Wolfgang GRECHEING, Nima HEIDARI, Ottmal LEITGOEB, Walter PRAGER, Wolfgang PICHLER, Annelie M. WEINBER

Is plating of mid-shaft clavicular fractures possible with a conventional straight 3.5 millimeter locking compression plate?

Amaç: Cerrahi olarak tedavi edilen klavikula kırıklarında klinik sonuçların iyi ve kaynamama riskinin düşük olduğu bilinmektedir. Çalışmamızda klavikula orta diafiz kırıklarının osteosentezinde standart 3.5 mm’lik AO kilitli kompresyon plaklarının kullanılabilirliğini değerlendirmeyi amaçladık. Çalışma Planı: Kırkdokuz kadavra klavikulasının uzunluğu ve akromiyal ve sternal taraftaki kavislerin derinlikleri ölçüldü. Daha sonra sırasıyla 6, 7, 8 ve 9 delikli kilitli kompresyon plakları nın klavikulaya nasıl oturdukları değerlendirildi. Bulgular: Ortalama klavikula uzunluğu 155±12 mm, ortalama akromiyal kavis derinliği 18.1±3.7 mm, ortalama sternal kavis derinliği ise 12±4 mm olarak saptandı. En uygun plağın, 49 klavikulanın 48’inde klavikula yapısına uyum sağlayan, 7 delikli kilitli kompresyon plağı oldu ğu görüldü. Çıkarımlar: Kilitli AO kompresyon plaklarının klavikula orta diafiz kırıklarında klavikula anatomisine uyum sağlayıp sağlam bir tespit alternatifi olabilecekleri görülmüştür. Parçalı kırıklarda da bu plaklarla köprüleme yapılarak sağlam bir tespit sağlanabilir.

Klavikula diafiz kırıklarında 3.5 milimetrelik konvansiyonel kilitli kompresyon plakları ile osteosentez yapılabilir mi?

Objective: Current literature describes improved clinical outcomes and a minor rate of pseudoarthrosis following operatively treated clavicular fractures. We investigated the feasibility of using a standard 3.5 mm AO locking compression plate (LCP) of adequate length for the stabilisation of mid-shaft fractures of the clavicle. Methods: The length and acromial and diaphyseal curvature depths were measured in 49 cadaveric clavicles. We then assessed how well the 6, 7, 8 and 9-hole plates fit on the clavicles. Results: The mean clavicular length was 155±12 mm, with a mean acromial curvature of 18.1± 3.7 mm and a mean diaphyseal curvature of 12 mm±4 mm. The optimum plate for the clavicle was a 7-hole LCP, providing adequate fixation in 48 of the 49 clavicles. Conclusion: The described technique for plate osteosynthesis of the clavicle with AO locking compression plate is feasible and results in a biomechanically strong construct for mid-shaft fractures. With the use of a locking plate, comminuted fractures may be bridged without a reduction in the strength of the construct.

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1. Rowe CR. An atlas of anatomy and treatment of midclavicular fractures. Clin Orthop Relat Res 1968;(58):29-42.
2. Neer C. Non-union of the clavicle. J Am Med Assoc 1960;172:1006-11.
3. Robinson CM, Court-Brown CM, McQueen MM, Wakefield AE. Estimating the risk of non-union following non-operative treatment of a clavicular fracture. J Bone Joint Surg Am 2004;86:1359-65.
4. 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.
5. McKee MD, Pedersen EM, Jones C, Stephen DJ, Kreder HJ, Schemitsch EH, et al. Deficits following non-operative treatment of displaced midshaft clavicular fractures. J Bone Joint Surg Am 2006;88:35-40.
6. Altamimi SA, McKee MD; Canadian Orthopaedic Trauma Society. Non-operative treatment compared with plate fixation of displaced midshaft clavicular fractures. Surgical technique. J Bone Joint Surg Am 2008;90 Suppl 2 Pt 1:1-8.
7. Canadian Orthopaedic Trauma Society. Non-operative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial. J Bone Joint Surg Am 2007;89:1-10.
8. Celestre P, Roberston C, Mahar A, Oka R, Meunier M, Schwartz A. Biomechanical evaluation of clavicle fracture plating techniquees: does a locking plate provide improved stability? J Orthop Trauma 2008;22:241-7.
9. Shen JW, Tong PJ, Qu HB. A three-dimensional reconstruction plate for displaced midshaft fractures of the clavicle. J Bone Joint Surg Br 2008;90:1495-8.
10. Robertson C, Celestre P, Mahar A, Schwartz A. Reconstruction plates for stabilization of mid-shaft clavicle fractures: differences between non-locked and locked plates in two different positions. J Shoulder Elbow Surg 2009;18:204-9.
11. Huang JI, Toogood P, Chen MR, Wilber JH, Cooperman DR. Clavicular anatomy and the applicability of precontoured plates. J Bone Joint Surg Am 2007;89:2260-5.
12. Chan KY, Jupiter JB, Leffert RD, Marti R. Clavicle malunion. J Shoulder Elbow Surg 1999;8:287-90.
13. Chen DJ, Chuang DC, Wei FC. Unusual thoracic outlet syndrome secondary to fractured clavicle. J Trauma 2002;52:393-8.
14. Fujita K, Matsuda K, Sakai Y, Sakai H, Mizuno K. Late thoracic outlet syndrome secondary to malunion of the fractured clavicle: case report and review of the literature. J Trauma 2001;50:332-5.
15. Nowak J, Holgersson M, Larsson S. Can we predict longterm 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;13:479-86.
16. Lenza M, Belloti JC, Gomes Dos Santos JB, Matsumoto MH, Faloppa F. Surgical interventions for treating acute fractures or non-union of the middle third of the clavicle. Cochrane Database Syst Rev 2009:CD007428.
17. Nordqvist A, Petersson C. The incidence of fractures of the clavicle. Clin Orthop Relat Res 1994:(300):127-32.
18. 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.
19. Wagner M. General principles for the clinical use of the LCP. Injury 2003;34 Suppl 2:B31-B42.