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Zhao XL, Liu YQ, Wang JG, Liu YC, Zhou JX, Wang BY, Zhang YJ. Distal clavicle fractures treated by anteroinferior plating with a single screw: Two case reports. World J Clin Cases 2023; 11:7502-7507. [PMID: 37969449 PMCID: PMC10643073 DOI: 10.12998/wjcc.v11.i30.7502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/08/2023] [Accepted: 10/11/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND For the treatment of distal clavicle fractures, each treatment method has its own advantages and disadvantages, and there is no optimal surgical solution. CASE SUMMARY Based on this, we report 2 cases of distal clavicle fractures treated utilizing an anterior inferior plate with a single screw placed in the distal, in anticipation of providing a better surgical approach to distal clavicle fracture treatment. Two patients were admitted to the hospital after trauma with a diagnosis of distal clavicle fracture, and were admitted to the hospital for internal fixation of clavicle fracture by incision and reduction, with good postoperative functional recovery. CONCLUSION With solid postoperative fixation and satisfactory prognostic functional recovery, this technique has been shown to be simple, easy to perform and effective.
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Affiliation(s)
- Xin-Lei Zhao
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou 014010, Inner Mongolia Autonomous Region, China
| | - Yan-Qing Liu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou 014010, Inner Mongolia Autonomous Region, China
| | - Jian-Guo Wang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou 014010, Inner Mongolia Autonomous Region, China
| | - You-Cai Liu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou 014010, Inner Mongolia Autonomous Region, China
| | - Jia-Xuan Zhou
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou 014010, Inner Mongolia Autonomous Region, China
| | - Bei-Yu Wang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou 014010, Inner Mongolia Autonomous Region, China
| | - Yi-Jun Zhang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou 014010, Inner Mongolia Autonomous Region, China
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Degeorge B, Ravoyard S, Lazerges C, Toffoli A, Chammas M, Coulet B. Clinical Impact of Malunion After All-Arthroscopic Coracoclavicular Stabilization for Displaced and Unstable Lateral Clavicle Fractures. J Orthop Trauma 2022; 36:e271-e277. [PMID: 34941602 DOI: 10.1097/bot.0000000000002330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the clinical outcome of lateral clavicle malunion treated with all-arthroscopic coracoclavicular (CC) stabilization. DESIGN Retrospective, case series. SETTING Department of hand and upper extremity surgery, university hospital center. PATIENTS Forty-five patients with unstable and displaced lateral clavicle fracture treated between January 2015 and August 2019 were included in the study. INTERVENTION Closed reduction and arthroscopic CC stabilization using cortical buttons. MAIN OUTCOME MEASUREMENTS Shoulder pain and active motion. Patient-reported outcome measures included the Constant score, the Subjective Shoulder Value, the AcromioClavicular Joint Instability score, and the Specific AcromioClavicular Score. Radiographic evaluation assessed bony union and malunion. RESULTS Mean duration of follow-up was 25 months (12-60 months). Five patients (11%) had lateral clavicle nonunion and 7 (16%) had lateral clavicle malunion (5 in the coronal plane and 2 in the axial plane). Lateral clavicle malunion did not significantly affect clinical or functional outcomes (P > 0.05). Mean active shoulder motion was forward flexion 163 degrees (SD 28), abduction 162 degrees (SD 26), and external rotation 63 degrees (SD 21). On average, the patients scored 88.3 (SD 17.7) in the Constant score, 90% (SD 12) in the Subjective Shoulder Value, 88.8 (SD 9.4) in the AcromioClavicular Joint Instability score, and 11.4 (SD 8.5) for SACS. The overall complication rate was 38% (including 7 malunions, 5 nonunions, 2 adhesive capsulitis, and 3 button malpositions). CONCLUSIONS Closed reduction and internal fixation of lateral clavicle fracture with all-arthroscopic CC stabilization using cortical button potentiates bony union but may generate lateral clavicle malunion, which does not affect the clinical or functional outcome. This result can be attributed to CC ligament healing and acromioclavicular joint congruence. All-arthroscopic CC stabilization is a minimally invasive but demanding surgical alternative for managing unstable and displaced lateral clavicle fracture. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Benjamin Degeorge
- Service de Chirurgie Orthopédique et Traumatologique du Membre Supérieur, Chirurgie de la Main et des Nerfs Périphériques, CHU Lapeyronie, Montpellier, France ; and
- Clinique Saint-Jean Sud de France, Groupe OrthoSud, Saint Jean de Védas, France
| | - Salomé Ravoyard
- Service de Chirurgie Orthopédique et Traumatologique du Membre Supérieur, Chirurgie de la Main et des Nerfs Périphériques, CHU Lapeyronie, Montpellier, France ; and
| | - Cyril Lazerges
- Service de Chirurgie Orthopédique et Traumatologique du Membre Supérieur, Chirurgie de la Main et des Nerfs Périphériques, CHU Lapeyronie, Montpellier, France ; and
| | - Adriano Toffoli
- Service de Chirurgie Orthopédique et Traumatologique du Membre Supérieur, Chirurgie de la Main et des Nerfs Périphériques, CHU Lapeyronie, Montpellier, France ; and
- Clinique Saint-Jean Sud de France, Groupe OrthoSud, Saint Jean de Védas, France
| | - Michel Chammas
- Service de Chirurgie Orthopédique et Traumatologique du Membre Supérieur, Chirurgie de la Main et des Nerfs Périphériques, CHU Lapeyronie, Montpellier, France ; and
| | - Bertrand Coulet
- Service de Chirurgie Orthopédique et Traumatologique du Membre Supérieur, Chirurgie de la Main et des Nerfs Périphériques, CHU Lapeyronie, Montpellier, France ; and
