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Ayrışmış orta cisim klavikula kırıklarının ekspanse olabilen esnek kilitli intramedüller çivi ile tedavi sonuçları

Year 2015, , 13 - 17, 19.03.2015
https://doi.org/10.3944/AOTT.2015.14.0070

Abstract

Amaç: Çalışmamızda yetişkin orta cisim klavikula kırıklarında ekspanse olabilen esnek kilitli intrame¬düller çivi uygulanan olguların sonuçları değerlendirmek amaçlanmıştır.

Çalışma planı: Tamamen ayrışmış ve en az iki cm kısalığı bulunan ve ekspanse olabilen esnek kilitli intramedüller çivi ile tespit yapılan 11 erkek ve 6 kadın hasta çalışmaya dahil edildi. Hastaların son takiplerinde erken ve geç dönem komplikasyonları ve Constant ve DASH skorlama sistemine göre fonksiyonel skorları değerlendirildi.

Bulgular: Ortalama ameliyat süresi 30.4 (25-42) dakika idi. Ortalama takip süresi 10.3 (8-19) ay, ortalama kaynama süresi ise 15.8 (9-20) hafta idi. Bir hastada yüzeyel enfeksiyon görüldü. Hiçbir hastada derin enfeksiyon görülmedi. Hiçbir hastada nörovasküler komplikasyon ile karşılaşılmadı. Hiçbir hastada implant migrasyonu ve irritasyonu ile karşılaşılmadı. Bir hastada uygulama hatasına bağlı olduğu düşünülen instabiliteye yol açmayan implant kırılması görüldü. Sağlam tarafla karşılaştı¬rıldığında hiçbir hastada anlamlı kısalık görülmedi. Hastaların son kontrollerinde ortalama Constant skoru 94.3 (86-97), DASH skoru ise 11.8 (7.3-17.4) idi.

Çıkarımlar: Ekspanse olabilen esnek kilitli intramedüller çivi ayrışmış orta diafiz klavikula kırıkların¬da minimal invaziv olarak uygulanabilen, düşük komplikasyon oranı olan ve iyi fonksiyonel sonuçlar elde edilmesini sağlayan bir yöntem olarak görülmektedir. Daha geniş serileri içeren karşılaştırmalı çalışmaların gerekliliği aşikardır.

