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Results for “CLAVICLE”

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At least 145 records · Page 8Linked to original sources

PubMed2000

[Outcome of surgically treated lateral clavicle fractures].

This retrospective study presents the results of 41 patients with a lateral clavicle fracture eight years after the treatment at the Staatliche Orthopädische Klinik of the LMU München in the time between 31.10.1979 and 31.10.1994. It could be shown that the lateral clavicle fractures, due to their variety, hold a special position among the clavicle fractures and thus need a differentiated therapeutic procedure. Among the operation methods the K-wire stabilisation with cerclage was the most often chosen operation technique i.e. in 24 cases. The K-wire without cerclage was used in two cases. Twelve fractures were treated with AO-plate-osteosynthesis. Three fractures had to be treated by resection, as they produced two pseudarthrosis and one serious AC-arthrosis during the conservative therapy. 92.7% of the subjective results of the 41 checked up patients were good and very good. The clinical follow-up of 36 and the radiological follow-up of 33 patients revealed in 97% a good and very good outcome in the Boenisch-Score.

Adult↗

PubMed2003

Duplication of the clavicle with triplication of the coracoid process.

A very rare case of duplication of the clavicle and triplication of the coracoid process of the scapula is presented. Duplication of the clavicle has been described in only six reports based on a search of the world literature. There is no mention of duplication or triplication of the coracoid process of the scapula in the world literature and this would appear to be the first report of this kind. A combination of bifurcation and triplication of the clavicle and coracoid process, respectively, in the present case illustrates that even anomalous bones search for their counterpart to form a joint. The process of duplication or triplication is explained with a new hypothesis.

Adult↗

PubMed2005

Stress fracture of the clavicle associated with sternocostoclavicular hyperostosis.

We report a case of stress fracture of the clavicle associated with sternocostoclavicular hyperostosis. A 60-year-old man sustained a stress fracture of the right clavicle with no history of trauma. On radiography, hyperostosis of the anterior chest wall and ankylosis of the sternoclavicular joint were evident in addition to the fracture. Fracture healing was uneventful after 2.5 months. Ankylosis of the sternoclavicular joint may have caused increased stress at the midshaft of the clavicle by daily activity or minor trauma. Such a fracture is a rare complication of sternocostoclavicular hyperostosis.

Ankylosis↗

PubMed1997

Does osteolysis of the distal clavicle occur following spinal cord injury?

OBJECTIVE: To determine whether there is an association between spinal cord injury and "atraumatic" osteolysis of the distal clavicle. PATIENTS AND DESIGN: Seventy-seven consecutive spinal cord injury patients without upper extremity injuries were studied. Of these, 39 each had a pair of chest radiographs--one at admission and one at least 1 month later--which included both acromioclavicular joints. Each radiograph was evaluated by two independent musculoskeletal radiologists, who were masked as to which radiograph was the baseline. RESULTS: Ten of 76 acromioclavicular joints demonstrated osteolysis of the distal clavicle: three bilateral, three left side only, and one right side only. There was one case in which the admission radiograph was read as osteolysis but reverted to normal at 35 months follow-up. CONCLUSION: There is an apparent association between spinal cord injury and osteolysis of the distal clavicle.

Acromioclavicular Joint↗

PubMed2003

Pycnodysostosis associated with bilateral congenital pseudarthrosis of the clavicle.

We report the case of a 22-year-old woman with pycnodysostosis associated with bilateral congenital pseudarthrosis of the clavicle. The patient was first seen at the age of 19 years and had no symptoms during the 3-year follow-up period. The diagnosis of pycnodysostosis was made by typical clinical and radiological findings. Bilateral painless mid-clavicular mass and plain radiograms confirmed the diagnosis of bilateral congenital pseudarthrosis of the clavicle. Surgery was not performed for pseudarthrosis of the clavicles, just observation was preferred.

Abnormalities, Multiple↗

PubMed2002

Hydatid disease at the proximal end of the clavicle.

We report a case of hydatid disease at the proximal end of the clavicle of a 47-year-old woman. In an open biopsy, laminated layers, characteristic of Echinococcus multilocularis larvae, were revealed by periodic acid-Schiff (PAS) staining. A marked foreign-body reaction was observed in the pathological findings. The patient was definitely diagnosed as having osseous hydatid disease. We performed resection of the infected part of the clavicle, and after the operation, she has been cured under medication with albendazole for 9 years, with no finding of recurrence in the clavicle.

Albendazole↗

PubMed1991

Growth potential of the rat clavicle.