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Cunningham G, Culebras Almeida LA, Gauthier M. All-suture technique for fixation of unstable displaced distal clavicle fracture. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:168-173. [PMID: 37587969 PMCID: PMC10426583 DOI: 10.1016/j.xrrt.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background Displaced Neer type II and V clavicle fractures are usually treated surgically in active patients. However, distal fragment fixation remains a challenge, and no consensus has been established regarding the optimal surgical treatment. Osteosuture techniques have been popularized over the last decade, and multiple different techniques have been described. The aim of this study was to describe an all-suture technique in patients with displaced type II and V clavicle fractures and report its outcome in a prospective case series. Methods Between 2017 and 2020, 15 patients with displaced acute distal clavicle fractures were treated with an all-suture open technique performed by one shoulder specialized surgeon, with a minimum follow-up of 1 year. Osteosuture repair consisted in a coracoclavicular cerclage with 4 no6 Ethibonds and a figure-of-0 and figure-of-8 fracture cerclage with 2 no2 SutureTapes. Single assessment numerical evaluation (SANE) and adjusted Constant score were recorded at 6 months and 1 year. The radiologic union was assessed on plain radiographs. Results At 12 months, all patients reported excellent clinical results, with a mean SANE of 98.2 [± 5.2, range 80 to 100] and a mean adjusted Constant score of 99.0 [± 1.9, range 94 to 100]. One patient developed shoulder stiffness that resolved before the final follow-up. Fractures consolidated in 93% of the cases, with union happening between 3 and 6 months [range 3 to 12 months]. One patient developed an asymptomatic malunion. Conclusion Excellent clinical and radiological outcomes can be achieved with this minimally invasive all-suture fixation technique for displaced distal clavicle fractures, which allows for an anatomic reduction and stable fixation. This pilot study showed low complications and a high level of union after a follow-up of 1 year. Among the numerous advantages are a smaller exposure than for plate fixation, avoidance of hardware-related complications such as screw failure, coracoid fracture from drilling, or rotator cuff damage caused by hook-plates. Furthermore, it avoids a reoperation to remove symptomatic hardware.
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Affiliation(s)
- Gregory Cunningham
- Division of Orthopaedics and Traumatology, University Hospitals of Geneva, Geneva, Switzerland
- Shoulder and Elbow Center, Hirslanden Clinique La Colline, Geneva, Switzerland
| | - L. Alejandro Culebras Almeida
- Shoulder and Elbow Center, Hirslanden Clinique La Colline, Geneva, Switzerland
- Department of Orthopaedics, Balgrist University Hospital, Zürich, Switzerland
| | - Morgan Gauthier
- Division of Orthopaedics and Traumatology, University Hospitals of Geneva, Geneva, Switzerland
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Panagopoulos A, Solou K, Tatani I, Triantafyllopoulos IK, Lakoumentas J, Kouzelis A, Athanasiou V, Kokkalis ZT. What is the optimal surgical treatment for Neer type IIB (IIC) distal clavicle fractures? A systematic review and meta-analysis. J Orthop Surg Res 2022; 17:215. [PMID: 35392941 PMCID: PMC8991691 DOI: 10.1186/s13018-022-03108-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 03/29/2022] [Indexed: 11/20/2022] Open
Abstract
Background The purpose of the present study was to systematically review the current treatment strategies for the treatment of Neer type IIB distal clavicle fractures in terms of functional outcome and complication rates and to examine the most appropriate surgical method by comparing all the available surgical techniques and implants. Methods We performed a systematic review of the existing literature (2000–2021) in accordance with the PRISMA statement. We searched PubMed, Scopus, Web of Science, Research Gate and Google Scholar using the general terms ‘distal AND clavicle AND fracture’ to capture as many reports as possible. The MINORS tool was used to assess the risk of bias of the nonrandomized studies. We categorized the reported surgical techniques into four main types: open or arthroscopic coracoclavicular (CC) stabilization, locking plate fixation with or without CC augmentation, hook plate fixation and acromioclavicular joint (ACJ) transfixation. We reported findings for two main outcomes: clinical results and complication rates categorized into major and minor. Results Our database search yielded a total of 630 records; 34 studies were appropriate for qualitative analysis. There were 790 patients, with a mean age of 40.1 years, a female percentage of 37% and a mean follow-up period of 29.3 months. In total, 132 patients received a hook plate, 252 received a locking plate, 368 received CC stabilization and 41 received transacromial transfixation. All studies were retrospective and had fair MINORS scores. Locking plate, CC stabilization and ACJ transfixation showed similar clinical results but were much better than hook plate fixation; CC augmentation did not significantly improve the outcome of locking plate fixation. The rate of major complications was similar among groups; hook plate and AC joint transfixation had the worst rates of minor complications. Open CC techniques were slightly better than arthroscopic techniques. Conclusions The present systematic review for the optimal fixation method for Neer type IIB fractures of the distal clavicle showed similar major complication rates among techniques; the hook plate technique demonstrated inferior clinical results to other techniques. Open CC stabilization and locking plate fixation without CC augmentation seem to be the best available treatment options.
