Emerging Orthopaedics: Do Clavicle Fractures Require Surgery?

Orthopaedic Surgeon and Triangle Division Medical Director Dr. William Silver specializes in Sports Medicine and treatment of the knee and shoulder.  He shares with us the outcome of a recent study comparing a surgical and non-surgical approach to displaced midshaft clavicle fracture.  Courses of treatment for many procedures depend on conversations between you and your medical provider as you discuss your goals.  What is the best way to help you Emerge Stronger, Healthier, Better?

A study published in the July 19 issue of The Journal of Bone & Joint Surgery compares surgical and nonsurgical treatment approaches for displaced midshaft clavicle fracture. The authors conducted a prospective, randomized, controlled trial of 117 patients who received either nonsurgical treatment with a figure-of-eight harness or surgical treatment with anteroinferior plate osteosynthesis. At 6-week, 6-month, and 1-year follow-ups, they found no difference across cohorts in Disabilities of the Arm, Shoulder and Hand score, visual analog scale pain level, time to return to previous activities, or cosmetic dissatisfaction. However, the authors note that seven nonsurgical patients (14.9 percent) developed nonunion, compared to none in the surgical group. Further, nonsurgically treated patients displayed radiographic evidence of greater clavicle shortening compared with those in the surgical cohort, and more patients in that group answered “yes” when asked if their clavicle felt short and if they felt bone prominence. In the surgical group, more patients answered “yes” when asked if they felt paresthesia.

In summary, 117 patients received either a nonsurgical or surgical treatment for a displaced midshaft clavicle fracture. The patients returned for a 6-week, 6-month and 1 year follow up to try and find the difference between the two treatment options. It was found that there was very little difference between the surgical and non surgical option other then 15% of nonsurgical patients bones did not complete connect, and also showed evidence of greater clavicle shortening.

Dr. Silver is a board certified Orthopaedic Surgeon with a Certificate of Added Qualification in Sports Medicine.  To schedule an appointment with Dr. Silver, contact (919) 220-5255.

Dr. Liebelt Performs First Total Knee Replacement with New Robotic-Arm Assisted Application!

Liebelt Knee North Carolina



Innovative Robotic Technology Allows Surgeons to Personalize Procedures to Each Patient in North Carolina


Durham, North Carolina – N.C. Specialty Hospital is one of the first hospitals in the Southeast to offer Stryker’s robotic-arm assisted total knee application for use with its Mako System. This latest advancement in joint replacement surgery transforms the way total knee replacements are performed.

Total knee replacements in the United States are expected to increase 673 percent by 2030,1 yet studies have shown that approximately 30 percent of patients are dissatisfied after conventional surgery.2 Mako Total Knee combines Stryker’s advanced robotic technology with its clinically proven GetAroundKnee (Triathlon Total Knee System), which enabled surgeons to have a more predictable surgical experience with increased accuracy during laboratory testing.3

“Mako is changing the way joint replacement surgeries are performed by providing each patient with a personalized surgical experience based on their specific diagnosis and anatomy,” said Dr. Ralph Liebelt of EmergeOrtho, who performed the first procedure this Spring.  “Using a virtual 3D model, the Mako System allows surgeons to create each patient’s surgical plan pre-operatively before entering the operating room. During surgery, the surgeon can validate that plan and make any necessary adjustments while guiding the robotic-arm to execute that plan. It’s exciting to be able to offer this transformative technology across the joint replacement service line to perform total knee, total hip and partial knee replacements.”

The Mako Total Knee application is a knee replacement treatment option designed to relieve the pain caused by joint degeneration due to osteoarthritis. Through CT-based 3D modeling of bone anatomy, surgeons can use the Mako System to create a personalized surgical plan and identify the implant size, orientation and alignment based on each patient’s unique anatomy. The Mako System also enables surgeons to virtually modify the surgical plan intra-operatively and assists the surgeon in executing bone resections.

“We are proud to be the first hospital in the state to offer this highly advanced robotic technology in our area,” said Randi Shults, Chief Executive Officer of NC Specialty Hospital.  “This addition to our orthopaedic service line further demonstrates our commitment to provide the community with outstanding healthcare.”