RESUMEN
BACKGROUND: Intramedullary clavicle fixation is a potential alternative to plate fixation. Previous studies documenting the complication rates of intramedullary clavicle fixation have demonstrated variable rates of soft tissue complications and fracture healing. QUESTIONS/PURPOSES: We asked the following questions: (1) Does use of the Rockwood Clavicle Pin (DePuy Orthopaedics Inc, Warsaw, IN) predispose patients to soft tissue complications requiring additional surgery or a high infection risk? (2) Does the Rockwood Clavicle Pin provide a truly minimally invasive insertion technique and reliable fracture fixation? PATIENTS AND METHODS: We retrospectively evaluated 18 patients (mean age, 31 years) who sustained a closed midshaft fracture of the clavicle treated with open intramedullary nailing with a Rockwood Clavicle Pin. We determined the incidence of complications and rate of fracture healing. RESULTS: Fourteen complications occurred in 10 patients. Five patients experienced a complication with fracture healing, including three nonunions. Nine patients experienced complications relating to soft tissue, including infection, skin necrosis, or posterior pain from pin prominence. CONCLUSIONS: The Rockwood Clavicle Pin remains a historically relevant method of clavicle fixation. However, due to an unacceptably high rate of nonunion, repeat operation, and soft tissue complications, we do not recommend this device for treating middiaphyseal clavicle fractures. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Asunto(s)
Clavos Ortopédicos , Clavícula/lesiones , Fijación Intramedular de Fracturas/efectos adversos , Fracturas Óseas/cirugía , Adolescente , Adulto , Clavícula/diagnóstico por imagen , Desbridamiento , Diseño de Equipo , Femenino , Curación de Fractura , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Estudios Retrospectivos , Traumatismos de los Tejidos Blandos/etiología , Adulto JovenRESUMEN
The throwing shoulder in pitchers frequently exhibits a paradox of glenohumeral joint motion, in which excessive external rotation is present at the expense of decreased internal rotation. The object of this study was to determine the role of humeral head retroversion in relation to increased glenohumeral external rotation. Glenohumeral joint range of motion and laxity along with humeral head and glenoid version of the dominant versus nondominant shoulders were studied in 25 professional pitchers and 25 nonthrowing subjects. Each subject underwent a computed tomography scan to determine bilateral humeral head and glenoid version. The throwing group demonstrated a significant increase in the dominant shoulder versus the nondominant shoulder in humeral head retroversion, glenoid retroversion, external rotation at 90 degrees, and external rotation in the scapular plane. Internal rotation was decreased in the dominant shoulder. Total range of motion, anterior glenohumeral laxity, and posterior glenohumeral laxity were found to be equal bilaterally. The nonthrowing group demonstrated no significant difference in humeral head retroversion, glenoid retroversion, external rotation at 90 degrees or external rotation in the scapular plane between shoulders, and no difference in internal rotation at 90 degrees, total motion, or laxity. A comparison of the dominant shoulders of the two groups indicated that both external rotation at 90 degrees and humeral head retroversion were significantly greater in the throwing group.