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Affiliation(s)
- Andreas Panagopoulos
- Department of Shoulder and Elbow Surgery, Patras University Hospital, Papanikolaou 1, 26504, Rio-Patras, Greece.
| | - Konstantina Solou
- Department of Shoulder and Elbow Surgery, Patras University Hospital, Papanikolaou 1, 26504, Rio-Patras, Greece
| | - Irini Tatani
- Department of Shoulder and Elbow Surgery, Patras University Hospital, Papanikolaou 1, 26504, Rio-Patras, Greece
| | | | - John Lakoumentas
- Department of Medical Physics, School of Medicine, Patras University, Rio-Patras, Greece
| | - Antonis Kouzelis
- Department of Shoulder and Elbow Surgery, Patras University Hospital, Papanikolaou 1, 26504, Rio-Patras, Greece
| | - Vasileios Athanasiou
- Department of Shoulder and Elbow Surgery, Patras University Hospital, Papanikolaou 1, 26504, Rio-Patras, Greece
| | - Zinon T Kokkalis
- Department of Shoulder and Elbow Surgery, Patras University Hospital, Papanikolaou 1, 26504, Rio-Patras, Greece
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Concomitant glenohumeral injuries in patients with distal clavicle fractures undergoing arthroscopic-assisted surgery: a systematic review. J Orthop Surg Res 2022; 17:31. [PMID: 35033147 PMCID: PMC8761272 DOI: 10.1186/s13018-022-02919-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/03/2022] [Indexed: 11/10/2022] Open
Abstract
Background To determine the incidence of concomitant intra-articular glenohumeral injuries in patients undergoing surgical management from distal clavicle fractures (DCF) with shoulder arthroscopy and their impact on outcome. Methods This systematic review was conducted following the PRISMA guidelines. PubMed, EMBASE, and Virtual Health Library databases were accessed in October 2021. All the clinical studies evaluating the surgical management of DCF and using concomitant intra-operatory shoulder arthroscopy were included. Studies that did not specify the concomitant injury type were not eligible. Data from the incidence of intra-articular glenohumeral injuries, injury type, length of the follow-up, and clinical outcomes were retrieved. The quantitative content assessment was performed using the STROBE statement checklist. Evaluation of the publication bias of the included studies was performed using the risk of bias assessment tool for systematic reviews. Results Data from five retrospective and five prospective cohort studies were analyzed. Eight of the included studies were conducted on patient cohorts with Neer type II injuries. Data pooling revealed a mean of 17.70% of concomitant glenohumeral injuries, whereas 84.21% of them required additional surgical management (Table 1). Rotator cuff injuries, labral tears, and biceps pulley lesions were the most common concomitant injuries. Conclusion Preoperative MRI or diagnostic arthroscopy to evaluate glenohumeral associated injuries to DCF should be recommended.
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Kim BS, Kim DH, Choi BC, Cho CH. Comparison of Locking Plate Osteosynthesis versus Coracoclavicular Stabilization for Neer Type IIB Lateral Clavicle Fractures. Clin Orthop Surg 2022; 14:319-327. [PMID: 36061845 PMCID: PMC9393275 DOI: 10.4055/cios22080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 05/19/2022] [Accepted: 05/26/2022] [Indexed: 11/17/2022] Open
Abstract
Background The best option for the treatment of Neer type IIB lateral clavicle fractures remains controversial. The aim of this study was to compare outcomes and complications between pre-contoured locking plate osteosynthesis (PLPO) and coracoclavicular stabilization (CCS) using a TightRope for the treatment of type IIB fractures. Methods Forty-six consecutive type IIB fractures were treated with PLPO (17 cases) or CCS (29 cases). The mean follow-up period was 33.7 months (range, 12–144 months). Radiographic outcomes were evaluated using serial plain radiographs. Clinical outcomes were evaluated using the University of California, Los Angeles (UCLA) score, the American Shoulder and Elbow Surgeons (ASES) score, and subjective shoulder value (SSV). Results Of the 46 cases, complete bony union within 6 months after surgery was achieved in 42 cases (91.3%). The union rate was 100% (17/17) in the PLPO group and 86.2% (25/29) in the CCS group, showing a statistically significant difference (p = 0.043). No significant differences in terms of UCLA score (32.8 vs. 32.1), ASES score (93.2 vs. 90.8), or SSV (89.1% vs. 90.3%) were observed between the PLPO and CCS groups. The complication rates were 17.6% (3/17; 2 cases of screw breakage and 1 case of stiffness) in the PLPO group and 37.9% (11/29; 4 cases of nonunion, 3 cases of stiffness, 2 cases of skin irritation, 1 case of superficial infection, and 1 case of coracoid button migration) in the CCS group, showing no statistically significant difference (p > 0.05). Four cases with nonunion after CCS did not require reoperation because they had good to excellent clinical outcomes without radiographic progression. Conclusions Although a higher nonunion rate was observed in the CCS group compared with the PLPO group, satisfactory clinical outcomes were obtained for both groups. Both techniques can be regarded as useful options for the treatment of Neer type IIB lateral clavicle fractures.
