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Moyo C Kruyt - One of the best experts on this subject based on the ideXlab platform.

Karl Stoffel - One of the best experts on this subject based on the ideXlab platform.

  • the comminuted midshaft Clavicle Fracture a biomechanical evaluation of plating methods
    Clinical Biomechanics, 2011
    Co-Authors: Paul R P Taylor, R E Day, Rochelle L Nicholls, John Rasmussen, Piers Yates, Karl Stoffel
    Abstract:

    Abstract Background The optimal plate location and fixation method for midshaft Fractures of the Clavicle remains undetermined. The objective of this study was to develop a realistic biomechanical model with which to compare superior with inferior-medial plate placement, and the failure resistance of locked and against non-locked constructs. Methods We estimated implant loads for operated patients in early rehabilitation utilising 3-D mathematical model of the shoulder. During simulation of upper limb motion associated with eating, the Fracture opened in an inferior and frontal direction. The peak X, Y, and Z loads from the simulation were reproduced using a materials testing machine. A one centimetre transverse osteectomy was created at the midshaft of forty composite Clavicles. Each specimen was then fixed with either (1) non-locked superior plating (n = 10), (2) locked superior plating (n = 10), (3) non-locked inferior-medial plating (n = 10), or (4) locked inferior-medial plating (n = 10). Specimens were loaded at 20 N/s in four-point bending for 50 cycles to the peak X, Y, Z moment obtained from the computational model (− 3.50, 2.46, and − 1.00 Nm), then loaded to failure at 20 N/s. Findings Inferior-medial unlocked plates were significantly stiffer than superior locked plates (P = 0.046). Interpretation Operative fixation of midshaft Clavicle Fractures is controversial, though becoming more widely accepted. Few biomechanical data are available to assist surgical decision-making. Inferior plates may be better equipped to resist the in vivo loads experienced by the Clavicle during early rehabilitation after internal fixation, particularly during the shoulder flexion motions associated with eating.

M J Stuart - One of the best experts on this subject based on the ideXlab platform.

  • g29 p the management of children diagnosed with an uncomplicated Clavicle Fracture broad arm sling and written self care information versus broad arm sling and hospital outpatient follow up
    Archives of Disease in Childhood, 2014
    Co-Authors: R A Crowder, A Rowland, S Tan, M Handford, M J Stuart
    Abstract:

    Background and objectives In July 2013 the Paediatric Emergency Department (ED) of a UK District General Hospital seeing approximately 30000 children per year aged under 16 years in the ED, began managing children diagnosed with an uncomplicated (no skin compromise and no clinical neuro-vascular deficit) Clavicle Fracture with a broad-arm sling and written self-care information, rather than a broad-arm sling and hospital-based Fracture clinic follow-up. All other children continued to be referred to the Fracture clinic. This study assessed the impact of this change in practice. Methods A 15 month retrospective review of all children diagnosed with a Clavicle Fracture was conducted. Referrals to Fracture clinic and the number of children re-attending the ED with complications related to the initial injury (for example pain or sling problem) were analysed. All children had a broad-arm sling applied. Results 91 children were diagnosed with a Clavicle Fracture, 59 (median 5/month) pre-change in practice and 32 (median 7/month) post-change. 64 (70%) were referred to the Fracture clinic, (52 (88%) pre-change in practice and 12 (38%) post-change). The remainder were discharged with written self-care information. In the one month following initial attendance, 3 (5%) re-attended the ED pre-change in practice and 0 (0%) post-change. Conclusions Children with an uncomplicated Clavicle Fracture can be appropriately managed with a broad-arm sling and written self-care information, rather than by hospital Fracture clinic follow-up. This more efficiently uses healthcare resources, reduces re-attendances during the month following initial injury and reduces social inconvenience for children and families.

Joseph L Rubino - One of the best experts on this subject based on the ideXlab platform.

  • distal third Clavicle Fracture fixation a biomechanical evaluation of fixation
    Journal of Shoulder and Elbow Surgery, 2013
    Co-Authors: Ryan G Rieser, Kenny Edwards, Gregory C Gould, Ronald J Markert, Tarun Goswami, Joseph L Rubino
    Abstract:

    Background Approximately 25% of distal Clavicle Fractures are unstable. Unstable patterns have longer times to union and higher nonunion rates. Stable restoration of the distal Clavicle is important in decreasing the nonunion rate in distal Clavicle Fractures. The purpose of this study was to biomechanically compare operative constructs for the treatment of unstable, comminuted distal-third Clavicle Fractures in a cadaveric model using a locking plate and coracoclavicular reconstruction. We hypothesized that the combination of coracoclavicular reconstruction and a distal Clavicle locking plate is biomechanically superior to either construct used individually. Materials and methods An unstable distal Clavicle Fracture was created in 21 thawed fresh-frozen cadaveric specimens. The 21 specimens were divided into 3 treatment groups of 7: distal-third locking plate, acromioclavicular (AC) TightRope (Arthrex, Naples, FL, USA), and distal-third locking plate and AC TightRope together. After fixation, each specimen was cyclically tested with recording of displacement to determine the stiffness and stability of each construct, followed by load-to-failure testing in tension and compression to determine the maximum load. Results The combined construct of the locking distal Clavicle plate and coracoclavicular reconstruction resulted in increased stiffness, maximum resistance to compression, and decreased displacement compared with either construct alone. Conclusion Greater Fracture stability was achieved with the combination of the AC TightRope and locking Clavicle plate construct than with either alone, suggesting a possibility for increased Fracture-healing rates.

Charlotte Steins N Bisschop - One of the best experts on this subject based on the ideXlab platform.