AYRIŞMIŞ, ORTA HAT KLAVİKULA KIRIKLARINDA CERRAHİ TEDAVİNİN FONKSİYONEL SONUÇLARININ DEĞERLENDİRİLMESİ: GERİYE DÖNÜK, ORTA DÖNEM TAKİP SONUÇLARIMIZ

Amaç:Bu çalışmanın amacı ayrışmış orta hat klavikula kırıklarının cerrahi tedavisinde açık redüksiyon ve internal kilitli plak ile tespitin orta dönem sonuçlarını değerlendirmek. Gereç ve Yöntem:Ağustos 2011 ve Temmuz 2013 arasında açık redüksiyon ve internal kilitli plak ile tespit yapılan 23 hasta (9 [39,1%] erkek, 14 [60,9%]; ortalama yaş 6,8±12,4 yıl) çalışmaya dahil edildi. Tüm hastalar son kontrollerinde Disabilities of the Arm, Shoulder and hand (DASH) ve Constant Shoulder (CS) skorları ile değerlendirildi.Bulgular: Ortalama takip süresi 28,6 ay (12-44 ay) ve ortalama kaynama süresi 14.1 ±2,6 hafta (aralık: 10-20 hafta ) idi. Hiçbir hastada kaynamama ya da implant yetmezliği gelişmedi. Son kontrollerinde ortalama CS ve DASH skoru 86,3±3,5 ve 14,0±4,2 idi.Sonuç:Ayrışmış orta hat klavikula kırıklarının cerrahi tedavisinde açık redüksiyon ve internal kilitli plak ile tespit iyi fonksiyonel sonuç sağlamaktadır.

Evaluation of Functional Outcomes in the Surgical Treatment of Displaced Middle-Third Clavicular Fracture: A Retrospective Study and Mid-Term Follow-Up

Background:The aim of this study was to evaluate the mid-term functional outcomes of open reduction and internal locked-plate fixation in the surgical treatment of displaced middle-third clavicular fractures.Method: We performed a retrospective review of 23 consecutive patients (9 [39.1%] male, 14 [60.9%] female; mean age, 46.8 ± 12.4 years) who underwent open reduction and internal locked-plate fixation between August 2011 and July 2013. All patients were clinically rated at the final follow-up visit using the Disabilities of the Arm, Shoulder and Hand (DASH) and the Constant Shoulder (CS) scores.Results:The average follow-up duration was 28.6 months (range: 12-44 months) and the mean union time was 14.1 ± 2.6 weeks (range: 10-20 weeks). None of the patients experienced nonunion or implant failure. At the final follow-up, the mean CS and DASH scores were 86.3 ± 3.5 (range: 80-93) and 14.0 ± 4.2 (range: 6.8-25), respectively.Conclusion:Surgical treatment using open reduction and internal fixation of displaced middle-third clavicular fractures results in good functional results, has a high rate of union, and provides good functional outcomes with locked-plate fixation.