References

  • Houwert RM, Wijdicks FJ, Steins Bisschop C, Verleis- donk EJ, Kruyt M. Plate fixation versus intramedullary fixation for displaced mid-shaft clavicle fractures: a sys- tematic review. Int Orthop 2012;36:579-85.
  • S Thyagarajan D, Day M, Dent C, Williams R, Evans R. Treatment of mid-shaft clavicle fractures: A comparative study. Int J Shoulder Surg 2009;3:23-7.
  • NEER CS 2nd. Nonunion of the clavicle. J Am Med As- soc 1960;172:1006-11.
  • Assobhi JE. Reconstruction plate versus minimal invasive retrograde titanium elastic nail fixation for displaced mid- clavicular fractures. J Orthop Traumatol 2011;12:185-92.
  • Faldini C, Nanni M, Leonetti D, Acri F, Galante C, Luciani D, et al. Nonoperative treatment of closed displaced midshaft clavicle fractures. J Orthop Traumatol 2010;11:229-36.
  • Lazarides S, Zafiropoulos G. Conservative treatment of fractures at the middle third of the clavicle: the relevance of shortening and clinical outcome. J Shoulder Elbow Surg 2006;15:191-4.
  • Pearson AM, Tosteson AN, Koval KJ, McKee MD, Cantu RV, Bell JE, et al. Is surgery for displaced, midshaft clavicle fractures in adults cost-effective? Results based on a mul- ticenter randomized, controlled trial. J Orthop Trauma 2010;24:426-33.
  • Hartmann F, Hessmann MH, Gercek E, Rommens PM. Elastic intramedullary nailing of midclavicular fractures. Acta Chir Belg 2008;108:428-32.
  • Duan X, Zhong G, Cen S, Huang F, Xiang Z. Plating ver- sus intramedullary pin or conservative treatment for mid- shaft fracture of clavicle: a meta-analysis of randomized controlled trials. J Shoulder Elbow Surg 2011;20:1008-15.
  • Jubel A, Andermahr J, Prokop A, Isenberg J, Rehm KE. Minimal invasive biological osteosynthesis of the clavicle with a titanium nail. [Article in German] Kongressbd Dtsch Ges Chir Kongr 2002;119:485-90. [Abstract]
  • Constant CR, Murley AH. A clinical method of func- tional assessment of the shoulder. Clin Orthop Relat Res 1987;214:160-4.
  • Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (dis- abilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG) Am J Ind Med 1996;29:602-8.
  • Jupiter JB, Leffert RD. Non-union of the clavicle. Associ- ated complications and surgical management. J Bone Joint Surg Am 1987;69:753-60.
  • Zlowodzki M, Zelle BA, Cole PA, Jeray K, McKee MD; Evidence-Based Orthopaedic Trauma Working Group. Treatment of acute midshaft clavicle fractures: systematic review of 2144 fractures: on behalf of the Evidence-Based Orthopaedic Trauma Working Group. J Orthop Trauma 2005;19:504-7.
  • McKee MD, Wild LM, Schemitsch EH. Midshaft mal- unions of the clavicle. J Bone Joint Surg Am 2003;85:790-7.
  • Nowak J, Holgersson M, Larsson S. Sequelae from cla- vicular fractures are common: a prospective study of 222 patients. Acta Orthop 2005;76:496-502.
  • Cho CH, Song KS, Min BW, Bae KC, Lee KJ. Opera- tive treatment of clavicle midshaft fractures: comparison between reconstruction plate and reconstruction locking compression plate. Clin Orthop Surg 2010;2:154-9.
  • Chen QY, Kou DQ, Cheng XJ, Zhang W, Wang W, Lin ZQ, et al. Intramedullary nailing of clavicular midshaft fractures in adults using titanium elastic nail. Chin J Trau- matol 2011;14:269-76.
  • Kettler M, Schieker M, Braunstein V, König M, Mutschler W. Flexible intramedullary nailing for stabilization of dis- placed midshaft clavicle fractures: technique and results in 87 patients. Acta Orthop 2007;78:424-9.
  • Mueller M, Burger C, Florczyk A, Striepens N, Rangger C. Elastic stable intramedullary nailing of midclavicular fractures in adults: 32 patients followed for 1-5 years. Acta Orthop 2007;78:421-3.
  • Meier C, Grueninger P, Platz A. Elastic stable intramedul- lary nailing for midclavicular fractures in athletes: indica- tions, technical pitfalls and early results. Acta Orthop Belg 2006;72:269-75.
  • Grassi FA, Tajana MS, D’Angelo F. Management of mid- clavicular fractures: comparison between nonoperative treatment and open intramedullary fixation in 80 patients. J Trauma 2001;50:1096-100.
  • Smekal V, Irenberger A, Struve P, Wambacher M, Krap- pinger D, Kralinger FS. Elastic stable intramedullary nail- ing versus nonoperative treatment of displaced midshaft clavicular fractures-a randomized, controlled, clinical trial. J Orthop Trauma 2009;23:106-12.
  • Smekal V, Irenberger A, Attal RE, Oberladstaetter J, Krap- pinger D, Kralinger F. Elastic stable intramedullary nailing is best for mid-shaft clavicular fractures without comminu- tion: results in 60 patients. Injury 2011;42:324-9.
  • King R, Ikram A. Intramedullary locked fixation of clavi- cle shaft fractures: review of early results. J Bone Joint Surg Br 2013;95:Supp 29-71.
  • Kraus TM, Martetschläger F, Schrödl C, Siebenlist S, Ganslmeier A, Kirchhoff C, et al. Elastic stable intramed- ullary nailing of clavicular midshaft fractures: comparison of open vs closed fracture reduction. [Article in German] Unfallchirurg 2013;116(2):102, 104-8. [Abstract]

Results of midshaft clavicle fractures treated with expandable, elastic and locking intramedullary nails

Year 2015, , 13 - 17, 19.03.2015
https://doi.org/10.3944/AOTT.2015.14.0070

Abstract

Objective: The aim of the study was to present the results of osteosynthesis with elastic expandable intramedullary nail for clavicle fractures.

Methods: The study included 17 patients (11 males, 6 females; mean age 36.4 years, range: 21 to 54 years) who underwent surgery for a displaced clavicle fracture and had a shortening of more than 2 cm. The Constant Score and DASH (Disabilities of The Arm, Shoulder and Hand) scoring were used to determine the functional status of the patients.

Results: Mean operation time was 30.4 (range: 25 to 42) minutes and mean follow-up period was 10.3 (range: 8 to 19) months. Mean union time was 15.8 (range: 9 to 20) weeks. A superficial infection was treated with wound debridement and antibiotherapy in one patient. No patient suffered from neurovascular compromise, deep infection or implant irritation. Implant fracture developed at months after surgery in one patient treated for Type B1 clavicle fracture and healed without any other intervention. There was no statistically significant shortening (p>0.05). In the final follow-up, the mean Constant Score was 94.3 (range: 86 to 97), and mean DASH score was 11.8 (range: 7.3 to 17.4).

