Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
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3.5 mm T-shaped LCP (Locking Compression Plate) Fixation for Unstable Distal Clavicular Fractures

3.5 mm T형 잠김 금속판을 이용한 원위 쇄골 골절의 치료 결과

  • Lee, Churl-Woo (Department of Orthopedic Surgery, National Medical Center) ;
  • Kim, Hee-Chun (Department of Orthopedic Surgery, National Medical Center) ;
  • Roh, Jae-Young (Department of Orthopedic Surgery, National Medical Center) ;
  • Park, Young-Su (Department of Orthopedic Surgery, National Medical Center)
  • Published : 2008.06.15
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Abstract

Purpose: To review the clinical and radiological results after an open reduction and internal fixation with a T-shaped LCP for unstable distal clavicle fractures. Materials and Methods: From February 2005 to June 2006, ten patients with distal clavicle Neer type II fractures were treated with an open reduction and internal fixation with a T-shaped LCP. Bony union was identified by plain radiography. The clinical results were analyzed according to the UCLA scoring system. Results: The mean time to fracture union was 9weeks and union was achieved in all cases. The mean UCLA score was 33.4 (30-35); excellent in 8 cases and good in 2 cases. In one case, loosening of one distal screw was occured and mild AC joint subluxation was observed in another case. Conclusion: 3.5 mm T-shaped LCP fixation is a useful technique for treating unstable distal clavicle fractures. This procedure provide stable fixation with no further AC joint injury.

목적: 쇄골 원위부 불안정성 골절에 대하여 3.5 mm T형 잠김 금속판을 이용한 내고정을 시행한 후 임상적 결과를 보고하고자 한다. 대상 및 방법: 2005년 2월부터 2006년6월까지 3.5 mm T형 잠김 금속판을 이용하여 수술적 치료를 시행한 Neer 2형 원위 쇄골 골절 환자 중 1년 이상 추시가 가능하였던 10예를 대상으로 후향적 연구를 시행하였다. 남자가 6예 여자가 4예였으며, 평균 연령은 45.7세($32{\sim}62$)였다. 동반 손상은 다발성 골절이 1예가 있었으며, 비수술적 치료의 실패로 불유합이 발생하여 자가골 이식술을 동반한 수술적 치료를 시행한 예가 2예 있었다. 평균 추시 기간은 14.8개월($12{\sim}22$)이었으며, 골유합은 단순 방사선검사 소견으로 판정하였고, 임상적 결과는 UCLA점수와 관절 운동 범위 등으로 평가 하였다. 결과: 방사선학적 골유합은 평균 9주($6{\sim}12$주)에 얻을 수 있었으며, 최종 추시 시 UCLA 점수는 평균 33.4점($30{\sim}35$)으로 전예에서 양호 이상의 결과를 얻었고, 관절 운동 범위도 전예에서 정상으로 회복되었다. 합병증으로 1예에서 나사못의 이완소견이 관찰 되었고, 1예에서 견봉-쇄골 관절의 경도의 아탈구가 발생하였으나, 결과에 영향을 미치지는 않았다. 결론: 불안정성 원위 쇄골 골절에 사용한 3.5 mm T형 잠김 금속판을 이용한 내고정은 견봉 쇄골 관절에 영향을 주지 않으며, 견고한 고정을 얻을 수 있었고, 분쇄의 정도가 아주 심하지 않은 원위쇄골 골절의 치료 시 고려 할 수 있는 유용한 술기로 사료된다.