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Affiliation(s)
- Beom-Soo Kim
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Du-Han Kim
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Byung-Chan Choi
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Chul-Hyun Cho
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
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Erden T, Kapicioglu M, Ersen A, Toker B, Sahin K, Bilsel K. Arthroscopic coracoclavicular button fixation versus anatomic locking plate fixation for unstable distal clavicular fractures. JSES Int 2021; 5:835-839. [PMID: 34505092 PMCID: PMC8411051 DOI: 10.1016/j.jseint.2021.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Hypothesis Neer type II distal clavicle fractures are unstable and associated with high nonunion rates. The aim of this retrospective study was to compare the clinical and radiographic outcomes of anatomic locking plate fixation and arthroscopic coracoclavicular button fixation for unstable distal clavicle fractures. Methods Forty-seven patients with Neer type II distal clavicle fractures were treated surgically using either anatomic locking plate fixation (group 1, n = 20) or all arthroscopic coracoclavicular button fixation (group 2, n = 27) between 2012 and 2019 in 2 centers. Clinical and radiographic outcomes after an average follow-up period of 49 months for group 1 and 32 months for group 2 were assessed using the American Shoulder and Elbow Surgeons Shoulder score, Constant-Murley score, visual analog scale score and X-rays. Results At the final follow-up, the mean American Shoulder and Elbow Surgeons Shoulder score, Constant-Murley score, and visual analog scale score for group 1 and group 2 were 92.5 ± 3.9 (range 88.3-98.3), 93.6 ± 4.0 (range 90-100), and 0.6 ± 0.6 (range 0-2) and 95 ± 3.3 (range 86.6-100), 96.2 ± 3.0 (range 88-100), and 0.4 ± 0.5 (range 0-1), respectively (P = .32, P = .15, and P = .59, respectively). At the final follow-up, acceptable reduction and bone healing were achieved in all patients. All patients in both groups were able to resume work as well as sports activities. Postoperative complications included 1 case of acromioclavicular joint arthritis and 1 case of screw penetration in group 1 and 2 cases of coracoid process fracture that did not require additional surgery in group 2. Five patients underwent hardware removal owing to skin irritation and dissatisfaction with the cosmetic appearance in group 1. Conclusion Both distal anatomic locking plate fixation and arthroscopic coracoclavicular button fixation provide satisfactory functional and radiological outcomes. Both procedures can be used to treat distal clavicle fractures because they have a minimal risk of complications and present similar, high union rates.
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Affiliation(s)
- Tunay Erden
- Acıbadem Fulya Hospital, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Mehmet Kapicioglu
- Bezmialem Vakif University Medical School, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Ali Ersen
- Istanbul University Medical Faculty, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Berkin Toker
- Acıbadem Fulya Hospital, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Koray Sahin
- Istanbul University Medical Faculty, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Kerem Bilsel
- Bezmialem Vakif University Medical School, Department of Orthopaedics and Traumatology, Istanbul, Turkey
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Fixation of distal clavicle fractures with coracoclavicular instability: a comparative biomechanical study in human cadavers. JSES Int 2021; 6:144-148. [PMID: 35141689 PMCID: PMC8811411 DOI: 10.1016/j.jseint.2021.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background The need for coracoclavicular (CC) stabilization in the fixation of fractures with CC instability (Neer type IIB and V) was biomechanically demonstrated by higher construct strength than isolated locking plate osteosynthesis. It was the purpose of this study to prove noninferiority of the new cow-hitch suture repair technique compared with the well-established suture tape double-button fixation with regard to overall fixation strength and cyclic loading properties. Methods Twelve human cadaver shoulders (7 right and 5 left) were matched for sex and age (mean age: 75 ± 5 years). An oblique parasagittal fracture line 20 mm medial to the acromioclavicular joint line was created, and the CC ligaments were dissected. Six shoulders were reconstructed by a double FiberTape fixation with two suture buttons (group DB), and the remaining six shoulders by a cow-hitch suture repair using a double FiberWire with only coracoid button fixation (group CH). Both reconstruction techniques were tested in a servo-hydraulic material testing machine for cyclic displacement (mm), stiffness (N/mm), and maximum load-to-failure (N) after 500 cycles at 3 mm/s and inferosuperior load between 15 and 70 N. Superior fragment displacement in space was recorded using a MicroScribe digitizer. Results There were no statistically significant differences regarding cyclic displacement (group DB: 0.7 mm; group CH: 1.3 mm; P = .36), stiffness (group DB: 177 N/mm; group CH: 116 N/mm; P = .17), maximum load-to-failure (group DB: 560 N; group CH: 492 N; P = .59), and superior displacement in space of the medial fragment (group DB: 3.2 mm; group CH: 1.6 mm; P = .48). Conclusion Fixation of unstable distal clavicle fractures using a double FiberWire cow-hitch suture repair with isolated coracoid button fixation for stand-alone CC stabilization resulted in similar biomechanical properties to a double-suture button fixation with FiberTapes while avoiding prominent clavicular implants.