Conclusion: Expandable elastic locking intramedullary nail appears to provide minimal complication and high success rate for the surgical treatment of non-comminuted displaced clavicle shaft fractures. Additional studies with large series are necessary for further investigation.

References

  • Houwert RM, Wijdicks FJ, Steins Bisschop C, Verleis- donk EJ, Kruyt M. Plate fixation versus intramedullary fixation for displaced mid-shaft clavicle fractures: a sys- tematic review. Int Orthop 2012;36:579-85.
  • S Thyagarajan D, Day M, Dent C, Williams R, Evans R. Treatment of mid-shaft clavicle fractures: A comparative study. Int J Shoulder Surg 2009;3:23-7.
  • NEER CS 2nd. Nonunion of the clavicle. J Am Med As- soc 1960;172:1006-11.
  • Assobhi JE. Reconstruction plate versus minimal invasive retrograde titanium elastic nail fixation for displaced mid- clavicular fractures. J Orthop Traumatol 2011;12:185-92.
  • Faldini C, Nanni M, Leonetti D, Acri F, Galante C, Luciani D, et al. Nonoperative treatment of closed displaced midshaft clavicle fractures. J Orthop Traumatol 2010;11:229-36.
  • Lazarides S, Zafiropoulos G. Conservative treatment of fractures at the middle third of the clavicle: the relevance of shortening and clinical outcome. J Shoulder Elbow Surg 2006;15:191-4.
  • Pearson AM, Tosteson AN, Koval KJ, McKee MD, Cantu RV, Bell JE, et al. Is surgery for displaced, midshaft clavicle fractures in adults cost-effective? Results based on a mul- ticenter randomized, controlled trial. J Orthop Trauma 2010;24:426-33.
  • Hartmann F, Hessmann MH, Gercek E, Rommens PM. Elastic intramedullary nailing of midclavicular fractures. Acta Chir Belg 2008;108:428-32.
  • Duan X, Zhong G, Cen S, Huang F, Xiang Z. Plating ver- sus intramedullary pin or conservative treatment for mid- shaft fracture of clavicle: a meta-analysis of randomized controlled trials. J Shoulder Elbow Surg 2011;20:1008-15.
  • Jubel A, Andermahr J, Prokop A, Isenberg J, Rehm KE. Minimal invasive biological osteosynthesis of the clavicle with a titanium nail. [Article in German] Kongressbd Dtsch Ges Chir Kongr 2002;119:485-90. [Abstract]
  • Constant CR, Murley AH. A clinical method of func- tional assessment of the shoulder. Clin Orthop Relat Res 1987;214:160-4.
  • Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (dis- abilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG) Am J Ind Med 1996;29:602-8.
  • Jupiter JB, Leffert RD. Non-union of the clavicle. Associ- ated complications and surgical management. J Bone Joint Surg Am 1987;69:753-60.
  • Zlowodzki M, Zelle BA, Cole PA, Jeray K, McKee MD; Evidence-Based Orthopaedic Trauma Working Group. Treatment of acute midshaft clavicle fractures: systematic review of 2144 fractures: on behalf of the Evidence-Based Orthopaedic Trauma Working Group. J Orthop Trauma 2005;19:504-7.
  • McKee MD, Wild LM, Schemitsch EH. Midshaft mal- unions of the clavicle. J Bone Joint Surg Am 2003;85:790-7.
  • Nowak J, Holgersson M, Larsson S. Sequelae from cla- vicular fractures are common: a prospective study of 222 patients. Acta Orthop 2005;76:496-502.
  • Cho CH, Song KS, Min BW, Bae KC, Lee KJ. Opera- tive treatment of clavicle midshaft fractures: comparison between reconstruction plate and reconstruction locking compression plate. Clin Orthop Surg 2010;2:154-9.
  • Chen QY, Kou DQ, Cheng XJ, Zhang W, Wang W, Lin ZQ, et al. Intramedullary nailing of clavicular midshaft fractures in adults using titanium elastic nail. Chin J Trau- matol 2011;14:269-76.
  • Kettler M, Schieker M, Braunstein V, König M, Mutschler W. Flexible intramedullary nailing for stabilization of dis- placed midshaft clavicle fractures: technique and results in 87 patients. Acta Orthop 2007;78:424-9.
  • Mueller M, Burger C, Florczyk A, Striepens N, Rangger C. Elastic stable intramedullary nailing of midclavicular fractures in adults: 32 patients followed for 1-5 years. Acta Orthop 2007;78:421-3.
  • Meier C, Grueninger P, Platz A. Elastic stable intramedul- lary nailing for midclavicular fractures in athletes: indica- tions, technical pitfalls and early results. Acta Orthop Belg 2006;72:269-75.
  • Grassi FA, Tajana MS, D’Angelo F. Management of mid- clavicular fractures: comparison between nonoperative treatment and open intramedullary fixation in 80 patients. J Trauma 2001;50:1096-100.
  • Smekal V, Irenberger A, Struve P, Wambacher M, Krap- pinger D, Kralinger FS. Elastic stable intramedullary nail- ing versus nonoperative treatment of displaced midshaft clavicular fractures-a randomized, controlled, clinical trial. J Orthop Trauma 2009;23:106-12.
  • Smekal V, Irenberger A, Attal RE, Oberladstaetter J, Krap- pinger D, Kralinger F. Elastic stable intramedullary nailing is best for mid-shaft clavicular fractures without comminu- tion: results in 60 patients. Injury 2011;42:324-9.
  • King R, Ikram A. Intramedullary locked fixation of clavi- cle shaft fractures: review of early results. J Bone Joint Surg Br 2013;95:Supp 29-71.
  • Kraus TM, Martetschläger F, Schrödl C, Siebenlist S, Ganslmeier A, Kirchhoff C, et al. Elastic stable intramed- ullary nailing of clavicular midshaft fractures: comparison of open vs closed fracture reduction. [Article in German] Unfallchirurg 2013;116(2):102, 104-8. [Abstract]
There are 26 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Original Article
Authors

