Klavikula orta diyafiz parçalı kırıklarının köprüleme plaklama yöntemi kullanılarak kilitli plak ile tedavisi

Öz

Amaç: Bu çalışmanın amacı minimal cerrahi diseksiyonla uygulanan köprü plaklama tedavisi sonrası klavikula orta diyafiz parçalı kırıklarının kaynamasını ve fonksiyonel sonuçlarını değerlendirmekti.

Çalışma planı: Retrospektif olarak yapılan çalışmaya klavikula orta diyafiz parçalı kırıkları 2004 ile 2010 yılları arasında tedavi edilen 17’si erkek ve 6’sı kadın toplam 23 hasta alındı. Tüm kırıklar minimal cerrahi diseksiyonla köprü plaklama tekniği kullanılarak opere edildi. Hastaların fonksiyonel değerlendirilmesi için Constant omuz skorlama sisteminden yararlanıldı.

Bulgular: Ortalama takip süresi 22 (dağılım: 6-68) ay olarak ölçülürken, ortalama 13 (dağılım: 8-20) haftalık bir dönemden sonra bütün kırıklarda kaynama görüldü. Hiçbir hastada implant yetmezliği, yüzeysel ya da derin enfeksiyon gözlenmedi. Yine hiçbir hastada iatrojenik nörovasküler hasar yoktu. Sağlam tarafla karşılaştırıldığında iki hastada klavikula uzunluklarının farklı oldu[u saptandı. Hastaların eklem hareket açıklığı normal idi. Ortalama Constant skoru 89.6 (dağılım: 72-100) olarak hesaplandı.

Çıkarımlar: Klavikula orta diyafiz kırıklarının köprüleme plak tekniği ile kilitli plaklar kullanılarak cerrahi tedavisi yüksek hasta konforu sağlar, erken mobiliteye izin verir ve aynı zamanda düşük komplikasyon oranına sahiptir.

Anahtar Kelimeler

• Kırık; klavikula; köprüleme; orta şaft.

Treatment of comminuted mid-diaphyseal clavicle fractures by plate fixation using a bridging technique

Öz

Objective: The aim of this study was to determine the healing and functional results of the treatment of comminuted mid-diaphyseal clavicular fractures using a bridging plate technique with minimal surgical dissection.

Methods: This retrospective study included 23 patients (17 males and 6 females) with comminuted mid-diaphyseal clavicular fractures treated between 2004 and 2010. All fractures were operated on using a bridging plate technique with minimal surgical dissection. Patients were evaluated for function using the Constant shoulder scoring system.

Results: Mean follow-up was 22 (range: 6 to 68) months and healing occurred in all patients after a mean of 13 (range: 8 to 20) weeks. No implant failures or superficial or deep infections were observed. Iatrogenic neurovascular damage was not observed in any patient. Two patients had clavicle length discrepancy in comparison with the healthy side. Range of motion was normal in all patients. The mean Constant score was 89.6 (range: 72 to 100) points.

Conclusion: The surgical treatment of mid-diaphyseal fractures with the bridging plate technique using locking plates provides good patient comfort, allows early mobility and has a low complication rate.

Anahtar Kelimeler

• Bridging
• clavicle
• fracture
• midshaft

Kaynakça

1. Smekal V, Oberladstaetter J, Struve P, Krappinger D. Shaft fractures of the clavicle: current concepts. Arch Or- thop Trauma Surg 2009;129:807-15.
2. Nordqvist A, Petersson C. The incidence of fractures of the clavicle. Clin Orthop Relat Res 1994;300:127-32.
3. Bravo CJ, Wright CA. Displaced, comminuted diaphyseal clavicle fracture. J Hand Surg Am 2009; 34:1883-5.
4. Schiffer G, Faymonville C, Skouras E, Andermahr J, Jubel A. Midclavicular Fracture: not just a trivial injury: cur- rent treatment options. Dtsch Arztebl Int 2010;107:711- 7.
5. Postacchini F, Gumina S, De Santis P, Albo F. Epide- miology of clavicle fractures. J Shoulder Elbow Surg 2002;11:452-6.
6. Neer CS 2nd. Nonunion of the clavicle. J Am Med Assoc 1960;172:1006-11.
7. Lenza M, Belloti JC, Andriolo RB, Gomes Dos Santos JB, Faloppa F. Conservative interventions for treating middle third clavicle fractures in adolescents and adults. Cochrane Database Syst Rev 2009;2:CD007121.
8. 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.

