Klavikula cisim kırıklarının cerrahi tedavisinin orta-uzun dönem sonuçları

Year 2020, Volume: 4 Issue: 2, 180 - 185, 12.07.2020

Saygın Kamacı Erdi Özdemir , Anıl Gülcü , Angelo Colosimo

https://doi.org/10.30565/medalanya.709140

Abstract

Amaç: Bu çalışmanın amacı klavikula cisim kırıklarında cerrahi tedavinin ortauzun dönem sonuçlarını, aktivite seviyesi yüksek hastaların dahil olduğu geniş bir popülasyonda değerlendirmektir.

Yöntemler: Klavikula cisim kırığı nedeniyle 1 mayıs 2011 ile 30 ekim 2017 tarihleri arasında cerrahi olarak tedavi edilmiş, en az bir yıl takipli 94 hasta retrospektif olarak incelendi. Ortalama takip suresi 42 ± 27.7 (12 – 83) aydı. Hastalar radyolojik ve klinik iyileşme sağlanana kadar takip edildi. Tüm kırıklar OTA sınıflamasına göre sınıflandı. Hasta dosyaları demografik bilgiler, yaralanma nedeni, ameliyata kadar geçen süre, komplikasyonlar, radyolojik ve fonksiyonel iyileşme zamanları açısından tarandı. Fonksiyonel sonuçları değerlendirmek için hastalara Constant skorlama sistemi uygulandı.

Bulgular: Yaralanma anındaki ortalama yaş 31.4 ± 15.4 (11-74) yıl idi. Doksanbir klavikula (%96.8) ortalama 62 ± 33 günde radyolojik ve fonksiyonel iyileşme gösterdi. Son takipteki ortalama Constant skoru 91 ± 6.6 (76 -100) idi. En sık altta yatan sebep sporla ilişkili yaralanmalar (n=53, %56.3) ardından motosiklet kazaları (n=17, %18.0) ve düşmeler (n=12, %12.7) olarak saptandı. 43 (%45.7) hastanın haftada en az 3 defa sportif aktivitede bulunmaktaydı. Genel komplikasyon oranı %19.1 (n=18) idi. En sık görülen komplikasyon implant irritasyonu (n=11, %11.7) idi. Bu hastaların altısında implant çıkarma ameliyatı uygulandı. Kaynamama oranı %3.2 (n= 3) olarak hesaplandı.

Sonuç: Klavikula cisim kırıklarının anatomik kilitli plaklar ile cerrahi tedavisi yüksek kaynama oranı ve orta-uzun dönemde başarılı fonksiyonel sonuç sağlamaktadır. Ancak, cerrahi planlanmasında potansiyel ciddi komplikasyonlar göz önüne alınmalıdır.

Keywords

klavikula cisim kırığı, tedavi, anatomik kilitli plak, sporcu, komplikasyon

Mid to long term results of surgical fixation of mid-shaft clavicle fractures

Abstract

Aim: The aim of the study is to represent surgical and functional outcomes of plate fixation of mid-shaft clavicle fractures (MCF) via anatomical locking plate, in a large patient population including highly active patients. 

Methods: We retrospectively evaluated 94 patients surgically treated for MCF between May 1st 2011 and October 30th 2017. Patients with minimum one-year of follow-up were included to the study. The mean follow-up was 42 ± 27.7 months (12 to 83) months. All patients were followed up until radiological and clinical healing was achieved. All fractures were classified according to the OTA classification. Medical charts were retrospectively reviewed for demographic data, cause of injury, time to surgery, athletic activity, operative complications, radiographic and functional healing time. Constant score was applied to patients at final follow-up to evaluate functional outcomes. 

Results: The mean age at the time of injury was 31.4±15.4 (11 to 74) years. Ninety-one clavicles (96.8%) demonstrated radiologic and functional healing in a mean of 62 ± 33 days. The mean Constant score at the final follow-up was 91 ± 6.6 (76 to 100). The major underlying cause was sports related injuries (n=53, 56.3%) followed by motorcycle accidents (n=17,18.0%) and low falls (n=12, 12.7%). Forty-three patients (45.7%) were involved in regular athletic activity at least 3 times weekly. The overall complication rate was 19.1% (n=18). The most common complication was implant irritation in 11 patients (11.7%), 6 of which underwent implant removal surgery. The overall non-union rate was 3.2% (n=3). 

Conclusion: Operative treatment of displaced mid-shaft clavicle fractures with precontoured locking plate provides high union rates and satisfactory mid to long-term functional outcomes. However, one should consider the significant, potentially serious operative complications. 

Keywords

mid-shaft clavicle fracture, treatment, anatomical locking plate, athlete, complication

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