An experiment was performed to determine whether the clavicle, which is capped with secondary cartilage at both ends, is endowed with a tissue-separating quality or is only adaptive to forces exerted by the surrounding structures. The medial end of the clavicle from 10-day-old male rats was transplanted across the interparietal suture into an opening in the adjoining parietal bones corresponding to the outline of the transplant. The transverse dimensions of the neurocranium when measured at 25 and 35 days of age were greater in the animals with transplants than in the untreated controls. Histologic examination showed that although the cartilaginous component of the transplants was reduced, the zonal arrangements was comparable to that in situ. It was concluded that the medial end of the clavicle has a potential for separating skeletal components and that preservation of the basic structure is dependent on mechanical resistance.

Animals↗

PubMed1992

Growth of the mandible following replacement of the mandibular condyle with the sternal end of the clavicle: an experimental investigation in Macaca mulatta.

This study was designed to investigate the long-term effects of transplanted clavicles to the temporomandibular joint (TMJ) in juvenile monkeys. Sixteen juvenile female monkeys (Macaca mulatta) were used in this experiment. Eight animals were used as controls and were allowed to grow undisturbed for an 18-month period (group control). Eight animals were divided into two groups and underwent bilateral condylar excision via extraoral vertical ramus osteotomies. Four of these animals had their condylar segments removed and immediately replaced to serve as surgical controls (group condyle). The other four underwent condylar replacement with the sternal end of their clavicles (group SCJ). Standardized lateral cephalometric radiographs with the aid of tantalum bone markers were used to evaluate maxillary and mandibular growth. One-way analysis of variance (ANOVA) was used to determine the significance of differences between groups. All animals showed good mandibular function and a class I molar relationship following an 18-month evaluation period. Statistical analysis showed there was no significant difference in maxillary or mandibular growth between any of the three groups. The results of this investigation show that the sternal end of the clavicle may be a viable option in mandibular condylar transplant surgery.

Analysis of Variance↗

PubMed1992

Arthroscopic resection of the outer end of the clavicle from a superior approach: a critical, quantitative, radiographic assessment of bone removal.

The technique of arthroscopic resection of the outer end of the clavicle through a superior approach is evaluated to determine whether adequate bone removal can be achieved. Furthermore, the results are compared with open resection. Twelve patients with osteolysis of the outer end of the clavicle refractory to conservative treatment underwent resection: six open and six arthroscopically through a superior approach. The distances from the acromial side of the AC joint to the lateral edge of the clavicle at its superior and inferior cortices were measured before and after surgery on anteroposterior radiographs. Bone removal was assessed by the difference between pre- and postoperative measurements. Satisfactory bone removal was possible arthroscopically and averaged 17 mm. This compared favorably with 18-mm average bone removal in the open group. Comparable pain relief and function were achieved in both groups. However, pain relief was achieved on average 3.4 months earlier in the arthroscopic group. Hospital stay was significantly shortened because the arthroscopic resections were outpatient procedures, whereas the open procedures had an average hospital stay of 3 days.

Acromioclavicular Joint↗

PubMed2006

Arthroscopic distal clavicle resection: a comparison of bursal and direct approaches.

PURPOSE: To test the hypothesis that the direct (superior) approach to arthroscopic distal clavicle resection is as safe and effective as the bursal (subacromial) approach. METHODS: All patients who had an arthroscopic distal clavicle resection in our institution between 1994 and 2002 were reviewed. Patients with a history of acromioclavicular joint (ACJ) instability, previous shoulder surgery, glenohumeral pathology, full-thickness rotator cuff tear, or other significant orthopaedic comorbidity were excluded. Outcome data were collected including the American Shoulder and Elbow Surgeons (ASES) score as well as subjective ratings of pain and instability. RESULTS: Follow-up was completed on 66 shoulders of 60 patients. Twenty-four shoulders had a bursal approach (group I) and 42 had a direct approach (group II). There were 45 men and 15 women with an average age of 46 years (range, 21 to 78 years). Follow-up averaged 6.0 years (range, 2 to 11.5 years). The average ASES score was 90 (range, 53-100) in group I and 94 (range, 55-100) in group II. Four patients (10%) in group II required reoperation: 2 patients required ACJ stabilization at 6 and 9 months postoperatively because of anteroposterior instability, and 2 patients required resection again at 5 years because of recurrent symptoms. CONCLUSIONS: Both the direct and bursal approaches lead to satisfactory outcomes in the majority of patients with ACJ arthrosis. However, the direct approach to the ACJ may damage the superior capsular ligaments, potentially leading to distal clavicle instability. Care should be taken when performing the direct ACJ resection to avoid disrupting the capsular restraints. LEVEL OF EVIDENCE: Level IV therapeutic case series.

