Background: The surgical treatment of bony non-unions is traditionally performed with additional bone grafts when atrophic and/or stronger implants when hypertrophic. In the case of the clavicle shaft, however, in our experience, a more controversial method where no additional bone graft is needed leads to equally good consolidation rates, independent of the non-union morphology. This method requires the meticulous anatomical reconstruction of the initial fracture and fixation according to the AO principle of relative stability. Methods: A retrospective review following the STROBE guidelines was performed on a consecutive cohort of all patients who received surgical treatment of a midshaft clavicle non-union at the Medical Center of the University of Freiburg between January 2003 and December 2023. Patients were identified using a retrospective systematical query in the Hospital Information System (HIS) using the International Statistical Classification of Diseases and Related Health Problems Version 10 (ICD-10) codes of the German Diagnosis Related Groups (G-DRG). Two groups were formed to compare the consolidation rates of patients who received additional bone grafting from the iliac crest with those of patients who did not. A 3.5 mm reconstruction LCP plate was used in all patients. Consolidation rates were evaluated using follow-up radiographs and outcomes after material removal with a mean follow-up of 31.5 ± 44.3 months (range 0-196). Results: Final data included 50 patients, predominantly male (29:21); age: 46.0 ± 13.0 years, BMI 26.1 ± 3.7. Autologous bone grafts from the iliac crest were used in 38.0% (n = 19), while no bone addition was used in 62.0% (n = 30). Six patients were lost to follow-up. Radiological consolidation was documented after a mean of 15.1 ± 8.0 months for the remaining 44 patients. Consolidation rates were 94.4% (n = 17) in patients for whom additional bone grafting was used and 96.2% (n = 25) in patients for whom no graft was used. There was no relevant difference in the percentage of atrophic or hypertrophic non-unions between both groups (p = 0.2425). Differences between groups in the rate of consolidation were not significant (p = 0.7890). The complication rate was low, with 4.5% (n = 2). Conclusions: Independent of the non-union morphology, non-unions of the clavicle midshaft can be treated successfully with 3.5 mm locking reconstruction plates without the use of additional bone grafting in most cases.

Despite residual functional deficits clinically observed in conservatively treated mid-shaft clavicle fractures, no study has reported a quantitative assessment of the treatment effects on the kinematics of the shoulder complex during functional movement. Using computerised motion analysis, the current study quantified the 3D residual kinematic deviations or strategies of the shoulder complex bones during multi-plane elevations in fifteen patients with conservatively treated mid-shaft clavicle fractures and fifteen healthy controls. Despite residual clavicular malunion, the patients recovered normal shoulder kinematics for arm elevations up to 60° in all three tested planes. For elevations beyond 60°, normal clavicle kinematics but significantly increased scapular posterior tilt relative to the trunk was observed in the patient group, leading to significantly increased clavicular protraction and posterior tilt relative to the scapula (i.e., AC joint). Slightly different changes were found in the sagittal plane, showing additional changes of increased scapular upward rotations at 90° and 120° elevations. Similar kinematic changes were also found on the unaffected side, indicating a trend of symmetrical bilateral adaptation. The current results suggest that shoulder kinematics in multi-plane arm elevations should be monitored for any compromised integrated motions of the individual bones following conservative treatment. Rehabilitation strategies, including muscle strengthening and synergy stability training, should also consider compensatory kinematic changes on the unaffected side to improve the bilateral movement control of the shoulder complex during humeral elevation.

Clavicle fracture is a common orthopedic injury, accounting for approximately 2.6%-4% of all adult skeletal fractures. In 2023, the American Academy of Orthopaedic Surgeons (AAOS) developed evidence-based treatment guidelines for clavicle fractures, which include 4 recommendations and 10 options. This article, based on a thorough review of the guidelines, discusses the clinical treatment of clavicle fractures, aiming to share advancements and the latest diagnostic and therapeutic considerations with orthopedic colleagues to enhance treatment outcomes.
锁骨骨折是骨科常见创伤，占成人全身骨折的2.6%～4%。2023年美国骨科医师学会（AAOS）发布了锁骨骨折治疗的临床实践指南，包括4条推荐建议以及10条治疗选择。本文在充分研读指南基础上，结合该领域已发表相关文献，对锁骨骨折临床治疗展开论述，总结锁骨骨折治疗进展和最新诊疗要点，以期提高临床治疗预后。.

