If the fracture is oblique or spiral or if there is a large butterfly fragment, an interfragmentary lag or cortical screw was applied.
In one case, severe comminution and disruption of soft tissue during surgery might be the reason and in the second case there was a comminuted butterfly fragment. We fixed the main butterfly fragment with 2.7 cortical screw to one fragment.
Results of radiographs revealed a long oblique, comminuted, distal diaphyseal to distal metaphyseal fracture of the left humerus with moderate displacement and a large butterfly fragment, as well as a linear metallic object and multiple soft tissue to mineral opacity foreign objects of varying sizes and shapes in the ventriculus (Fig 1).
The arrows identify a long oblique, comminuted, distal diaphyseal to distal metaphyseal fracture of the left humerus with moderate displacement and a large butterfly fragment. The circle identifies the foreign debris visible in the ventriculus, including a linear metallic opacity (*), as well as multiple foreign objects of varying shapes with a soft tissue to mineral opacity.
In this present study, Robinson Type- 2 B1 (Displaced with simple or butterfly fragment) were common and there were 16 patients (80%), Type-2 B2 (Displaced with comminution) occurred in 4 patients (20%).
In 2 patients (10%), delayed union occurred as there was a displaced butterfly fragment which united with the main fragment at the end of 16 weeks.
In this present study, there were 38 patients (100%) of comminuted mid shaft clavicle fracture where Robbinson 2B1 (Simple or single butterfly fragment) 24 patients (63%) were Robbinson 2B2 (Comminuted or segmental) 14 patients (37%).
In this present study, there were 38 patients (100%) of comminuted midshaft clavicle fracture where Robbinson 2B1 (Simple or single butterfly fragment) 24 patients (63%) were Robbinson 2B2 (Comminuted or segmental) 14 patients (37%).
In type-2 middle third fracture type-2 B1 (displaced with simple or single butterfly fragment) occurred in 32 patients (80%) and type-2 B2 (displaced with comminuted or segmental) fracture occurred in 4 patients (10%).
For type-2 B1 Robinson classification (Displaced with simple or single butterfly fragment of middle third clavicle fracture) reconstruction plates were used in 10 patients (25%), pre contoured plates in 20 patients (50%) and dynamic compression plates in 0 patients (0%),IM nails used in 2 patients(5%).
The patients mean age at the time of presentation 36 yrs (Range: 18 to 60yrs) of the 24 patients 15 were due to motor vehicle accidents, 9 were due to fall, majority (60%) had isolated humeral injury, remaining 40% had other injuries in the body, nearly 60% fractures were comminuted with long butterfly fragment
. 4 patients had radial nerve injury, one patient had median nerve injury.
In another patient who had delayed union, there was comminution at the fracture site (butterfly fragments
) of both bones in mid third shafts.