant irritation or removal. Level of Evidence Level II, therapeutic study.

Background and aim Isolated midshaft clavicle fractures (MCF) and acromioclavicular joint (ACJ) injuries are common, but simultaneous cases are rare and often receive insufficient clinical attention, resulting in missed diagnoses. Moreover, there is no consensus on the injury mechanism, classification, and treatment, and the prognosis remains poorly summarized. This review aims to provide an overview of MCFs with ipsilateral ACJ injuries, focusing on injury mechanism, classification, treatment, and prognosis. Methods We searched the literature published between 1962 and 2024 on PubMed, Web of Science, and EMBASE using the search terms “clavicle fracture [Title/Abstract]) AND (acromioclavicular [Title/Abstract])”. Studies reporting clinical outcomes in patients with MCF and ipsilateral ACJ injuries were included. 37 studies were included after screening. The study quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. Data on study design, patient demographics, treatment approaches, and outcomes were extracted for qualitative analysis. We then summarized key findings and presented our insights. Results MCFs with ipsilateral ACJ injuries are often associated with comorbidities such as rib fractures, hemopneumothorax, scapula fractures, neurovascular injuries, and atypical MCF displacement patterns. These cases should raise suspicion for combined injuries. Due to the \"floating\" nature of the lateral clavicle, the \"Piano Key Sign\" is typically negative and not reliable for diagnosis. Initial ACJ evaluation may be inconclusive, so reevaluation after MCF fixation is recommended. Type IV ACJ injuries can be underestimated on anteroposterior radiographs, and additional axillary radiographs and CT scans may better visualize posterior clavicle displacement. Most researchers believe ACJ capsule and ligament damage occurs first, but is insufficient to cause significant dislocation, suggesting that isolated MCF may involve combined ACJ injury with intact coracoclavicular ligaments. Notably, most patients reported favorable outcomes without major complications within two years, regardless of treatment approach. Conclusions MCFs with ipsilateral ACJ injuries are rare and often missed when ACJ injuries are mild. The injury mechanism is unclear, and no classification system exists to indicate severity. These injuries are typically treated separately without a unified protocol. Despite promising outcomes, further studies are needed to address these issues and improve understanding of long-term results.

[LANGUAGE= \"English\"] BACKGROUND: Although non-surgical management is a commonly used treatment for pediatric clavicle fractures, there is limited data in the literature regarding the most effective method. This study aims to compare the radiological outcomes of the figure-of-eight bandage versus the arm sling in the treatment of mid-shaft clavicle fractures in school-age children.METHODS: Patients were divided into two groups based on the preferred conservative management method: Group 1 (arm sling) and Group 2 (figure-of-eight bandage). The degree of angulation and shortening was measured at initial admission and during follow-up. Demographic characteristics and radiological data were compared between the two groups.RESULTS: Group 1 included 10 girls and 10 boys, while Group 2 included 12 girls and 17 boys (p=0.761). The mean shortening at initial presentation was 7.28±6.06 mm in Group 1 and 6.65±5.58 mm in Group 2 (p=0.625). At follow-up, the mean shortening was 6.24±5.59 mm in Group 1 and 5.59±4.91 mm in Group 2 (p=0.569). The mean angulation at initial presentation was 21.28±10.05° in Group 1 and 20.41±12.23° in Group 2 (p=0.752). At follow-up, the mean angulation was 14.45±9.41° in Group 1 and 11.82±10.27° in Group 2 (p=0.189). In intra-group comparisons, no significant difference was found between the initial shortening and follow-up shortening in either group (Group 1: p=0.062; Group 2: p=0.190). A significant reduction in angulation was observed in both groups during follow-up (p=0.001 for Group 1; p=0.001 for Group 2).CONCLUSION: The radiological outcomes of the figure-of-eight bandage and the arm sling in the treatment of mid-shaft clavicle fractures in school-age children are similar.[LANGUAGE= \"Turkish\"] AMAÇ: Cerrahi dışı tedavi, pediatrik klavikula kırıklarında için sıklıkla kullanılması, hangi yöntemle yapılacağına dair literatürde sınırlı veri bulunmaktadır. Çalışmanın amacı, okul çağı çocuklarındaki klavikula orta diafiz kırıklarında sekiz bandajı ve kol askısının radyolojik sonuçlarını karşılaştırmaktır. GEREÇ VE YÖNTEM: Hastalar tercih edilen konservatif tedavi yöntemine göre iki gruba ayrıldı. (Grup 1: kol askısı, Grup 2: sekiz bandajı). İlk başvuruda ve takipte açılanma ve kısalma miktarı ölçüldü. Genel özellikler ve radyolojik veriler iki grup arasında karşılaştırıldı.BULGULAR: Grup 1'de 10 kız ve 10 erkek, Grup 2'de ise 12 kız ve 17 erkek vardı (p=0.761). Grup 1'de ilk başvurudaki ortalama kısalma 7.28±6.06 mm ve Grup 2'de 6.65±5.58 mm idi (p=0.625). Takipteki ortalama kısalma Grup 1'de 6.24±5.59 mm ve Grup 2'de 5.59±4.91 mm idi (p=0.569). Başlangıç başvurusundaki ortalama açılanma Grup 1'de 21.28±10.05° ve Grup 2'de 20.41±12.23° idi (p=0.752). Takipteki ortalama açılanma Grup 1'de 14.45±9.41° idi; Grup 2'de 11.82±10.27° (p=0.189). Grup içi karşılaştırmalarda, her iki grupta da başlangıç kısalma miktarı ile takipteki kısalma miktarı arasında anlamlı bir fark bulunmadı [p=0.062 (grup 1); p=0.190 (grup 2)]. Açısal değerler incelendiğinde, iki grupta da takipler sırasında açılanma miktarının istatistiksel olarak anlamlı şekilde azaldığı görüldü [p=0.001 (grup 1); p=0.001 (grup 2)].SONUÇ: Okul çağı çocuklarındaki klavikula orta diafiz kırıklarında sekiz bandajı ve kol askısının radyolojik sonuçları benzerdir.

