Clavicle fractureoperative treatment(MIPO)

Department of Orthopaedic surgeryInha University Hospital

Kwon Dae Gyu, M.D.

Epidemiology

2~5% of all fracture

35~44% of shoulder girdle injury

Incidence: 29~64 명 /10 만

Mid 69~82%, lateral 21~28%, medial 2~3%

Various treatment options

Conservative treatment

Intramedullary nailing

Open reduction & internal fixation c plat-ing

Conservative Tx

Nonunion rate< 1%

수술적 치료시 불유합 : 3times

환자의 만족도

Stanley D. The mechanism of clavicular fracture. JBJS Br 1988

Andersen K. Treatment of clavicular fracture. Acta ortho Scan 1987.

Eskola. Outcome of clavicular fracture in 89 patients. Arch ortho Trau sur. 1986

Neer. Nonunion of the clavicle. JAMA.1960

Conservative vs Operative

2144 명을 대상으로 한 metaanalysisNonunion rate: op 2.2% vs nonop 5.9%

(displaced fx.: 15.1%)

JOT 2005

Conservative vs Operative

132 patients( non-op 65, op 67) Radiographic union: 28.4wks vs 16.4wks Nonunion: 7 vs 2 Symptomatic malunion: 9 vs 0 Functional score: improved in op group at all time

point

JBJS 2007

Adolescents often have high functional demands Remodeling potential is limited

Surgical Indication

개방형 골절신경 혈관의 손상이 동반다발성 손상부유 견관절 , 피부의 tenting

젊고 활동적인 환자에서 단축이 1.5cm 이상 심한 외관상의 문제 더 좋은 기능적 결과를 빠른 시간내에 얻길 원하는 경우

Minimal Invasive Plate Osteosynthesis(MIPO) - clavicle

Advantage

수술절개가 작다 - 미용적으로 우수

골막 및 연부조직의 박리가 적다 - 생리학적으로 골유합에 유리

생역학적으로 강력한 고정력

Operative technique

position

Operative technique

Design

Operative technique

2-small incision

Operative technique

Reduction technique– Reduction forcep I

Operative technique

Reduction technique– Reduction forceps II

Operative technique

Reduction technique– Temporary external fixator

Operative technique

Reduction technique– Temporary external fixator

Operative technique

Reduction technique– IM nail(TEN)

Operative technique

Reduction technique– Mixed or miniopen

Operative technique

Pitfalls– Care should be exercised when using sharp tools

such as drill bits, Schanz screws, and K-wires in this region in order to avoid injury to the lung, ves-sels, and the brachial plexus.

– Tunneling should be done with care so that the pe-riosteum is not stripped off from the bone.

– Rotational malalignment may occur during fracture reduction and should be corrected before definitive fracture fixation takes place.

Postop management

ROM start early

Load-bearing activities should be delayed until there are radiological signs of fx heal-ing

Case 1M/19

Case 1M/19 Postop

Case 1M/19 Postop 3M

Case 2M/24

Case 2M/24 Postop

Case 2M/24 Postop 3M

Case 3M/18

Case 3M/18 Postop

Case 4F/23 Initial

Case 4F/23 TD 1wk

Case 4F/23 TD 2wks

Case 4F/23 Postop

Case 4F/23 Postop 2M

Other Case M/25

감사합니다 .