Clin Orthop Surg.  2013 Dec;5(4):327-333. 10.4055/cios.2013.5.4.327.

Biologic Fixation through Bridge Plating for Comminuted Shaft Fracture of the Clavicle: Technical Aspects and Prospective Clinical Experience with a Minimum of 12-Month Follow-up

• Jung GH
• Park CM
• Kim JD

• KMID: 1787037
• DOI: http://doi.org/10.4055/cios.2013.5.4.327

Abstract

For comminuted shaft fracture of clavicle, the operative goal, aside from sound bone healing without complications of direct reduction, is maintenance of the original length in order to maintain the normal biomechanics of adjacent joint. Our bridge plating technique utilizing distraction through a lumbar spreader was expected to be effective for restoring clavicular length with soft tissue preservation. However, there are two disadvantages. First, there is more exposure to radiation compared to conventional plating; and second, it is difficult to control the rotational alignment. Despite these disadvantages, our technique has important benefits, in particular, the ability to preserve clavicular length without soft tissue injury around the fracture site.

Keyword

Clavicle; Shaft fracture; Communited fracture; Biologic fixation; Bridge plating

MeSH Terms

Adult
Aged
Clavicle/injuries/radiography/*surgery
Female
Follow-Up Studies
Fracture Fixation, Internal/*instrumentation/*methods
Fractures, Comminuted/radiography/*surgery
Humans
Male
Middle Aged
Prospective Studies
Range of Motion, Articular
Young Adult

Figure

• 

  Fig. 1 A 20-year-old woman injured in a sports accident (Judo). Simple radiographs showed a comminuted segmental fracture of the clavicle (Robinson classification, 2B2).

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  Fig. 2 The fracture was fixed by biologic fixation through bridge plating to preserve the soft tissue around the fracture site.

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  Fig. 3 (A) Postoperatively, the fractured clavicle failed to achieve cortical contact due to indirect reduction. (B) Callus bridging occurred 16 weeks after surgery. (C) The clavicle was remodeled at 9 months follow-up.

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  Fig. 4 The shoulder motion was fully recovered to the preinjury level.

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  Fig. 5 A locking reconstruction plate (Synthes) was preoperatively bent to match the normal cadaveric clavicle.

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  Fig. 6 Stepwise reduction and fixation. (A) Simple radiograph shows clavicular fracture with comminution and shortening, and the overlapping fragments. (B, C) The plate was passed through a submuscular tunnel and provisionally fixed with K-wires. (D) After fixation of the shorter fragment with a conventional screw, distractive force was applied through a lumbar spreader to achieve ligamentotaxis with the K-wire. (E and F) Simulated photos show how to use the lumbar spreader and Kelly clamp for indirect reduction. (G) The realignment of fracture sites was achieved by indirect reduction.

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  Fig. 7 Postoperative radiographs show the restoration of clavicular length and realignment of comminuted segments.

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