Sinan Zehir This is me

Turgut Akgul This is me

Regayip Zehir This is me

Publication Date March 19, 2015
Published in Issue Year 2015

Cite

APA Zehir, S., Akgul, T., & Zehir, R. (2015). Results of midshaft clavicle fractures treated with expandable, elastic and locking intramedullary nails. Acta Orthopaedica Et Traumatologica Turcica, 49(1), 13-17. https://doi.org/10.3944/AOTT.2015.14.0070
AMA Zehir S, Akgul T, Zehir R. Results of midshaft clavicle fractures treated with expandable, elastic and locking intramedullary nails. Acta Orthopaedica et Traumatologica Turcica. March 2015;49(1):13-17. doi:10.3944/AOTT.2015.14.0070
Chicago Zehir, Sinan, Turgut Akgul, and Regayip Zehir. “Results of Midshaft Clavicle Fractures Treated With Expandable, Elastic and Locking Intramedullary Nails”. Acta Orthopaedica Et Traumatologica Turcica 49, no. 1 (March 2015): 13-17. https://doi.org/10.3944/AOTT.2015.14.0070.
EndNote Zehir S, Akgul T, Zehir R (March 1, 2015) Results of midshaft clavicle fractures treated with expandable, elastic and locking intramedullary nails. Acta Orthopaedica et Traumatologica Turcica 49 1 13–17.
IEEE S. Zehir, T. Akgul, and R. Zehir, “Results of midshaft clavicle fractures treated with expandable, elastic and locking intramedullary nails”, Acta Orthopaedica et Traumatologica Turcica, vol. 49, no. 1, pp. 13–17, 2015, doi: 10.3944/AOTT.2015.14.0070.
ISNAD Zehir, Sinan et al. “Results of Midshaft Clavicle Fractures Treated With Expandable, Elastic and Locking Intramedullary Nails”. Acta Orthopaedica et Traumatologica Turcica 49/1 (March 2015), 13-17. https://doi.org/10.3944/AOTT.2015.14.0070.
JAMA Zehir S, Akgul T, Zehir R. Results of midshaft clavicle fractures treated with expandable, elastic and locking intramedullary nails. Acta Orthopaedica et Traumatologica Turcica. 2015;49:13–17.
MLA Zehir, Sinan et al. “Results of Midshaft Clavicle Fractures Treated With Expandable, Elastic and Locking Intramedullary Nails”. Acta Orthopaedica Et Traumatologica Turcica, vol. 49, no. 1, 2015, pp. 13-17, doi:10.3944/AOTT.2015.14.0070.
Vancouver Zehir S, Akgul T, Zehir R. Results of midshaft clavicle fractures treated with expandable, elastic and locking intramedullary nails. Acta Orthopaedica et Traumatologica Turcica. 2015;49(1):13-7.