PURPOSE: To review clinical and radiological results after open reduction and internal fixation with T plate for unstable distal clavicle fractures. MATERIALS AND METHODS: From July. 1999 to December 2002, nine patients with distal clavicle Neer type II fractures were treated by open reduction and internal fixation with T plate. The bony union was confirmed by plain radiography. The clinical results were analyzed according to the classification by Kona et al. RESULTS: Average time to fracture union was 8 weeks in all cases. The functional results were as follows: excellent in 7 cases and good in 2 cases. Screw loosening occurred in one case, but bony union was achieved. CONCLUSION: We recommend T plate fixation as another treatment method for unstable distal clavicle fractures.
Classification ; Clavicle* ; Humans ; Radiography

While clavicular injuries are fairly common, bipolar clavicular injuries are not. They may involve dislocations at both ends of the clavicle, or a fracture at one end and a dislocation at the other. We present two cases; a patient with a bipolar clavicular dislocation, and another with a fracture in both medial and lateral ends of the clavicle with anterior dislocation of the sternoclavicular joint. Both were treated conservatively, with fairly good range of motion and return to normal activity.
Accidental Falls ; Accidents, Traffic ; Clavicle/*injuries ; Clavicle/radiography ; Dislocations/radiography ; Dislocations/*therapy

BACKGROUND: Neer type II distal clavicle fractures have the drawback of coracoclavicular instability and insufficient distal bony fragment, thereby making it difficult to achieve adequate fixation. Although various surgical treatments have been described for Neer type II fracture, the optimal treatment remains controversial. This study reports the clinical results and usefulness of anatomical locking plate with additional K-wire fixation. METHODS: A totally of 21 patients with type II distal clavicle fracture were included in the study. The surgical procedure reduced the fracture temporarily; it included insertion of one or two K-wire from the lateral margin of the distal fragment to the proximal fragment through the fracture site, followed by application and fixation of the locking plate. The bony union and migration of K-wire was evaluated in the follow-up radiography. The coracoclavicular distance and acromioclavicular joint arthrosis were assessed at the final follow-up. The Constant Score (CS) and Korean Shoulder Score (KSS) were evaluated for clinical scoring. RESULTS: Bone union was achieved in all cases. At the final follow-up, coracoclavicular distance of the injured shoulder was increased, as compared to the intact shoulder (p=0.002), with no accompanying clinical symptoms. No K-wire migration was observed. At the final follow-up, K-wire irritation was observed in two cases and acromioclavicular arthrosis in one case, with no other adverse effects. Pain visual analogue scale, CS, and KSS were improved in all cases. CONCLUSIONS: The method of anatomical locking plate with additional K-wire fixation could be useful in achieving beneficial clinical results.
Acromioclavicular Joint ; Clavicle* ; Follow-Up Studies ; Humans ; Methods ; Radiography ; Shoulder

PURPOSE: To evaluate normal variations and thus to avoid confusion in differentiation from lesions of the accessory structures (rhomboid fossa, foramen for supraclavicular nerve, conold tubercle) of the clavicle in chest radiographs. MATERIALS AND METHODS: We studied the variations of the clavicle in 300 chest radiographs (134 men, 166 women) and 355 dry bones (right 166, left 189; 151 men, 74 women, 130 unknown sex). RESULTS: In chest radiographs, the incidence of the depressed rhomboid fossa was 229 cases (39.5%;male 52.0%, female 29.9%);the flat type was 329 cases (56.9%;male 45.7%, female 65.7%);and the elevated type was 20 cases (3.5%; male 2.4%, female 4.3%). In the dry bones, the incidence of the depressed thombold fossa was 129 cases (57.3%;male 59.6%, female 52.7%);the flat type was 65 cases (28.9%;male 24.5%, female 37. 8%) ;and the elevated type was 31 cases (13.8%;male 15.9%, female 9.5%). The incidence of the foramen for supraclavicular nerve was 0.8% in chest radiographs, and 1.4% in the dry bones. The incidence of the elevated conold tubercle was 65.1% (male 64.0%, female 65.9%) in chest radiographs, and 96.9% (male 95.4%, female 100.0%) in the dry bones. CONCLUSIONS: The incidence of the depressed rhomboid fossa in chest radiographs was higher in men and the right clavicle. The incidence of flat rhombo~d fossa in chest radiographs decreased according to increase of age. The foramen for supraclavicular nerve was occasionally found (0.8% in chest radiographs; 1.4% in the dry bones).
Clavicle* ; Female ; Humans ; Incidence ; Male ; Radiography, Thoracic* ; Thorax*

