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PDS sling fixation of Neer type 2 fractures of the distal clavicle—A simple technique with excellent results
Abstracts Table 2
169 Bone protection at discharge
Geriatric ward Orthopaedic ward
Discharge on Ca (%)
Discharge on vitamin D3 (%)
Discharge on bisphosphonates (%)
Discharge on calcium and vitamin D3 (%)
Discharge on calcium, vitamin D3 and bisphosphonates (%)
75 63
75 63
69 47
75 64
66 47
days, n = 41). Seventy-two patients underwent surgical fixation (Table 1). Thirty-two patients were discharged from a geriatric ward, 38 from an orthopaedic ward, 3 from private practice and 1 from a respiratory ward. At the time of discharge two patients had been referred to falls clinic and four patients had DEXA scans. Fifty patients were discharged on at least one form of bone protection (Table 2). Conclusion: Adherence to BOA guidelines is sub-optimal with inadequate identification and secondary prevention of fragility fractures. This is demonstrated by a failure to refer the majority of patients to falls clinics. BOA guidelines recommend all patients above 60 years, presenting with a fragility fracture, to be evaluated for osteoporosis by measurement of bone density (preferably by DEXA); at 1 year this applied to just four patients. Unless contraindicated, all patients should be discharged on calcium and vitamin D; we achieved this in just two thirds of patients. A joint ortho-geriatric protocol may go someway to improving this. Keywords: Fragility; Fracture; Hip; BOA Guidelines doi:10.1016/j.injury.2007.11.320 [O31] PDS sling fixation of Neer type 2 fractures of the distal clavicle—–A simple technique with excellent results J. Robinson ∗ , P. Kempshall, B. Sankar, M.G. Pritchard Morriston Hospital, UK Non-union rates following conservative management of lateral clavicular fractures can be as high as 30%. This study reports the results of a simple technique using a PDS loop in the fixation of Neer type 2 fractures of the clavicle, performed in our institution. Twelve patients with Neer type 2 fractures operated by a single surgeon over 3 years were included in the study. The mean age was 45, range 14—63. There were seven male and five female patients. Standard surgical and postoperative protocols were followed in all patients. A PDS cord looped around the coracoid was used to hold the reduced medial clavicular shaft fragment. Occasionally, this was supplemented with two ethibond sutures across the fracture. Patients were followed up postoperatively at 2, 6 and 12 weeks. Final outcomes were assessed using radiographs and the Oxford and DASH scoring systems at 12 months. Ten fractures united within 12 weeks. All of these patients returned to their pre-injury activity level. There were two non-unions, both in non-compliant patients. One of these non-unions remained asymptomatic and one patient
was lost to follow-up. The mean Oxford score at 12 months was 14.25 (range 12—16) and the mean DASH score was 5 (range 3.75—7). We conclude that this technique is safe, simple and cost effective. It achieves high rates of union without the need for implant removal. As with other techniques, proper patient selection is essential. We recommend this technique as an excellent treatment option when dealing with these notoriously difficult fractures. Keywords: Clavicle; Fracture; Suture; Fixation doi:10.1016/j.injury.2007.11.321 [O32] Rockwood pin fixation of clavicle fractures S. Ahmad, D. Sunderamoorthy ∗ , H. Jahraja, A. Shah, M. Waseem Macclesfield District General Hospital, UK Aim: To prospectively review the results of clavicle fractures treated with Rockwood intramedullary pin fixation. Patients and methods: Twenty-five patients with clavicle fractures underwent fixation of clavicle fractures with intramedullary Rockwood pin. The indications were persistent wide separation of fracture with interposition of soft tissue in 12, symptomatic non-union in 3, associated multiple injuries in 3, with 1 having a floating shoulder, impending open fracture with tented skin in 4 and associated acromioclavicular joint injury in 3. All patients underwent open reduction through an incision centred over the fracture site along the Langer line. Intramedullary pin was inserted in retrograde manner. Autologous bone grafting from iliac crest was done in all patients with non-union. Radiographic and functional assessment conducted using DASH scores. Results: There were 21 male and 4 female patients with a mean age of 34 years (range 17—64 years). Mean follow-up was 12 months (range 5—30 months). Radiographic union occurred in all patients within 4 months. The commonest indication for Rockwood pin fixation was displaced middle third clavicle fracture followed by impending open fractures. Commonest complication was skin irritation at the distal end of the pin with formation of tender bursa occurring in nine patients, three of whom had skin breakdown. Fracture union occurred in all patients with no further intervention and wounds healed completely after removal of the pin. One patient developed non-union and was later treated with ORIF with DCP and bone-graft. There were no deep infections, pin breakage or migration or refractures after pin removal. The average DASH score was 25 (range 18—52).