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Panagopoulos A, Solou K, Nicolaides M, Triantafyllopoulos IK, Kouzelis A, Kokkalis ZT. Coracoclavicular fixation techniques for Neer IIb and ‘extra-lateral’ fractures of the distal clavicle: A systematic review. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021. [DOI: 10.1016/j.xrrt.2021.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Kapicioglu M, Erden T, Bilgin E, Bilsel K. All arthroscopic coracoclavicular button fixation is efficient for Neer type II distal clavicle fractures. Knee Surg Sports Traumatol Arthrosc 2021; 29:2064-2069. [PMID: 32382804 DOI: 10.1007/s00167-020-06048-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 04/29/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Neer type II distal clavicle fractures are associated with a high rate of non-union or malunion due to impaired coracoclavicular ligament stability. The purpose of this study was to assess the clinical and radiological outcomes of arthroscopically assisted indirect osteosynthesis for type II distal clavicle fractures using a cortical suture button device. METHODS Seventeen patients Neer type II fractures of the distal clavicle were treated surgically using cortical suture button fixation between 2012 and 2017. The clinical and radiological results were assessed using the American Shoulder and Elbow Surgeons Shoulder Score (ASES), Constant-Murley score and visual analogue scale (VAS) score. RESULTS Anatomic reduction and bone healing were achieved in all patients at the final follow-up. The median age of the patients was 31 years (range 19-57). The mean follow-up was 25.9 months (range 14-64). The average delay before surgery was 2 days (range 1-4). At the final follow-up, the mean ASES, Constant-Murley score and VAS score were 92.6 ± 3.2 (range 84.9-96.6), 96.2 ± 2.4 (range 92-100) and 0.47 ± 0.51 (range 0-1), respectively. All patients were able to resume work as well as sport activities. The postoperative complications included two coracoid process fractures, and none of the patients required additional surgery related to the index procedure. CONCLUSION All arthroscopic coracoclavicular button fixation of Neer type II distal clavicle fractures would provide sufficient stability and union with satisfactory radiological and clinical outcomes. This arthroscopic fixation technique would be more efficient than other osteosynthesis methods because it is a minimally invasive surgery with a low complication rate. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Mehmet Kapicioglu
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University Medical School, Istanbul, Turkey
| | - Tunay Erden
- Department of Orthopaedics and Traumatology, Acıbadem Fulya Hospital, Istanbul, Turkey.
| | - Emre Bilgin
- Department of Orthopaedics and Traumatology, Tepecik Education and Research Hospital, Izmir, Turkey
| | - Kerem Bilsel
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University Medical School, Istanbul, Turkey
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Yagnik GP, Seiler JR, Vargas LA, Saxena A, Narvel RI, Hassan R. Outcomes of Arthroscopic Fixation of Unstable Distal Clavicle Fractures: A Systematic Review. Orthop J Sports Med 2021; 9:23259671211001773. [PMID: 33997073 PMCID: PMC8111282 DOI: 10.1177/23259671211001773] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Surgical management of unstable distal clavicle fractures (DCFs) remains controversial. Traditional open techniques result in acceptable union rates but are fraught with complications. In response to these limitations, arthroscopic techniques have been developed; however, clinical outcome data are limited. Purpose: The primary purpose was to systematically evaluate the clinical and radiographic outcomes of arthroscopic fixation of unstable DCFs. The secondary purpose was to characterize the overall complication rate, focusing on major complications and subsequent reoperations. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of the literature was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and included a search of the PubMed, Web of Science, Cochrane Register of Controlled Trials, EMBASE, and Scopus databases. English-language studies between 2008 and 2019 that reported on outcomes of patients with DCFs who underwent operative fixation using an arthroscopic or arthroscopically assisted surgical technique were included. Data consisted of patient characteristics, fracture type, surgical technique, concomitant injuries, union rates, functional outcomes, and complications. Results: A total of 15 studies consisting of 226 DCFs treated using an arthroscopically based technique were included in the systematic review. The majority of fractures were classified as Neer type II. Most (97%) of the fractures underwent arthroscopic fixation using a cortical button coracoclavicular stabilization surgical technique. Bony union was reported in 94.1% of the fractures. Good to excellent outcomes were recorded in most patients at the final follow-up. The Constant-Murley score was the most widely used functional outcome score; the pooled mean Constant score was 93.06 (95% CI, 91.48-94.64). Complications were reported in 14 of the 15 studies, and the overall complication rate was 27.4%. However, only 12% of these were considered major complications, and only 6% required a reoperation for hardware-related complications. Conclusion: Arthroscopic fixation of DCFs resulted in good functional outcomes with union rates comparable to those of traditional open techniques. While the overall complication profile was similar to that of other described techniques, there was a much lower incidence of major complications, including hardware-related complications and reoperations.