Keywords

References

  1. Arciero RA: Operative techniques for displaced distal clavicle fractures. Operative techniques in sports medicine, 12: 27-31, 2004. https://doi.org/10.1053/j.otsm.2004.04.005
  2. Andrew AW, Keiji K, Mark EZ, William PC III: Internal fixation of dorsally displaced fractures of the distal part of the radius. A biomechanical analysis of volar plate fracture stability. J Bone Joint Surg Am, 88: 2411-2417,.2006. https://doi.org/10.2106/JBJS.E.00946
  3. Chun JM, Kim SY, Lee KW, Shin SJ, Kim EG: Modified tension band fixation for unstable fracture of the distal clavicle. J Korean Orthop Assoc, 37: 416-420, 2002. https://doi.org/10.4055/jkoa.2002.37.3.416
  4. Edwards DJ, Kavanagh TG, Flannery MC: Fractures of the distal clavicle: a case for fixation. Injury, 23: 44-46, 1992. https://doi.org/10.1016/0020-1383(92)90125-C
  5. Ellman H, Hanker G, Bayer M: Repair of the rotator cuff. End-result study of factors influencing reconstruction. J Bone Joint Surg Am, 68 : 1136-1144, 1986. https://doi.org/10.2106/00004623-198668080-00002
  6. Eskola A, Vainionpaa S, Patiala H, Rokkanen P: Outcome of operative treatment in fresh lateral clavicular fracture. Ann Chir Gynaecol, 76: 167-169, 1987.
  7. Flinkkila T, Ristiniemi J, Hyvonen P, Ham-alainen M: Surgical treatment of unstable fractures of the distal clavicle: a comparative study of Kirschner wire and clavicular hook plate fixation. Acta Orthop Scand, 73: 50-53, 2002. https://doi.org/10.1080/000164702317281404
  8. Goldberg JA, Bruce WJ, Sonnabend DH, Walsh WR: Type 2 fractures of the distal clavicle: a new surgical technique. J Shoulder Elbow Surg, 6: 380-382, 1997. https://doi.org/10.1016/S1058-2746(97)90006-9
  9. Heppenstall RB: Fractures and dislocations of the distal clavicle. Ortho Clin N Am, 6: 477-486, 1975.
  10. Kang HJ, Park KK, Yoon HK, Song HK, Han SB: T plate fixation for Unstable Fracture of distal clavicle. J Korean Fracture Soc, 19: 329-334, 2006. https://doi.org/10.12671/jkfs.2006.19.3.329
  11. Kona J, Bosse MJ, Staeheli JW, Rosseau RL: Type II distal clavicle fractures: a retrospective review of surgical treatment. J Orthop Trauma, 4: 115-120, 1990. https://doi.org/10.1097/00005131-199004020-00002
  12. Levy O: Simple, minimally invasive surgical technique for treatment of type 2 fractures of the distal clavicle. J Shoulder Elbow Surg, 12: 24-28, 2003. https://doi.org/10.1067/mse.2003.128564
  13. Muramatsu K, Shigetomi M, Matsunaga T, Murata Y, Taguchi T: Use of the AO hook plate for the treatment of unstable fractures of the distal clavicle. Arch Orthop Trauma Surg, 127:191-194, 2007. https://doi.org/10.1007/s00402-006-0284-5
  14. Neer CS II: Fracture of the distal clavicle with detaqchment of the coracoclavicular ligaments in adults. J Trauma, 3: 99-110, 1963. https://doi.org/10.1097/00005373-196303000-00001
  15. Neer CS II: Fracture of the distal third of the clavicle. Clin Orthop Relat Res, 58: 43-50,1968.
  16. Neer CS II: CNonunion of the clavicle. JAMA, 172 :1006-1011, 1960. https://doi.org/10.1001/jama.1960.03020100014003
  17. Nordqvist A, Petersson C, Redlund-Johnell: The natural course of lateral clavicle fracture. 15 (11-21) year follow-up of 110 cases. Acta Orthop Scand, 64: 87-91, 1993.
  18. Park JY, Seo JB, Kim MH, Yu JW: Tension band fixation for type II fracture of the clavicle. J Korean Fracture Soc, 18: 421-425, 2005. https://doi.org/10.12671/jkfs.2005.18.4.421
  19. Rockwood Jr CA: Fracture of the outer clavicle in children and adults. J Bone Joint Surg Br ,64: 642, 1982.
  20. Yamaguchi H, Arakawa H, Kobayashi M: Results of the Bosworth method for unstable fractures of the distal clavicle. Int Orthop, 22: 366-368, 1998. https://doi.org/10.1007/s002640050279