Background This study aims to systematically evaluate and compare the intraoperative outcomes, postoperative efficacy, and clinical prognosis of Nice knot versus lag screw in augmenting locking plate fixation for comminuted clavicular fractures. Through comprehensive assessment of different therapeutic approaches, we endeavor to provide more scientific and effective therapeutic options for patients with comminuted clavicular fractures. Methods From January 2020 to December 2022, 123 patients with unilateral midshaft comminuted clavicular fractures were enrolled, including 58 cases in the Nice knot (NK) group and 65 cases in the lag screw (LS) group. The general information, intraoperative conditions, postoperative clinical outcomes, and imaging results of patients in both groups were recorded and compared. The Visual Analog Scale (VAS) score, Constant-Murley score, Disabilities of the Arm, Shoulder and Hand (DASH) score and incidence of complications were assessed between the two groups. Results There were no significant differences in general information between the two groups. The NK group demonstrated significantly shorter operation time and less intraoperative blood loss compared to the LS group ( P  < 0.01). Both groups had one case of implant failure, while two cases of nonunion were observed in the LS group ( P  > 0.05). Follow-up results revealed no significant differences in VAS score, QuickDASH score, or Constant-Murley score between the two groups ( P  > 0.05). Conclusion This study demonstrated that both the Nice knot and lag screw achieved favorable clinical outcomes in augmenting locking plate fixation for Robinson IIB clavicle fractures. However, the NK group exhibited advantages of decreased intraoperative blood loss and shorter operation time, which makes it a valuable, effective, and safe surgical approach for managing Robinson IIB clavicle fractures, worthy of clinical promotion.

BACKGROUND AND OBJECTIVESIt has recently been proposed that an infraclavicular brachial plexus block (BPB) at the costoclavicular (CC) space may overcome some of the limitations of the lateral sagittal (LS) approach. In this study, we hypothesized that the CC approach will produce faster onset of sensory blockade of the 4 major terminal nerves of the brachial plexus than the LS approach. METHODSForty patients undergoing elective upper extremity surgery under a BPB were randomized to receive either the LS (Gp-LS, n = 20) or CC approach (Gp-CC, n = 20) for infraclavicular BPB. Twenty-five milliliters of 0.5% ropivacaine was used for the BPB in both study groups. Sensory-motor blockade of the ipsilateral median, radial, ulnar, and musculocutaneous nerves was assessed by a blinded observer at regular intervals for 45 minutes after the block. Sensory block was assessed using a verbal rating scale (0–100) and motor block using a 3-point qualitative scale (0–2). Onset of sensory (primary outcome variable) and motor blockade was defined as the time it took to achieve a sensory verbal rating scale of 30 or less and motor grade of 1 or less, respectively. Time to readiness for surgery was defined as the time it took to achieve a sensory score of 30 or less and motor grade of 1 or less in all the 4 nerves tested. RESULTSThe overall sensory onset time (median [interquartile range]) was significantly faster (P = 0.004) in Gp-CC (10 [10–26.25] minutes) than in Gp-LS (20 [15–30] minutes). The overall sensory score was significantly lower in Gp-CC than in Gp-LS at 5 (P < 0.001), 10 (P = 001), 15 (P = 0.001), and 20 (P = 0.04) minutes after the BPB. The overall motor score was significantly lower (P = 0.009) in Gp-CC than in Gp-LS at 10 minutes after the BPB. There were more (P = 0.04) patients with complete sensory-motor blockade at 20 minutes after the BPB in Gp-CC (25%) than in Gp-LS (0%). Time to readiness for surgery was also significantly faster (P = 0.002) in Gp-CC (10 [10–26.5] minutes) than in Gp-LS (20 [15–30] minutes). CONCLUSIONSThe CC approach for infraclavicular BPB produces faster onset of sensory blockade and earlier readiness for surgery than the LS approach. CLINICAL TRIAL REGISTRATIONThis study was registered at the Centre for Clinical Trials of The Chinese University of Hong Kong, identifier CUHK_CCT00389.

Objective This study was performed to compare the clinical effects of locking plates (LPs) with those of hook plates (HPs) in the treatment of Neer type II distal clavicle fractures. Methods From August 2014 to April 2018, 64 patients with Neer type II distal clavicle fractures were treated in our department. The clinical effects were assessed with respect to the operation time, intraoperative blood loss, incision length, fracture healing, postoperative pain, postoperative complications, and postoperative shoulder joint function. Results There were no significant differences in the healing time, operation time, or intraoperative blood loss between the LP and HP groups. The incision length was significantly shorter in the LP than HP group, and the postoperative complication rate was significantly lower in the LP than HP group. The visual analog scale score, Constant–Murley score, and University of California Los Angeles score were significantly better in the LP than HP group. Conclusions Compared with HPs, the use of LPs involves a smaller incision in the treatment of Neer type II distal clavicle fractures and significantly reduces postoperative pain and complications. Therefore, priority can be given to the use of LPs in the treatment of Neer type II distal clavicle fractures.