Medial clavicle fractures and injuries to the sternoclavicular joint are rare injuries but can have life-threatening consequences. There are no standardized treatment algorithms or guidelines for the diagnostics and treatment. This article provides an overview of the individual topographies as well as the conservative and surgical treatment strategies.Conservative treatment is preferred for medial clavicle fractures. The indications for surgical treatment are variable but this is frequently carried out if there is a fracture displacement > 1 cm or 1 shaft width and high functional demands. In the case of accompanying injuries to neurovascular structures, an open fracture or the threat of perforation of the skin, surgical treatment is mandatory. Open reduction and internal fixation using (locking) plates is currently the preferred form of treatment.In the case of posterior dislocation of the sternoclavicular joint, an immediate closed reduction must be attempted with the patient under analgosedation and with emergency treatment on standby. This temporal urgency does not exist for anterior and superior dislocations. Surgical treatment is indicated in cases of unsuccessful reduction, persistent symptomatic instability or injuries of the neurovascular bundle. From a multitude of treatment options, arthrodesis with suture cerclage has shown good results. Tendon grafts as well as special hook plates are increasingly being used due to better biomechanical qualities. The surgical treatment of combined injuries is determined by the individual injury pattern.Despite the variety of treatment strategies, the long-term outcome has consistently been positively described.
UNASSIGNED: Mediale Klavikulafrakturen und Verletzungen des Sternoklavikulargelenks sind selten, können jedoch lebensbedrohliche Folgen haben. Standardisierte Behandlungsalgorithmen oder Leitlinien zu Diagnostik und Therapie existieren nicht. Dieser Beitrag gibt einen Überblick zu den einzelnen Topografien und ihrer sowohl operativen als auch konservativen Versorgung.Mediale Klavikulafrakturen werden überwiegend konservativ behandelt. Die Indikationsstellung zur operativen Versorgung variiert, erfolgt jedoch häufig bei Frakturdislokationen > 1 cm bzw. einer Schaftbreite und hohem funktionellen Anspruch. Absolute Versorgungsindikationen stellen begleitende Verletzungen neurovaskulärer Strukturen, offene Fraktur oder eine drohende Perforation der Haut dar. Bevorzugt wird mittlerweile die offene Reposition und interne Fixierung mithilfe der (winkelstabilen) Plattenosteosynthese.Bei posterioren Luxationen im Sternoklavikulargelenk muss eine geschlossene Reposition unter Analgosedierung/in Versorgungsbereitschaft unmittelbar versucht werden. Diese zeitliche Dringlichkeit besteht nicht bei anterioren oder superioren Luxationen. Eine operative Therapie ist bei frustraner Reposition, anhaltender symptomatischer Instabilität oder bei Verletzungen des neurovaskulären Bündels indiziert. Aus mannigfaltigen Versorgungsoptionen hat sich die Arthrodese mit Faden-Cerclagen bewährt. Aufgrund besserer biologischer Eigenschaften werden zunehmend Sehnentransplantate verwendet. Bei Kombinationsverletzungen wird das operative Verfahren durch die einzelnen Verletzungsmuster festgelegt.Trotz der Vielseitigkeit der therapeutischen Strategien wird das langfristige Outcome durchweg positiv beschrieben.

