Klavikula cisim kırıklarının cerrahi tedavisinin orta-uzun dönem sonuçları

Yıl 2020, Cilt: 4 Sayı: 2, 180 - 185, 12.07.2020

Saygın Kamacı Erdi Özdemir Anıl Gülcü Angelo Colosimo

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

Öz

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.

Anahtar Kelimeler

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

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

Öz

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. 

Anahtar Kelimeler

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

Kaynakça

• 1. Kihlström C, Möller M, Lönn K, Wolf O. Clavicle fractures: epidemiology, classification and treatment of 2 422 fractures in the Swedish Fracture Register; an observational study. BMC Musculoskelet Disord. 2017;18(1):82. PMID: 28202071.
• 2. Postacchini F, Gumina S, De Santis P, Albo F. Epidemiology of clavicle fractures. J Shoulder Elbow Surg. 2002;11(5):452-6. PMID: 12378163.
• 3. Van Tassel D, Owens BD, Pointer L, Moriatis Wolf J. Incidence of clavicle fractures in sports: analysis of the NEISS Database. Int J Sports Med. 2014;35(1):83-6. PMID: 23771828.
• 4. Waldmann S, Benninger E, Meier C. Nonoperative Treatment of Midshaft Clavicle Fractures in Adults. Open Orthop J. 2018;12:1-6. PMID: 29430265.
• 5. McKee MD, Pedersen EM, Jones C, Stephen DJ, Kreder HJ, Schemitsch EH, et al. Deficits following nonoperative treatment of displaced midshaft clavicular fractures. J Bone Joint Surg Am. 2006;88(1):35-40. PMID: 16391247.
• 6. Canadian Orthopaedic Trauma Society. Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial. J Bone Joint Surg Am. 2007;89(1):1-10. PMID: 17200303.
• 7. Lenza M, Belloti JC, Andriolo RB, Faloppa F. Conservative interventions for treating middle third clavicle fractures in adolescents and adults. Cochrane Database Syst Rev. 2014(5):Cd007121. PMID: 24879341.
• 8. Rosenberg N, Neumann L, Wallace AW. Functional outcome of surgical treatment of symptomatic nonunion and malunion of midshaft clavicle fractures. J Shoulder Elbow Surg. 2007;16(5):510-3. PMID: 17582790.
• 9. Althausen PL, Shannon S, Lu M, O'Mara TJ, Bray TJ. Clinical and financial comparison of operative and nonoperative treatment of displaced clavicle fractures. J Shoulder Elbow Surg. 2013;22(5):608-11. PMID: 22960145.
• 10. Souza NASMd, Belangero PS, Figueiredo EAd, Pochini AdC, Andreoli CV, Ejnisman B. Displaced midshaft clavicle fracture in athletes - should we operate? Rev Bras Ortop. 2018;53(2):171-5. PMID: 29911083.
• 11. VanBeek C, Boselli KJ, Cadet ER, Ahmad CS, Levine WN. Precontoured plating of clavicle fractures: decreased hardware-related complications? Clin Orthop Relat Res. 2011;469(12):3337-43. PMID: 21416203.
• 12. Ranalletta M, Rossi LA, Piuzzi NS, Bertona A, Bongiovanni SL, Maignon G. Return to sports after plate fixation of displaced midshaft clavicular fractures in athletes. Am J Sports Med. 2015;43(3):565-9. PMID: 25492034.
• 13. Wijdicks F-JG, Van der Meijden OAJ, Millett PJ, Verleisdonk EJMM, Houwert RM. Systematic review of the complications of plate fixation of clavicle fractures. Arch Orthop Trauma Surg. 2012;132(5):617-25. PMID: 22237694.
• 14. Clavicle. Journal of Orthopaedic Trauma. 2018;32:S105. doi: 10.1097/BOT.0000000000001056
• 15. Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987(214):160-4. PMID: 3791738.
• 16. Whelan DB, Bhandari M, Stephen D, Kreder H, McKee MD, Zdero R, et al. Development of the radiographic union score for tibial fractures for the assessment of tibial fracture healing after intramedullary fixation. J Trauma. 2010;68(3):629-32. PMID: 19996801.
• 17. Lubbert PH, van der Rijt RH, Hoorntje LE, van der Werken C. Low-intensity pulsed ultrasound (LIPUS) in fresh clavicle fractures: a multi-centre double blind randomised controlled trial. Injury. 2008;39(12):1444-52. PMID: 18656872.
• 18. Qin M, Zhao S, Guo W, Tang L, Li H, Wang X, et al. Open reduction and plate fixation compared with non-surgical treatment for displaced midshaft clavicle fracture: A meta-analysis of randomized clinical trials. Medicine (Baltimore). 2019;98(20):e15638. PMID: 31096481.
• 19. van der Ven Denise JC, Timmers TK, Flikweert PE, Van Ijseldijk AL, van Olden GD. Plate fixation versus conservative treatment of displaced midshaft clavicle fractures: Functional outcome and patients' satisfaction during a mean follow-up of 5 years. Injury. 2015;46(11):2223-9. PMID: 26315667.
• 20. Guerra E, Previtali D, Tamborini S, Filardo G, Zaffagnini S, Candrian C. Midshaft Clavicle Fractures: Surgery Provides Better Results as Compared With Nonoperative Treatment: A Meta-analysis. The American Journal of Sports Medicine. 2019;47(14):3541-51. PMID: 30835150.
• 21. Robinson CM, Court-Brown CM, McQueen MM, Wakefield AE. Estimating the risk of nonunion following nonoperative treatment of a clavicular fracture. J Bone Joint Surg Am. 2004;86(7):1359-65. PMID: 15252081.
• 22. Murray IR, Foster CJ, Eros A, Robinson CM. Risk factors for nonunion after nonoperative treatment of displaced midshaft fractures of the clavicle. J Bone Joint Surg Am. 2013;95(13):1153-8. PMID: 23824382.
• 23. Napora JK, Grimberg D, Childs BR, Vallier HA. Factors Affecting Functional Outcomes After Clavicle Fracture. J Am Acad Orthop Surg. 2016;24(10):721-7. PMID: 27564794.
• 24. Nowak J, Holgersson M, Larsson S. Can we predict long-term sequelae after fractures of the clavicle based on initial findings? A prospective study with nine to ten years of follow-up. J Shoulder Elbow Surg. 2004;13(5):479-86. PMID: 15383801.
• 25. McKee RC, Whelan DB, Schemitsch EH, McKee MD. Operative versus nonoperative care of displaced midshaft clavicular fractures: a meta-analysis of randomized clinical trials. J Bone Joint Surg Am. 2012;94(8):675-84. PMID: 22419410.
• 26. Kingsly P, Sathish M, Ismail NDM. Comparative analysis of functional outcome of anatomical precontoured locking plate versus reconstruction plate in the management of displaced midshaft clavicular fractures. J Orthop Surg (Hong Kong). 2019;27(1):2309499018820351. PMID: 30798707.
• 27. Fridberg M, Ban I, Issa Z, Krasheninnikoff M, Troelsen A. Locking plate osteosynthesis of clavicle fractures: complication and reoperation rates in one hundred and five consecutive cases. Int Orthop. 2013;37(4):689-92. PMID: 23377107.