Evaluation and Management of Distal Clavicle Fracture in a Tertiary Care Hospital LRH, Peshawar
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Abstract
Background: Background: Distal clavicle fractures, constituting 10–30% of all clavicle fractures, present a significant challenge in orthopedic surgery due to their high propensity for displacement and subsequent complications such as nonunion and malunion. The Revised NEER classification system guides the management approach, distinguishing between stable and unstable fracture types, with varying recommendations for surgical and non-operative treatments.
Objective: This study aims to elucidate the patterns of distal clavicle fractures based on the NEER classification and to evaluate the outcomes of different management strategies in a tertiary care setting.
Methods: Conducted at the Department of Orthopedics, Lady Reading Hospital, Peshawar, this cross-sectional study spanned four months, from September to December 2023, following ethical approval. It employed a non-probability convenience sampling technique, including patients aged 20 to 60 years with radiographically confirmed lateral third clavicle fractures. Exclusion criteria encompassed patients without fractures or with healed fractures. Data on demographics, injury mechanism, comorbidities, and treatment were collected. The statistical analysis was performed using IBM SPSS version 25, focusing on frequencies, percentages, means, and standard deviations, with a p-value of ≤ 0.05 considered significant.
Results: Out of 70 participants, the mean age was 34.39 years (SD = 9.42), with 75.7% males. The majority of injuries were due to road traffic accidents (60%), followed by falls (17.1%), sports injuries (14.3%), and physical assaults (8.6%). Regarding comorbidities, 10% were smokers, 2.9% had hypertension, 1.4% diabetes, and 84.3% had no comorbidities. NEER classification revealed Type 2A fractures as the most common (28.6%), followed by Types 1 and 2B (18.6% each). Surgical management was predominant, with plating (58.6%) and conservative treatment (28.6%) being the most utilized methods.
Conclusion: The study highlights the prevalence of surgical intervention, particularly plating, in managing distal clavicle fractures, predominantly caused by road traffic accidents. These findings suggest a need for specific surgical protocols tailored to the fracture type to optimize patient outcomes and minimize complications.
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References
Zhang C, Huang J, Luo Y, Sun H. Comparison of the efficacy of a distal clavicular locking plate versus a clavicular hook plate in the treatment of unstable distal clavicle fractures and a systematic literature review. International orthopaedics. 2014 Jul;38:1461-8.
Panagopoulos A, Solou K, Tatani I, Triantafyllopoulos IK, Lakoumentas J, Kouzelis A, Athanasiou V, Kokkalis ZT. What is the optimal surgical treatment for Neer type IIB (IIC) distal clavicle fractures? A systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research. 2022 Apr 7;17(1):215.
Li L, Li TY, Jiang P, Lin G, Wu H, Han X, Yu X. Clavicle hook plate versus distal clavicle locking plate for Neer type II distal clavicle fractures. Journal of Orthopaedic Surgery and Research. 2019 Dec;14(1):1-1.
Nie S, Li HB, Hua L, Tang ZM, Lan M. Comparative analysis of arthroscopic-assisted Tight-rope technique and clavicular hook plate fixation in the treatment of Neer type IIB distal clavicle fractures. BMC Musculoskeletal Disorders. 2022 Dec;23(1):1-7.
Andersen JR, Willis MP, Nelson R, Mighell MA. Precontoured superior locked plating of distal clavicle fractures: a new strategy. Clinical Orthopaedics and Related Research®. 2011 Dec;469:3344-50.
Kim DW, Kim DH, Kim BS, Cho CH. Current concepts for classification and treatment of distal clavicle fractures. Clinics in orthopedic surgery. 2020 Jun;12(2):135.
Wang J, Guan J, Liu M, Cui Y, Zhang Y. Treatment of distal clavicle fracture of Neer type II with locking plate in combination with titanium cable under the guide. Scientific Reports. 2021 Mar 2;11(1):4949.
Yagnik GP, Jordan CJ, Narvel RR, Hassan RJ, Porter DA. Distal clavicle fracture repair: clinical outcomes of a surgical technique utilizing a combination of cortical button fixation and coracoclavicular ligament reconstruction. Orthopaedic journal of sports medicine. 2019 Sep 23;7(9).
Seo JB, Kwak KY, Yoo JS. Comparative analysis of a locking plate with an all-suture anchor versus hook plate fixation of Neer IIb distal clavicle fractures. Journal of Orthopaedic Surgery. 2020 Oct 28;28(3)
Kao FC, Chao EK, Chen CH, Yu SW, Chen CY, Yen CY. Treatment of distal clavicle fracture using Kirschner wires and tension-band wires. Journal of Trauma and Acute Care Surgery. 2001 Sep 1;51(3):522-5.
Pujol N, Philippeau JM, Richou J, Lespagnol F, Graveleau N, Hardy P. Arthroscopic treatment of distal clavicle fractures: a technical note. Knee Surgery, Sports Traumatology, Arthroscopy. 2008 Sep;16:884-6.
Xie Z, Song M, Zhou J, Yin G, Lin H. Precontoured locking compression plate with titanium alloy cable system: in treatment of Neer type IIb distal clavicle fracture. Orthopaedic Surgery. 2021 Apr;13(2):451-7.
Stegeman SA, Nacak H, Huvenaars KH, Stijnen T, Krijnen P, Schipper IB. Surgical treatment of Neer type-II fractures of the distal clavicle: a meta-analysis. Acta Orthopaedica. 2013 Jan 1;84(2):184-90.
Sharma V, Modi A, Armstrong A, Pandey R, Sharma D, Singh H, Padney R. The Management of Distal Clavicle Fractures–A Survey of UK Shoulder and Elbow Surgeons. Cureus. 2021 Aug 19;13(8).
Bisbinas I, Mikalef P, Gigis I, Beslikas T, Panou N, Christoforidis I. Management of distal clavicle fractures. Acta Orthop Belg. 2010 Apr 1;76(2):145-9.
Yagnik GP, Seiler JR, Vargas LA, Saxena A, Narvel RI, Hassan R. Outcomes of arthroscopic fixation of unstable distal clavicle fractures: a systematic review. Orthopaedic Journal of Sports Medicine. 2021 Apr 28;9(5).
Raval P, See A, Singh HP. Distal third clavicle fractures: a nationwide trainee-led collaborative review of current practice. Bone & Joint Open. 2022 Dec 23;3(12):953-9.
Andersen K, Jensen PØ, Lauritzen J. Treatment of clavicular fractures: Figure-of-elght bandage versus a slmple sling. Acta Orthopaedica Scandinavica. 1987 Jan 1;58(1):71-4.
Vaishya R, Vijay V, Khanna V. Outcome of distal end clavicle fractures treated with locking plates. Chinese Journal of Traumatology. 2017 Feb 1;20(1):45-8.
Regel JP, Pospiech J, Aalders TA, Ruchholtz S. Intraspinal migration of a Kirschner wire 3 months after clavicular fracture fixation. Neurosurgical review. 2002 Mar;25:110-2.
Leppilahti J, Jalovaara P. Migration of Kirschner wires following fixation of the clavicle-a report of 2 cases. Acta Orthopaedica Scandinavica. 1999 Jan 1;70(5):517-9.
Lyons FA, Rockwood Jr CA. Migration of pins used in operations on the shoulder. JBJS. 1990 Sep 1;72(8):1262-7.https://doi.org/10.1016/j.cjtee.2016.05.003