UNASSIGNED: Regional anaesthesia can be an attractive alternative anaesthetic approach in clavicle surgery, but it requires the peripheral block of multiple cervical and brachial nerves that transmit nociceptive information. Deep cervical plexus blocks, as paravertebral nerve block, can lead to severe side effects, such as unilateral diaphragmatic paralysis.
UNASSIGNED: A 66-year-old male patient, American Society of Anesthesiologists physical status III, was scheduled for open reduction and internal fixation of the right clavicle with plates and screws after a high-energy trauma. Pre-anaesthetic evaluation revealed right hemopneumothorax and bilateral rib fractures. We decided to perform regional anaesthesia (superficial cervical plexus block and clavipectoral fascial plane block), combined with dexmedetomidine perfusion to avoid invasive mechanical ventilation and prevent additional pulmonary complications. The surgical procedure was successfully completed without any further anaesthesia requirements. The patient remained comfortable during the postoperative period.
UNASSIGNED: Regional anaesthesia for clavicle surgeries has the advantage of promoting non-opioid free anaesthesia. Effective pain control enhances patient satisfaction and reduces the length of stay in hospital. In our case report, a combined superficial cervical plexus block and clavipectoral fascial plane block was a safe and effective regional anaesthetic approach.

BACKGROUND: Kirschner wire is a widely used implant in orthopedics, with migration being a typical problem following internal fixation. Subcostal wire migration might result in catastrophic problems such as penetration of the heart, lungs, trachea, big blood vessels, or abdominal cavity. Every orthopedic surgeon must be vigilant and mindful of the potential hazards of wire migration.
METHODS: a 45-year-old Indonesian male was referred from another hospital. 1 year prior, the patient underwent internal fixation of the left clavicle. 2 weeks before admission, the patient complained of stabbing pain in the left shoulder area. An X-ray examination revealed a broken end wire in the left infraclavicular area. Immediate wire-extraction surgery was planned. An X-ray and CT scan showed that the wire had migrated into the left lateral side of the 9th subcostal space and was heading inferiorly. The Thoracic and Cardiovascular Surgery Department carried out the wire evacuation. The wire was successfully removed without any concern.
CONCLUSIONS: Previous studies have suggested that wire migration can occur due to muscular activity, respiratory motion, gravity, and upper-extremity movement. Wire migration is a condition that can occur following shoulder fixation, especially in comminuted fractures that typically use K-wires to stabilize the fragments. Upon the detection of wire migration, prompt evacuation should be conducted to mitigate the severity.
CONCLUSIONS: In cases of wire migration, orthopedic surgeons should pay special attention. Actions that can be taken to prevent wire migration are to: bend the wire, use a threaded wire, and remove it quickly after callus formation.

The clavipectoral fascial plane block (CFPB) that has been utilized for clavicle fracture surgeries and pain management is an emerging anesthetic technique. It has been previously used for postoperative pain management, but it can also be used as a stand-alone anesthetic technique for clavicle fracture management. Here we describe a case of a 20-year-old male who underwent open reduction and internal fixation (ORIF) with plating for a mid-shaft clavicular fracture under a CFPB as a sole anesthetic.

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OBJECTIVE: This study aims to assess differences in clinical and surgical outcomes associated with the surgical treatment of midshaft clavicle fractures of different complexities based on fragment number. Additionally, the investigation seeks to present the outcomes of a series of patients who underwent surgery at our institution.
METHODS: A retrospective analysis was conducted on the medical records of patients aged over 18 who underwent midshaft clavicle fracture surgery at our center from November 2009 to May 2021. Patients were categorized based on the number of fracture fragments into groups of two, three, or more than three fragments. Consolidation, implant removal, complications, surgical duration, and functional outcomes (assessed through VAS, ASES, and Constant-Murley scale) were evaluated for each specific group and for the overall cohort.
RESULTS: In total, 260 patients were analyzed. There were no significant differences in any of the parameters between the three groups except for surgical time, which was shorter in simple fractures than in those with more than three fragments (68.2 min vs. 75.3 min; p = 0.01). Pseudoarthrosis rate was 2.69%, implant removal rate was 9.61%, and 4.23% of patients presented with complications other than the previous ones. Functional results were excellent, with averages of 97.3 (72.7-100) for the ASES score, 97.5 (75-100) for the Constant score, and 0.6 (0-8) on the VAS.
CONCLUSIONS: According to our results, there were no differences in postoperative results between simple and multifragmentary midshaft clavicle fractures. Patients across all groups reported satisfactory results.

暂无摘要。