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Affiliation(s)
- Gautam P Yagnik
- Miami Orthopedics and Sports Medicine Institute, Miami, Florida, USA
| | - Jacob R Seiler
- Miami Orthopedics and Sports Medicine Institute, Miami, Florida, USA
| | - Luis A Vargas
- Miami Orthopedics and Sports Medicine Institute, Miami, Florida, USA
| | | | - Raed I Narvel
- Florida International University, Miami, Florida, USA
| | - Robert Hassan
- Florida International University, Miami, Florida, USA
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12
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Fox HM, Ramsey DC, Thompson AR, Hoekstra CJ, Mirarchi AJ, Nazir OF. Neer Type-II Distal Clavicle Fractures: A Cost-Effectiveness Analysis of Fixation Techniques. J Bone Joint Surg Am 2020; 102:254-261. [PMID: 31809393 DOI: 10.2106/jbjs.19.00590] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Neer type-II distal clavicle fractures are unstable and are generally appropriately managed with operative fixation. Fixation options include locking plates, hook plates, and suture button devices. No consensus on optimal technique exists. METHODS A decision tree model was created describing fixation of Neer type-II fractures using hook plates, locking plates, or suture buttons. Outcomes included uneventful healing, symptomatic implant removal, deep infection requiring debridement, and nonunion requiring revision. Weighted averages derived from a systematic review were used for probabilities. Cost-effectiveness was evaluated by calculating incremental cost-effectiveness ratios (ICERs). The ICER is defined as the ratio of the difference in cost and difference in effectiveness of each strategy, and is measured in cost per quality-adjusted life year (QALY). The model was evaluated using thresholds of $50,000/QALY and $100,000/QALY. Sensitivity analysis was performed on all outcome probabilities for each fixation strategy to assess cost-effectiveness across a range of values. RESULTS Forty-three papers met final inclusion criteria. Using suture buttons as the reference case in the health-care cost model, suture button repair was dominant (both less expensive and clinically superior). Hook plates cost substantially more ($5,360.52) compared with suture buttons and locking plates ($3,713.50 and $4,007.44, respectively). Suture buttons and locking plates yielded similar clinical outcomes (0.92 and 0.91 QALY, respectively). Suture button dominance persisted in the societal perspective model. Sensitivity analysis on outcome probabilities showed that locking plates became the most cost-effective strategy if the revision rate after their use was lowered to 2.2%, from the overall average in the sources of >19%. No other changes in outcome probabilities for any of the 3 techniques allowed suture buttons to be surpassed as the most cost-effective. CONCLUSIONS The cost-effectiveness of suture buttons is driven by low revision rates and high uneventful healing rates. Similar QALY values for locking plate and suture button fixation were observed, which is consistent with existing literature that has failed to identify either as the clinically superior technique. Cost-effectiveness should fit prominently into the decision-making rubric for these injuries. LEVEL OF EVIDENCE Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Henry M Fox
- Departments of Orthopaedics and Rehabilitation (H.M.F., D.C.R., A.R.T., A.J.M., and O.F.N.) and Medical Informatics and Clinical Epidemiology (C.J.H.), Oregon Health & Science University, Portland, Oregon
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13
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Yagnik GP, Jordan CJ, Narvel RR, Hassan RJ, Porter DA. Distal Clavicle Fracture Repair: Clinical Outcomes of a Surgical Technique Utilizing a Combination of Cortical Button Fixation and Coracoclavicular Ligament Reconstruction. Orthop J Sports Med 2019; 7:2325967119867920. [PMID: 31579680 PMCID: PMC6757504 DOI: 10.1177/2325967119867920] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: When treated conservatively, unstable distal clavicle fractures demonstrate a high symptomatic nonunion rate. While a variety of surgical techniques have been described, many of these techniques are associated with high failure rates and hardware-related complications. The surgical technique used in this study has shown promising biomechanical results; however, long-term clinical results have not yet been described. Purpose: To assess the clinical and radiological outcomes of a surgical technique for fixing displaced distal clavicle fractures using a combination of cortical button fixation and coracoclavicular (CC) ligament reconstruction. Study Design: Case series; Level of evidence, 4. Methods: We conducted a retrospective review of 22 consecutive patients with displaced, unstable Neer type II or V distal clavicle fractures who underwent this surgical technique from 2012 to 2019. Primary outcome variables were radiographic union, patient satisfaction, and postoperative shoulder function. Preoperative and postoperative University of California, Los Angeles (UCLA), and American Shoulder and Elbow Surgeons (ASES) scores were compared. Secondary outcome variables included intraoperative complications, postoperative complications, time to radiographic union, and preoperative and postoperative CC distance. Quality of life was assessed using preoperative and postoperative 36-Item Short Form Health Survey (SF-36) scores. Results: Nearly all (21/22) patients were available for a final review; 1 patient was lost to follow-up at 2 weeks. All 21 patients achieved radiographic union by 4 months (mean, 60.38 days; range, 41-84 days; 95% CI, 53.80-66.96 days). All patients were satisfied