MID-TERM OUTCOMES OF MID-SHAFT CLAVICULAR NONUNIONS TREATED BY PLATE FIXATION WITH AUTOLOGOUS BONE GRAFTING: DOES THE TYPE OF INITIAL TREATMENT HAVE AN INFLUENCE ON THE SURGICAL RESULTS?

Öz

Objective: The recent literature is scarce regarding the outcomes of mid-shaft clavicular non-union treated by open reduction and internal fixation (ORIF) with autologous bone grafting, and the influence of the type of initial treatment has not yet been investigated. The study aims: (1) to present the mid-term surgical results of mid-shaft clavicular non-unions treated by plate fixation with autologous bone grafting and (2) to determine the effect the type of initial treatment has on the surgical results. Material and Method: The study reviews 14 patients (eight females) who’d undergone ORIF with autologous bone grafting due to atrophic mid-shaft clavicular nonunion where clinical and radiographical outcomes were recorded. The study divides the patients into two groups based on their initial treatment: Group A (eight with non-surgical treatment) and Group B (six with surgical treatment). Result: The mean QuickDASH score at final follow-up was 22. The Constant Score significantly improved from 40 to 87 postoperatively. The mean Preoperative Visual Analogous Scale (VAS) score went down from 7 to 2 (p<0.001). A solid union was achieved in all patients. In the preoperative between-group comparison, no significant differences were observed for any of the clinical outcome. At final follow-up, Group A exhibited significantly higher Constant Scores. Conclusion: Regardless of the type of initial treatment, plate fixation with autologous bone grafting is effective in obtaining solid fusion and improving the clinical status of patients with mid-shaft clavicular non-union. Additionally, this technique can provide shorter time to union and greater improvements in specific shoulder function in patients who’ve undergone non-surgical treatment.

Anahtar Kelimeler

• Mid-shaft clavicular non-union
• initial treatment
• plate fixation
• autologous bone grafting

OTOLOG KEMİK GREFTİ İLE PLAK FİKSASYONU İLE TEDAVİ EDİLEN MİD-ŞAFT KLAVİKULA KAYNAMAMALARININ ORTA DÖNEM SONUÇLARI: BAŞLANGIÇ TEDAVİSİNİN TİPİNİN CERRAHİ SONUÇLARA ETKİSİ VAR MIDIR?

Öz

Amaç: Otolog kemik grefti ile açık redüksiyon ve internal fiksasyon (ORIF) ile tedavi edilen mid-şaft klavikula kaynamamasının sonuçlarıyla ilgili güncel literatür azdır. Bu çalışmanın amaçları şunlardı: (1) otolog kemik grefti ile plak fiksasyonu ile tedavi edilen mid-şaft klaviküler kaynamamaların orta dönem cerrahi sonuçlarını ardışık bir vaka serisinde sunmak ve (2) başlangıç tedavi yönteminin klinik sonuçlara olan etkisini araştırmaktır. Gereç ve Yöntem: Atrofik mid-şaft klavikula kaynamaması nedeniyle otolog kemik grefti ile ORIF uygulanan 14 hasta (sekiz kadın) retrospektif olarak incelendi. Genel çalışma popülasyonunda çeşitli klinik ve radyografik sonuçlar kaydedildi. Hastalar daha sonra başlangıç tedavisinin türüne göre iki gruba ayrıldı: Grup A (sekizi cerrahi olmayan tedavi) ve Grup B (altısı cerrahi tedavi). Bulgular: Son değerlendirmede ortalama QuickDASH skoru 22 idi. Constant skoru ameliyat sonrası 40'tan 87'ye anlamlı olarak arttı. Ameliyat öncesi ortalama görsel analog skala (VAS) skoru son değerlendirmede 7'den 2'ye (p<0,001) geriledi. Tüm hastalarda kaynama görüldü. Ameliyat öncesi dönemde gruplar arası karşılaştırmada, klinik sonuçları arasında anlamlı bir fark gözlenmedi. Son değerlendirmede gruplar arası karşılaştırmada grup A anlamlı derecede daha yüksek Constant puanları sergiledi. Sonuç: Başlangıç tedavisinin türü ne olursa olsun, otolog kemik grefti ile plak tespiti, mid-şaft klaviküler kaynamaması olan hastalarda füzyon elde etmede ve klinik durumu iyileştirmede etkilidir. Ek olarak, bu teknik, başlangıçta konservatif tedavi gören hastalarda kaynamanın daha kısa sürede gerçekleşmesini ve spesifik omuz fonksiyonlarında daha büyük iyileşmeler sağlayabilir.

Anahtar Kelimeler

• Mid-şaft klavikula kaynamama
• başlangıç tedavisi
• plak ile osteosentez
• otolog kemik greftleme

Kaynakça

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