Nonoperative Treatment Compared with Plate Fixation of Displaced Midshaft Clavicular Fractures by Sahal A. Altamimi, and Michael D. McKee J Bone Joint.

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Presentation transcript:

Nonoperative Treatment Compared with Plate Fixation of Displaced Midshaft Clavicular Fractures by Sahal A. Altamimi, and Michael D. McKee J Bone Joint Surg Am Volume 90(Supplement 2 Part 1):1-8 March 1, 2008 ©2008 by The Journal of Bone and Joint Surgery, Inc.

Anteroposterior radiograph of the clavicle, demonstrating the typical deformity. Sahal A. Altamimi, and Michael D. McKee J Bone Joint Surg Am 2008;90:1-8 ©2008 by The Journal of Bone and Joint Surgery, Inc.

The patient is placed in the beachchair position with the head slightly tilted to the opposite side and taped in place. Sahal A. Altamimi, and Michael D. McKee J Bone Joint Surg Am 2008;90:1-8 ©2008 by The Journal of Bone and Joint Surgery, Inc.

Fig. 3 The operative site is draped from the sternum to the acromion. Sahal A. Altamimi, and Michael D. McKee J Bone Joint Surg Am 2008;90:1-8 ©2008 by The Journal of Bone and Joint Surgery, Inc.

Fig. 4 The skin, platysma, and subcutaneous tissue are raised as a single thick flap, exposing the underlying myofascial layer. Sahal A. Altamimi, and Michael D. McKee J Bone Joint Surg Am 2008;90:1-8 ©2008 by The Journal of Bone and Joint Surgery, Inc.

The myofascial layer is sharply incised down to bone and raised as a thick flap. Sahal A. Altamimi, and Michael D. McKee J Bone Joint Surg Am 2008;90:1-8 ©2008 by The Journal of Bone and Joint Surgery, Inc.

Sahal A. Altamimi, and Michael D. McKee J Bone Joint Surg Am 2008;90:1-8 ©2008 by The Journal of Bone and Joint Surgery, Inc.

Sahal A. Altamimi, and Michael D. McKee J Bone Joint Surg Am 2008;90:1-8 ©2008 by The Journal of Bone and Joint Surgery, Inc.

A 3.5-mm precontoured dynamic compression plate is placed on the superior surface of the clavicle and centered over the fracture site. Sahal A. Altamimi, and Michael D. McKee J Bone Joint Surg Am 2008;90:1-8 ©2008 by The Journal of Bone and Joint Surgery, Inc.

Fig. 8 Three bicortical screws are inserted into both the proximal and the distal fragment. Sahal A. Altamimi, and Michael D. McKee J Bone Joint Surg Am 2008;90:1-8 ©2008 by The Journal of Bone and Joint Surgery, Inc.

Fig. 9 After thorough irrigation, the myofascial layer is closed with interrupted absorbable sutures. Sahal A. Altamimi, and Michael D. McKee J Bone Joint Surg Am 2008;90:1-8 ©2008 by The Journal of Bone and Joint Surgery, Inc.

Two-layer soft-tissue closure is achieved, and the skin is closed with a subcuticular suture and infiltrated with local anesthetic (0.5% bupivacaine). Sahal A. Altamimi, and Michael D. McKee J Bone Joint Surg Am 2008;90:1-8 ©2008 by The Journal of Bone and Joint Surgery, Inc.

Postoperative anteroposterior radiograph of the clavicle, showing anatomic reduction of the fracture and secure plate fixation. Sahal A. Altamimi, and Michael D. McKee J Bone Joint Surg Am 2008;90:1-8 ©2008 by The Journal of Bone and Joint Surgery, Inc.

Schematic demonstrating the difference between the precontoured anatomic plate and a standard compression plate, which tends to project from the bone medially and laterally and produces soft-tissue irritation. Sahal A. Altamimi, and Michael D. McKee J Bone Joint Surg Am 2008;90:1-8 ©2008 by The Journal of Bone and Joint Surgery, Inc.