with the surgical procedure and their functional outcome. The mean UCLA score improved from 5.36 (95% CI, 4.14-6.60) preoperatively to 32.52 (95% CI, 30.56-34.48) postoperatively (mean difference, 27.14; P < .001). The mean ASES score improved from 16.23 (95% CI, 9.79-22.67) preoperatively to 88.11 (95% CI, 81.82-94.40) postoperatively (mean difference, 71.91; P < .001). Statistically significant improvements in SF-36 scores were seen in the physical functioning, role limitations due to physical health, pain, social functioning, and emotional well-being categories. There were 3 postoperative complications, including 1 patient with a minor complication secondary to hardware irritation, 1 patient with adhesive capsulitis, and 1 patient with wound dehiscence requiring wound closure. Conclusion: We describe a surgical technique for fixing displaced distal clavicle fractures using a combination of cortical button fixation and CC ligament reconstruction that resulted in a 100% union rate and excellent clinical outcomes with acceptable complications.
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Affiliation(s)
- Gautam P Yagnik
- Miami Orthopedics & Sports Medicine Institute, Baptist Health South Florida, Coral Gables, Florida, USA
| | - Charles J Jordan
- Miami Orthopedics & Sports Medicine Institute, Baptist Health South Florida, Coral Gables, Florida, USA
| | - Raed R Narvel
- Miami Orthopedics & Sports Medicine Institute, Baptist Health South Florida, Coral Gables, Florida, USA
| | - Robert J Hassan
- Miami Orthopedics & Sports Medicine Institute, Baptist Health South Florida, Coral Gables, Florida, USA
| | - David A Porter
- Miami Orthopedics & Sports Medicine Institute, Baptist Health South Florida, Coral Gables, Florida, USA
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14
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Hohmann E, Tetsworth K, Glatt V. Operative Treatment of Neer Type-II Distal Clavicular Fractures: An Overview of Contemporary Techniques. JBJS Rev 2019; 7:e5. [PMID: 31116128 DOI: 10.2106/jbjs.rvw.18.00046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Erik Hohmann
- Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,Department of Orthopaedic Surgery and Sports Medicine, Valiant Clinic/Houston Methodist Group, Dubai, United Arab Emirates
| | - Kevin Tetsworth
- Department of Orthopaedic Surgery, Royal Brisbane Hospital, Herston, Queensland, Australia.,Department of Surgery, School of Medicine, University of Queensland, Herston, Queensland, Australia.,Queensland University of Technology, Brisbane, Queensland, Australia.,Orthopaedic Research Centre of Australia, Herston, Brisbane, Queensland, Australia
| | - Vaida Glatt
- Orthopaedic Research Centre of Australia, Herston, Brisbane, Queensland, Australia.,University of Texas Health Science Center at San Antonio, San Antonio, Texas
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15
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Takase K, Yamamoto K. Outcomes and function of conoid ligament on the basis of postoperative radiographic findings of arthroscopic stabilization for the distal clavicle fractures. Orthop Traumatol Surg Res 2019; 105:281-286. [PMID: 30876712 DOI: 10.1016/j.otsr.2018.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 11/30/2018] [Accepted: 12/11/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE Distal clavicle fractures are divided into three types according to Neer's classification. These fractures are usually treated with a sling to immobilize the upper extremity, however, the treatment of type 2 fractures remain controversial. We focused on the anatomical basis of these fractures in which disruptions in the conoid ligament led to the distraction between the two bony fragments. In this study, we report an arthroscopic procedure for conoid ligament reconstruction and its therapeutic outcomes, and discuss the function of the reconstructed conoid ligament. HYPOTHESIS Arthroscopic conoid ligament reconstruction alone is sufficient to retain the posteriorly displaced proximal fragment of the clavicle in its reduced position. MATERIALS AND METHODS A retrospective cohort study were conducted on 18 patients with type 2 distal clavicle fractures. Arthroscopic techniques were performed with the patients in the beach chair position. Dacron artificial ligament® was used to reconstruct the conoid ligament, and the internal bone fixation materials included an EndoButton® on the coracoid process side and a screw with a spiked washer on the clavicle side. Preoperative assessment was performed via plain radiography or three-dimensional computed tomography to evaluate the displacement of the proximal fragment. Although the displacement was superoposterior in all the cases, the acromioclavicular joint was maintained. The mean duration of postoperative follow-up was 2 years and 5 months. RESULT There were no injury-related complications during the surgery and bony union was achieved within 3 months after surgery. Evaluation using 3DCT also showed that the preoperative superoposterior displacement of the proximal fragment of the clavicle was immediately reduced postoperatively, and this reduced position was maintained until the final follow-up examination. CONCLUSIONS We achieved good results by indirectly reducing fractures of the distal clavicle with conoid ligament damage using the minimally invasive surgical technique of arthroscopic conoid ligament reconstruction. Anatomical reconstruction of the conoid ligament might stabilize not only the superior displacement of the displaced proximal fragment of the clavicle but also its posterior displacement. STUDY DESIGN Case series with no comparison study. LEVEL OF EVIDENCE 4, retrospective cohort study.