Adult↗

PubMedDate not supplied

Free vascularized corticoperiosteal bone graft for the treatment of persistent nonunion of the clavicle.

Radiation-induced necrosis or infection can result in a persistent nonunion of the clavicle. We describe 3 cases in which a free vascularized corticoperiosteal flap was harvested from the medial aspect of the femoral condyle and transferred to the fractured clavicle by use of microvascular anastomoses. Healing was confirmed by tomography in all 3 patients. The function of the upper extremity was remarkably improved at final follow-up. Vascularized free corticoperiosteal bone flaps are an option in clavicle fracture treatment. The technique of periosteal grafting is ideally suited to chronic nonunions with poor chances of healing on their own. Rapid subperiosteal new bone and improved local blood flow serve to correct many of those changes attributed to necrosis of bone.

Adult↗

PubMedDate not supplied

Short malunions of the clavicle: an anatomic and functional study.

The anatomic and functional effects of clavicle malunion, defined as 15 mm of shortening, were evaluated in 10 subjects. Bilateral shoulder computed tomography with 3-dimensional reconstructions was performed. A self-administered questionnaire was completed, and biomechanical testing of subjects was undertaken comparing strength and velocity of movement between shoulders. Mean shoulder scores and visual analog global assessments of shoulder function were significantly worse in the injured shoulder. Biomechanical assessment recorded a reduction in muscular strength for adduction, extension, and internal rotation of the humerus as well as a reduced peak abduction velocity in the injured shoulder (P < .05). Computed tomography assessment showed that clavicular shortening produced increased upward angulation of the clavicle at the sternoclavicular joint (P < .005) and increased anterior scapular version (P < .05). These changes in static anatomic relationships are possible mechanisms limiting shoulder function after short clavicle malunions. Consideration should be given to the prevention of shortening by open reduction and internal fixation, especially in the young, active age group.

Adolescent↗

PubMedDate not supplied

Conservative treatment of fractures at the middle third of the clavicle: the relevance of shortening and clinical outcome.

Fractures of the clavicle are common and most often occur in the middle third. The clavicle has several important functions, each of which may be affected after fracture and malunion. In this retrospective study, we reviewed 132 patients with united fractures of the middle third of the clavicle after conservative management. Residual symptoms and overall patient satisfaction after treatment were assessed through a questionnaire. Clavicular shortening after union was calculated on a standardized anteroposterior chest radiograph. Intraobserver variability and interobserver variability of measurements by use of this method are insignificant. The mean follow-up was 30 months (range, 12-43 months). The mean modified Constant score was 84 (range, 62-100). Of the patients, 34 (25.8%) were dissatisfied with the result of their management. Final clavicular shortening of more than 18 mm in male patients and of more than 14 mm in female patients was significantly associated with an unsatisfactory result.

Accidents, Traffic↗

PubMed2000

The treatment of lateral clavicle fractures.

This study assesses the results of surgical treatment of 15 displaced Neer type II fractures of the lateral clavicle in 15 patients, which occurred between November 1988 and March 1995 and which were followed up for a mean period of 4.6 years (range 2-9 years). The patients fell into two groups, one 'acute group' and one 'non-union' group. Patients treated initially by a non-operative approach had suffered prolonged morbidity and time off work prior to and after surgery. The ultimate result was good. The fixation used was a Dacron arterial graft as a sling around the clavicle and coracoid process. Delayed (non-union) cases were augmented with bone graft and inter-fragmentary screw fixation. All fractures eventually united. We question the place of prolonged non-operative management in the treatment of displaced Neer type II fractures of the lateral clavicle.

Adolescent↗

PubMed1997

[Retrosternal luxation of the clavicle. Apropos of 4 cases surgically treated using a temporary screwed anterior plate and review of the literature].