PURPOSE: To evaluate normal variations and thus to avoid confusion in differentiation from lesions of the accessory structures (rhomboid fossa, foramen for supraclavicular nerve, conold tubercle) of the clavicle in chest radiographs. MATERIALS AND METHODS: We studied the variations of the clavicle in 300 chest radiographs (134 men, 166 women) and 355 dry bones (right 166, left 189; 151 men, 74 women, 130 unknown sex). RESULTS: In chest radiographs, the incidence of the depressed rhomboid fossa was 229 cases (39.5%;male 52.0%, female 29.9%);the flat type was 329 cases (56.9%;male 45.7%, female 65.7%);and the elevated type was 20 cases (3.5%; male 2.4%, female 4.3%). In the dry bones, the incidence of the depressed thombold fossa was 129 cases (57.3%;male 59.6%, female 52.7%);the flat type was 65 cases (28.9%;male 24.5%, female 37. 8%) ;and the elevated type was 31 cases (13.8%;male 15.9%, female 9.5%). The incidence of the foramen for supraclavicular nerve was 0.8% in chest radiographs, and 1.4% in the dry bones. The incidence of the elevated conold tubercle was 65.1% (male 64.0%, female 65.9%) in chest radiographs, and 96.9% (male 95.4%, female 100.0%) in the dry bones. CONCLUSIONS: The incidence of the depressed rhomboid fossa in chest radiographs was higher in men and the right clavicle. The incidence of flat rhombo~d fossa in chest radiographs decreased according to increase of age. The foramen for supraclavicular nerve was occasionally found (0.8% in chest radiographs; 1.4% in the dry bones).
Clavicle* ; Female ; Humans ; Incidence ; Male ; Radiography, Thoracic* ; Thorax*

BACKGROUND: Neer type II distal clavicle fractures have the drawback of coracoclavicular instability and insufficient distal bony fragment, thereby making it difficult to achieve adequate fixation. Although various surgical treatments have been described for Neer type II fracture, the optimal treatment remains controversial. This study reports the clinical results and usefulness of anatomical locking plate with additional K-wire fixation. METHODS: A totally of 21 patients with type II distal clavicle fracture were included in the study. The surgical procedure reduced the fracture temporarily; it included insertion of one or two K-wire from the lateral margin of the distal fragment to the proximal fragment through the fracture site, followed by application and fixation of the locking plate. The bony union and migration of K-wire was evaluated in the follow-up radiography. The coracoclavicular distance and acromioclavicular joint arthrosis were assessed at the final follow-up. The Constant Score (CS) and Korean Shoulder Score (KSS) were evaluated for clinical scoring. RESULTS: Bone union was achieved in all cases. At the final follow-up, coracoclavicular distance of the injured shoulder was increased, as compared to the intact shoulder (p=0.002), with no accompanying clinical symptoms. No K-wire migration was observed. At the final follow-up, K-wire irritation was observed in two cases and acromioclavicular arthrosis in one case, with no other adverse effects. Pain visual analogue scale, CS, and KSS were improved in all cases. CONCLUSIONS: The method of anatomical locking plate with additional K-wire fixation could be useful in achieving beneficial clinical results.
Acromioclavicular Joint ; Clavicle ; Follow-Up Studies ; Humans ; Methods ; Radiography ; Shoulder