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Affiliation(s)
- Katsumi Takase
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku Shinjuku-ku, 160-0023 Tokyo, Japan.
| | - Kengo Yamamoto
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku Shinjuku-ku, 160-0023 Tokyo, Japan
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16
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Which lateral clavicle fractures can be treated by an arthroscopic-assisted endobutton procedure? An analysis of risk factors. Arch Orthop Trauma Surg 2019; 139:331-337. [PMID: 30474705 DOI: 10.1007/s00402-018-3075-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Arthroscopy-assisted treatment of lateral clavicle fractures with coracoclavicular stabilization and an endobutton device have gained popularity over recent years. There is little evidence to support which types of lateral clavicle fractures are suitable for this treatment. The primary aim of this study was to evaluate the clinical und radiological outcomes of this treatment and to identify which fracture types are suitable. The secondary outcome was to evaluate potential risk factors for complications MATERIAL/METHODS: A retrospective single center review of 20 unstable lateral clavicle fractures treated with an arthroscopy-assisted CC stabilization technique and Endobutton device between September 2012 and August 2016. The functional outcome was evaluated using Constant and DASH Scores, VAS and SSV. RESULTS Between September 2012 and August 2016, 20 patients were treated using this method (average age 45 years; male: female ratio 14:6). The DASH Score was on average 2.0 (0-9.82) and the Constant Score on average 81.8 points (range 68-93) with an average difference between the affected and the unaffected side of 4.1 points (range 0-15). Six patients had nonunion fractures of which two needed revision. CONCLUSIONS Our study shows that arthroscopy-assisted CC stabilization using an endobutton technique delivers good functional results. Highly lateral unstable clavicle fractures seem to be especially suitable for this surgical technique. There was a high number of delayed unions. Analysis of risk factors showed that early mechanical stress, a lateral clavicular fragment larger than 3 cm and a time delay to surgery could be risk factors for nonunions.
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Lim TK, Oh WK. Intraoperative and Postoperative Complications after Arthroscopic Coracoclavicular Stabilization. Clin Orthop Surg 2019; 11:103-111. [PMID: 30838114 PMCID: PMC6389532 DOI: 10.4055/cios.2019.11.1.103] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/12/2018] [Indexed: 11/29/2022] Open
Abstract
Background Arthroscopic stabilization of torn coracoclavicular (CC) ligaments gained popularity recently. However, loss of reduction after the operation and complications unique to this technique involving tunnel placement through the distal clavicle and coracoid process are concerns. The purpose of this study was to report intraoperative and early postoperative complications associated with this procedure. Methods This study retrospectively evaluated 18 consecutive patients who had undergone arthroscopic stabilization for torn CC ligaments between 2014 and 2015. The indications for surgery were acute or chronic acromioclavicular dislocation and acute fracture of the distal clavicle, associated with CC ligament disruption. Clinical outcomes were evaluated with the American Shoulder and Elbow Surgeons (ASES) and the University of California, Los Angeles (UCLA) scores. Intra- and postoperative complications and reoperations were investigated. Results There were six female and 12 male patients with a mean age of 47 years (range, 22 to 86 years). At a mean follow-up of 17 ± 10 months (range, 10 to 28 months), the mean ASES score was 88.8 ± 19.9 and the mean UCLA score was 30.9 ± 5.2. Intraoperatively, seven complications developed: breach of lateral cortex of the coracoid process in five patients, medial cortex of the coracoid process in one, and anterior cortex of the clavicle in one. Postoperative complications developed in eight patients: four ossifications of the CC interspace, four tunnel widening of the clavicle, one bony erosion on the clavicle, and one superficial infection. A loss of reduction was found in six patients. Reoperation was performed in three patients for loss of reduction in two and superficial infection in the other. Conclusions Arthroscopic CC stabilization resulted in high rates of intraoperative and early postoperative complications. Most of them were related to the surgical technique involving bone tunnel placement in the coracoid process and the clavicle.
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Affiliation(s)
- Tae Kang Lim
- Department of Orthopaedic Surgery, Eulji Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Whang Kyun Oh
- Department of Orthopaedic Surgery, Eulji Hospital, Eulji University School of Medicine, Seoul, Korea
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