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Nordqvist A, Petersson C The incidence of fractures of theclavicle. Clin Orthop Relat Res1994 ;300:127-132
Postacchini F, Gumina S, De Santis P, Albo F Epidemiology of clavicle fractures. J Shoulder Elbow Surg 2002;11(5):452- 456
Robinson CM, Court-Brown CM, McQueen MM, Wakefield AE Estimating the risk of nonunion following nonoperative treatment of a clavicularfracture. J Bone JointSurg Am 2004;86-A(7):1359-1365
Eskola A, Vainionpaa S, Myllynen P, Patiala H, Rokkanen P Outcome of clavicular fracture in 89 patients. ArchOrthopTraumaSurg 1986;105(6):337-338
Faldini C, Nanni M, Leonetti D, Acri F, Galante C, Luciani D, et al. Nonoperative treatment of closed displaced midshaft clavicle fractures. J OrthopTraumatol 2010;11:229-36.
Lazarides S, Zafiropoulos G. Conservative treatment of fractures at the middlethird of theclavicle: therelevance of shortening and clinical outcome. J ShoulderElbowSurg 2006;15: 191-4.
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;88:35-40.
Jeray KJ. Acute midshaft clavicular fracture. J Am Acad Orthop Surg 2007;15:239-48.
Zlowodzki M, Zelle BA, Cole PA, Jeray K, McKee MD, Evidence-Based Orthopaedic TraumaWorking Group. Treatment of acute midshaft clavicle fractures: systematic review of 2144 fractures: on behalf of the Evidence Based Orthopaedic Trauma Working Group. J OrthopTrauma 2005;19:504-7.
Canadian Orthopaedic Trauma Society. Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial. J Bone JointSurg Am 2007;89:1-10.
Pearson AM, Tosteson AN, Koval KJ, McKee MD, Cantu RV, Bell JE, et al. Is surgery for displaced, midshaft clavicle fractures in adultscost-effective? Resultsbased on a multicenter randomized, controlled trial. J OrthopTrauma 2010;24: 426-33.
Robinson CM. Fractures of the clavicle in theadult. Epidemiology and classification. J Bone JointSurg. 1998;80(3):476-84.
Smekal V, Irenberger A, Struve P, Wambacher M, Krappinger D, Kralinger FS.Elasticstableintramedullary nailing versus nonoperative treatment of displaced midshaft clavicular fractures-a randomized, controlled, clinicaltrial. J OrthopTrauma 2009;23:106-12.
Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of thearm, shoulder, andhand). The upper extremity collaborative group (UECG). Am J IndMed 1996;29:602-8.
Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 1987;(214): 160-4.
Nowak J, Holgersson M, Larsson S. Can wepredict long term sequelae after fractures of the clavicle based on initial findings? A prospective study with nine to ten years of followup. J Shoulder Elbow Surg 2004;13:479-86.
Ledger M, Leeks N, Ackland T, Wang A. Short malunions of theclavicle: an anatomic and functional study. J Shoulder Elbow Surg 2005;14:349-54.
Neer 2nd CS. Nonunion of theclavicle. J AMA. 1960;172:1006-11.
Hill JM, McGuire MH, Crosby LA. Closed treatment of displaced middle-third fractures of the clavicle gives poor results. J Bone JointSurg. 1997;79(4):537-9.
Robinson CM, Goudie EB, Murray IR, Jenkins PJ, Ahktar MA, Read EO, et al. operative treatment for displaced midshaft clavicular fractures: a multicenter, randomized, controlledtrial. J Bone JointSurg Am. 2013;95(17):1576-84
McKee RC, Whelan DB, Schemitsch EH, McKee MD. Operative versus nonoperative care of displaced midshaft clavicular fractures: a meta-analysis of randomizedclinicaltrials. J Bone JointSurg Am. 2012;94(8):675-84.
Ozler T, Güven M, Kocadal AO, Uluçay C, Beyzadeoğlu T, Altıntaş F. Locked anatomic plate fixation in displaced clavicular fractures. ActaOrthopTraumatolTurc. 2012;46(4):237 42.
Robinson CM, Goudie EB, Murray IR, Jenkins PJ, Ahktar MA, Read EO, et al. Open operative treatment for displaced midshaft clavicular fractures: a multicenter, randomized controlled trial. J Bone JointSurg Am 2013;95:1576-84.
Virtanen K, Remes V, Pajarinen J, Savolainen V, Bjorkenheim JM, Paavola M. Sling compared with plate osteosynthesis for treatment of displaced midshaft clavicle fractures: a randomizedclinicaltrial. J Bone JointSurg Am 2012;94(17):1546-53
Kulshrestha V, Roy T, Audige L. Operative versus nono perative management of displaced midshaft clavicle fractures: a prospectivecohortstudy. J OrthopTrauma 2011;25(1):31-8