169 Bone protection at discharge
Geriatric ward Orthopaedic ward
Discharge on Ca (%)
Discharge on vitamin D3 (%)
Discharge on bisphosphonates (%)
Discharge on calcium and vitamin D3 (%)
Discharge on calcium, vitamin D3 and bisphosphonates (%)
75 63
75 63
69 47
75 64
66 47
days, n = 41). Seventy-two patients underwent surgical fixation (Table 1). Thirty-two patients were discharged from a geriatric ward, 38 from an orthopaedic ward, 3 from private practice and 1 from a respiratory ward. At the time of discharge two patients had been referred to falls clinic and four patients had DEXA scans. Fifty patients were discharged on at least one form of bone protection (Table 2). Conclusion: Adherence to BOA guidelines is sub-optimal with inadequate identification and secondary prevention of fragility fractures. This is demonstrated by a failure to refer the majority of patients to falls clinics. BOA guidelines recommend all patients above 60 years, presenting with a fragility fracture, to be evaluated for osteoporosis by measurement of bone density (preferably by DEXA); at 1 year this applied to just four patients. Unless contraindicated, all patients should be discharged on calcium and vitamin D; we achieved this in just two thirds of patients. A joint ortho-geriatric protocol may go someway to improving this. Keywords: Fragility; Fracture; Hip; BOA Guidelines doi:10.1016/j.injury.2007.11.320 [O31] PDS sling fixation of Neer type 2 fractures of the distal clavicle—–A simple technique with excellent results J. Robinson ∗ , P. Kempshall, B. Sankar, M.G. Pritchard Morriston Hospital, UK Non-union rates following conservative management of lateral clavicular fractures can be as high as 30%. This study reports the results of a simple technique using a PDS loop in the fixation of Neer type 2 fractures of the clavicle, performed in our institution. Twelve patients with Neer type 2 fractures operated by a single surgeon over 3 years were included in the study. The mean age was 45, range 14—63. There were seven male and five female patients. Standard surgical and postoperative protocols were followed in all patients. A PDS cord looped around the coracoid was used to hold the reduced medial clavicular shaft fragment. Occasionally, this was supplemented with two ethibond sutures across the fracture. Patients were followed up postoperatively at 2, 6 and 12 weeks. Final outcomes were assessed using radiographs and the Oxford and DASH scoring systems at 12 months. Ten fractures united within 12 weeks. All of these patients returned to their pre-injury activity level. There were two non-unions, both in non-compliant patients. One of these non-unions remained asymptomatic and one patient
was lost to follow-up. The mean Oxford score at 12 months was 14.25 (range 12—16) and the mean DASH score was 5 (range 3.75—7). We conclude that this technique is safe, simple and cost effective. It achieves high rates of union without the need for implant removal. As with other techniques, proper patient selection is essential. We recommend this technique as an excellent treatment option when dealing with these notoriously difficult fractures. Keywords: Clavicle; Fracture; Suture; Fixation doi:10.1016/j.injury.2007.11.321 [O32] Rockwood pin fixation of clavicle fractures S. Ahmad, D. Sunderamoorthy ∗ , H. Jahraja, A. Shah, M. Waseem Macclesfield District General Hospital, UK Aim: To prospectively review the results of clavicle fractures treated with Rockwood intramedullary pin fixation. Patients and methods: Twenty-five patients with clavicle fractures underwent fixation of clavicle fractures with intramedullary Rockwood pin. The indications were persistent wide separation of fracture with interposition of soft tissue in 12, symptomatic non-union in 3, associated multiple injuries in 3, with 1 having a floating shoulder, impending open fracture with tented skin in 4 and associated acromioclavicular joint injury in 3. All patients underwent open reduction through an incision centred over the fracture site along the Langer line. Intramedullary pin was inserted in retrograde manner. Autologous bone grafting from iliac crest was done in all patients with non-union. Radiographic and functional assessment conducted using DASH scores. Results: There were 21 male and 4 female patients with a mean age of 34 years (range 17—64 years). Mean follow-up was 12 months (range 5—30 months). Radiographic union occurred in all patients within 4 months. The commonest indication for Rockwood pin fixation was displaced middle third clavicle fracture followed by impending open fractures. Commonest complication was skin irritation at the distal end of the pin with formation of tender bursa occurring in nine patients, three of whom had skin breakdown. Fracture union occurred in all patients with no further intervention and wounds healed completely after removal of the pin. One patient developed non-union and was later treated with ORIF with DCP and bone-graft. There were no deep infections, pin breakage or migration or refractures after pin removal. The average DASH score was 25 (range 18—52).