The authors report 4 new cases of retrosternal dislocation of the clavicle operated by capsular and ligament restoration, and temporary stabilization by anterior plating. The 4 patients were men with a mean age of 17.5 years. The lesion was caused by a sports injury (football, rugby) in 3 out of 4 cases and was related to an indirect mechanism. Clinical examination allowed the diagnosis, was related to based on painful palpation of a dip over the joint, supported by radiology and computed tomography. CT did not reveal the epiphyseal separation present in two cases. Complications were frequent: 1 case of tracheal compression, 2 cases of temporary paresthesia of the upper limb, 2 cases of venous compression with one case of subclavian and medial jugularis venous thrombosis, 1 hemopneumothorax. Surgical reduction was performed in all 4 cases after 2 failures of attempted orthopedic treatment under general anesthesia. All patients recovered a full range of movement, a painless shoulder and no recurrence has been observed. All complications resolved after reduction. Venous thrombosis responded favourably after 6 months of anticoagulant therapy. One plate breakage was observed with no clinical implications. On the basis of an extensive review of the literature, the authors discuss the epidemiology, pathology and the importance of associated injuries, which are frequent and sometimes serious, justifying urgent reduction. Computed tomography is the most useful radiologic modality, both for diagnosis and for investigation of complications. Orthopedic treatment must be attempted first (especially in children) according to a well systematized technique. One third of attempts fail, and cases of delayed diagnosis and serious vascular complications, then require surgical treatment. The costoclavicular ligament is repaired either by Burrows's ligamentoplasty or by bone suture; the clavicle is stabilized by bone suture or by anterior plating. The authors do not advocate either joint fixation by Kirschner wire, or resection of the medial end of the clavicle.

Accidents, Traffic↗

PubMedDate not supplied

Heterotopic ossification after acromioplasty and distal clavicle resection.

A retrospective review of acromioplasty and distal clavicle resections disclosed 40 cases in which postoperative ectopic bone formation caused recurrent shoulder impingement or acromioclavicular joint pain. Symptomatic lesions either encroached on the supraspinatus outlet or were located in the acromioclavicular interval and were large in size. The incidence of symptomatic heterotopic ossification occurring after acromioplasty or distal clavicle excision was 3.2% and was disproportionately seen in patients with chronic pulmonary diseases (p < 0.05). Heterotopic bone formation could not be correlated with the method of bone resection and occurred after both open and arthroscopic procedures. No evidence of bone remnants or calcific deposits was seen in 17 patients in whom postoperative radiographs were taken within 8 weeks of the operation. It thus appeared that the heterotopic bone formed de novo after the procedure. Twenty patients had repeat shoulder surgery to ameliorate symptoms; four of these had a second recurrence of postoperative heterotopic bone formation. Three of the four required a third procedure and had effective prophylaxis against heterotopic ossification. It is suggested that patients at risk (e.g., with a profile of hypertrophic pulmonary osteoarthropathy or active spondylitic arthropathy) be treated with prophylaxis for heterotopic ossification after acromioplasty and distal clavicle resections.

Acromioclavicular Joint↗

PubMedDate not supplied

Surgical resection of the distal clavicle.

Distal clavicle resection is frequently performed for persistent acromioclavicular pain. However, patient outcome after this procedure has not been well described. The results of subjective and objective retrospective analysis of 23 open distal clavicle resections in 21 patients are reported. Patients were evaluated with a questionnaire, roentgenographs, physical examination, and isokinetic muscle strength testing at an average of 30 months after surgery. Eighteen of 23 shoulders had good or excellent postoperative ratings. All patients had normal motion. No significant weakness of the operated shoulder was seen on objective muscle testing when compared with the unoperated shoulder. The average preoperative Hospital for Special Surgery score was 34, and the average postoperative score was 84. Age and hand dominance were unrelated to postoperative outcomes. Less predictable results were obtained in patients with workmen's compensation and in those patients involved in litigation. Open distal clavicle resection yields good to excellent results in properly selected patients and does not create significant subjective or objective weakness.

Acromioclavicular Joint↗

PubMedDate not supplied

Arthroscopic resection of the distal clavicle with a superior approach.

Forty-one patients (41 shoulders) with acromioclavicular joint disease refractory to conservative treatment underwent arthroscopic distal clavicle resection. Thirty-one men and 10 women with an average age of 32 years were studied. The dominant extremity was involved in 68% of the patients. At an average follow-up period of 31 months (range 24 to 49 months), 18 excellent, 16 good, and seven poor results were found. Twenty-seven (93%) of 29 shoulders with acromioclavicular arthritis or osteolysis of the distal clavicle went on to have satisfactory results compared with only seven (58%) of 12 shoulders with previous grade II acromioclavicular separations or acromioclavicular hypermobility. Total amount of bone removal did not correlate with success, if the resection was even. Five reoperations were done; one uneven resection was revised with arthroscopy, and four shoulders underwent acromioclavicular stabilization procedures. The high failure rate in patients with even subtle acromioclavicular instability (42%) suggests that in these cases formal stabilization with ligament reconstruction should be considered in addition to resection of the distal clavicle.

Acromioclavicular Joint↗