9. Drosdowech DS, Manwell SE, Ferreira LM, Goel DP, Faber KJ, Johnson JA. Biomechanical analysis of fixation of middle third fractures of the clavicle. J Orthop Trauma 2011;25:39-43.
10. Rowe CR. An atlas of anatomy and treatment of midcla- vicular fractures. Clin Orthop Relat Res 1968;58:29-42.
11. Hill JM, McGuire MH, Crosby LA. Closed treatment of displaced middle-third fractures of the clavicle gives poor results. J Bone Joint Surg Br 1997;79:537-9.
12. Zlowodzki M, Zelle BA, Cole PA, Jeray K, McKee MD; Evidence-Based Orthopaedic Trauma Working Group. Treatment of acute midshaft clavicle fractures: system- atic review of 2144 fractures: on behalf of the Evidence- Based Orthopaedic Trauma Working Group. J Orthop Trauma 2005;19:504-7.
13. 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.
14. Canadian Orthopaedic Trauma Society. Nonopera- tive treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial. J Bone Joint Surg Am 2007;89:1-10.
15. Mirzatolooei F. Comparison between operative and non- operative treatment methods in the management of com- minuted fractures of the clavicle. Acta Orthop Traumatol Turc 2011;45:34-40.
16. Kulshrestha V, Roy T, Audige L. Operative versus non- operative management of displaced midshaft clavicle frac- tures: a prospective cohort study. J Orthop Trauma 2011; 25:31-8.
17. Boehme D, Curtis RJ Jr, DeHaan JT, Kay SP, Young DC, Rockwood CA Jr. Non-union of fractures of the mid- shaft of the clavicle. Treatment with a modified Hagie intramedullary pin and autogenous bone-grafting. J Bone Joint Surg Am 1991;73:1219-26.
18. Capicotto PN, Heiple KG, Wilbur JH. Midshaft clavicle nonunions treated with intramedullary Steinman pin fix- ation and onlay bone graft. J Orthop Trauma 1994;8:88- 93.
19. Schuind F, Pay-pay E, Andrianne Y, Donkerwolcke M, Rasquin C, Burny F. External fixation of the clavicle for fracture or nonunion in adults. J Bone Joint Surg Am 1998;70: 692-5.
20. Golish SR, Oliviero JA, Francke EI, Miller MD. A biomechanical study of plate versus intramedullary de- vices for midshaft clavicle fixation. J Orthop Surg Res 2008;3:28.
21. Strauss EJ, Egol KA, France MA, Koval KJ, Zuckerman JD. Complications of intramedullary Hagie pin fixation for acute midshaft clavicle fractures. J Shoulder Elbow Surg 2007;16:280-4.
22. Jiang H, Qu W. Operative treatment of clavicle midshaft fractures using a locking compression plate: comparison between mini-invasive plate osteosynthesis (MIPPO) technique and conventional open reduction. Orthop Traumatol Surg Res 2012;98:666-71.
23. Assobhi JE. Reconstruction plate versus minimal invasive retrograde titanium elastic nail fixation for displaced mid- clavicular fractures. J Orthop Traumatol 2011;12:185- 92.
24. Chu CM, Wang SJ, Lin LC. Fixation of mid-third cla- vicular fractures with Knowles pins: 78 patients followed for 2-7 years. Acta Orthop Scand 2002;73:134-9.
25. Baumgaertel F, Buhl M, Rahn BA. Fracture healing in bi- ological plate osteosynthesis. Injury 1998;29 Suppl 3:C3- 6.
26. Drosdowech DS, Manwell SE, Ferreira LM, Goel DP, Faber KJ, Johnson JA. Biomechanical analysis of fixation of middle third fractures of the clavicle. J Orthop Trauma 2011;25:39-43.
27. Demirhan M, Bilsel K, Atalar AC, Bozdag E, Sunbuloglu E, Kale A. Biomechanical comparison of fixation tech- niques in midshaft clavicular fractures. J Orthop Trauma 2011;25:272-8.
28. Kloen P, Sorkin AT, Rubel IF, Helfet DL. Anteroinferior plating of midshaft clavicular nonunions. J Orthop Trau- ma 2002;16:425-30.
29. Iannotti MR, Crosby LA, Stafford P, Grayson G, Goulet R. Effects of plate location and selection on the stability of midshaft clavicle osteotomies: a biomechanical study. J Shoulder Elbow Surg 2002;11:457-62.