Septic arthritis requires an early diagnosis and proper treatment to prevent the destruction of articular cartilage and joint contracture. This paper presents a rare case of septic arthritis of the acromioclavicular joint that was treated with arthroscopic debridement and resection of the distal clavicle.
Acromioclavicular Joint/radiography/*surgery ; Arthritis, Infectious/radiography/*surgery ; *Arthroscopy ; Clavicle/surgery ; Humans ; Male ; Middle Aged

The aim of our study was to evaluate the utility and diagnostic accuracy of the ossification grade of medial clavicular epiphysis on chest radiographs for identifying Korean adolescents and young adults under the age of majority. Overall, 1,151 patients (age, 16-30) without any systemic disease and who underwent chest radiography were included for ossification grading. Two radiologists independently classified the ossification of the medial clavicular epiphysis from chest radiographs into five grades. The age distribution and inter-observer agreement on the ossification grade were assessed. The diagnostic accuracy of the averaged ossification grades for determining whether the patient is under the age of majority was analyzed by using receiver operating characteristic (ROC) curves. Two separate inexperienced radiologists assessed the ossification grade in a subgroup of the patients after reviewing the detailed descriptions and image atlases developed for ossification grading. The median value of the ossification grades increased with increasing age (from 16 to 30 years), and the trend was best fitted by a quadratic function (R-square, 0.978). The inter-observer agreements on the ossification grade were 0.420 (right) and 0.404 (left). The area under the ROC curve (AUC) was 0.922 (95% CI, 0.902-0.942). The averaged ossification scores of 2.62 and 4.37 provided 95% specificity for a person < 19 years of age and a person ≥ 19 years of age, respectively. A preliminary assessment by inexperienced radiologists resulted in an AUC of 0.860 (95% CI, 0.740-0.981). The age of majority in Korean adolescents and young adults can be estimated using chest radiographs.
Adolescent* ; Age Distribution ; Area Under Curve ; Clavicle ; Epiphyses* ; Humans ; Radiography ; Radiography, Thoracic* ; ROC Curve ; Sensitivity and Specificity ; Thorax* ; Young Adult*

BACKGROUND: Nonoperative management of midshaft clavicle fractures has resulted in widely disparate outcomes and there is growing evidence that clavicle shortening poses the risk of unsatisfactory functional outcomes due to shoulder weakness and nonunion. Unfortunately, the literature does not clearly demonstrate the superiority of one particular method for measuring clavicle shortening. The purpose of this study was to compare the accuracy of clavicle shortening measurements based on plain radiographs with those based on computed tomography (CT) reconstructed images of the clavicle. METHODS: A total of 51 patients with midshaft clavicle fractures who underwent both a chest CT scan and standardized anteroposterior chest radiography on the day of admission were included in this study. Both an orthopedic surgeon and a musculoskeletal radiologist measured clavicle shortening for all included patients. We then determined the accuracy and intraclass correlation coefficients for the imaging modalities. Bland-Altman plots were created to analyze agreement between the modalities and a paired t-test was used to determine any significant difference between measurements. RESULTS: For injured clavicles, radiographic measurements significantly overestimated the clavicular length by a mean of 8.2 mm (standard deviation [SD], ± 10.2; confidence interval [CI], 95%) compared to CT-based measurements (p < 0.001). The intraclass correlation was 0.96 for both plain radiograph- and CT-based measurements (p = 0.17). CONCLUSIONS: We found that plain radiograph-based measurements of midshaft clavicle shortening are precise, but inaccurate. When clavicle shortening is considered in the decision to pursue operative management, we do not recommend the use of plain radiograph-based measurements.
Clavicle* ; Humans ; Methods ; Orthopedics ; Radiography* ; Shoulder ; Thorax* ; Tomography, X-Ray Computed ; X-Ray Film

Adult ; Clavicle ; injuries ; surgery ; Fractures, Bone ; diagnostic imaging ; surgery ; Humans ; Male ; Radiography