Cervical Spine Locking Plate In The Treatment Of Neer Type-2 Lateral Third Clavicle Fractures: A New Method Of Fixation

摘要

OBJECTIVE: There is very high risk of delayed union, malunion, non-union (22-35%) and acromioclavicular joint arthritis with conservative management of fracture lateral third of clavicle. This study was done to find a new method of fixation of such fractures.METHODS: 11 patients were operated for displaced fracture of the lateral third of the clavicle by Cervical Spine Locked Plate. The shoulder was immobilized for 3 weeks post-operatively. The patients were evaluated in clinic following operative treatment for the lateral third clavicle fractures at 6 weeks, 3 months and 6 months. All patients with more than 6 months follow-up after surgery were included. X-rays in AP projection were taken at every follow-up to look for bony union and clinical assessment was done by using the UCLA Shoulder Score at each follow-up. RESULTS: The UCLA Shoulder Score at each follow-up showed gradual improvement in the score. At final follow-up all the fractures had united and no additional procedure like bone grafting was done. CONCLUSION: We conclude that type-2 fracture of the lateral third of the clavicle require open reduction and can be safely fixed by a locked cervical spine plate which has not showed any complication. INTRODUCTION Fractures of the lateral third of the clavicle, which account for 10-15% of all clavicle fractures, can present a difficult treatment dilemma when trying to achieve union with standard conservative methods (1). There is very high risk of delayed union, malunion, non-union (22-35%) and acromioclavicular joint arthritis with conservative management. Most authors recommend open reduction and internal fixation as treatment of choice but there is still no consensus about the ideal method and ideal implant to achieve the best outcome (2). Numerous techniques have been described for fixation using coracoclavicular screw, crossed K-wires, hook plate, tension band wire around coracoid process, trans-acromial K-wire and Knowles pin (3). The disadvantage of these technique relate to the necessity of implant removal prior to mobilization. We report our experience with use of Cervical Spine Locked Plate in fixation of unstable fractures of the lateral third of the clavicle. PATIENTS AND METHODS Between July 2007 to Dec. 2008, 11 patients were operated for displaced fracture of the lateral third of the clavicle by a Cervical Spine Locked Plate. Patients with more than 6 month follow-up after surgery were included. A total of 11 fractures were operated on 5 males and 6 females with an average age of 55 years (range 45-58 years). The dominant shoulder was involved in 4 cases and non-dominant was involved in 7 cases. Patients were evaluated with X-rays to access union and shoulder function was accessed using UCLA Shoulder Score.IMPLANT: Cervical Spine Locked Plate is a very low profile plate designed for stabilization of the anterior cervical spine. This plate is available in different sizes according to levels to be fixed. The unique feature of this plate is its locking screws which get locked in plate which is advantageous in osteoporotic and cancellous bone.SURGICAL TECHNIQUE:All patients were operated on under general anaesthesia in beach chair position. The shoulder was prepped and draped with the arm free. An incision was made in Langer’s lines, positioned between the coracoid process and acromio-clavicular joint to permit access to both locations. The incision extended from the posterior aspect of the clavicle down to the coracoid. Large subcutaneous flaps were raised superficial to deltotrapezial fascia. The fascia was then sharply divided along the length of exposed clavicle, over the fracture site and to the acromio-clavicular joint. The fracture was exposed and cleaned from soft tissue. Fixation was done with Cervical Spine Locking Plate after reduction of the fracture either with pointed reduction forceps or temporary k-wire fixation. Closure was done after achieving complete hemostasis. The average surgical time for