DOI QR코드

DOI QR Code

Surgical Treatment of Unstable Distal Clavicle Fractures: Comparison of Transacromial Pin Fixation and Hook Plate Fixation

불안정 원위 쇄골 골절의 수술적 치료: 경견봉 강선 고정술과 갈고리형 금속판 고정술의 비교

  • Kim, Young Sung (Department of Orthopedic Surgery, Dongguk University Gyeongju Hospital, Dongguk University College of Medicine) ;
  • Lee, Ho Min (Department of Orthopedic Surgery, Dongguk University Gyeongju Hospital, Dongguk University College of Medicine) ;
  • Jang, Han Gil (Department of Orthopedic Surgery, Dongguk University Gyeongju Hospital, Dongguk University College of Medicine)
  • 김영성 (동국대학교 의과대학 경주병원 정형외과학교실) ;
  • 이호민 (동국대학교 의과대학 경주병원 정형외과학교실) ;
  • 장한길 (동국대학교 의과대학 경주병원 정형외과학교실)
  • Received : 2013.05.20
  • Accepted : 2013.07.26
  • Published : 2013.12.31

Abstract

Purpose: The purpose of this study is to compare the clinical and radiological outcomes of two surgical treatments, transacromial pin fixation and hook plate fixation, for unstable distal clavicle fractures. Materials and Methods: Twenty four patients with Neer type II distal clavicle fractures who underwent surgery with transacromial pin fixation (Group I: 12 patients) and hook plate fixation (Group II: 12 patients) were included. Reduction and union were evaluated using plain radiographs. Functional evaluation was performed according to UCLA score and Constant-Murley score at last follow-up. Results: All 24 cases showed bone union. Complete union took an average of 10 weeks for group I and 11.7 weeks for group II. Average UCLA score was 33 (group I) and 32.8 (group II). Average Constant score was 88.5 (group I) and 88.8 (group II). No significant difference for each variable was observed between the two groups. Conclusion: For the surgical treatment of Neer type II distal clavicle fractures, transacromial pin fixation and hook plate fixation are both useful methods.

서론: 불안정성 쇄골 원위부 골절에 대하여 변형된 경견봉 강선 고정술과 갈고리형 금속판 고정술을 시행 후 결과를 비교하였다. 대상 및 방법: Neer 분류 제 2형 골절에 대하여 경견봉 강선 고정술 혹은 갈고리형 금속판 고정술을 시행하고 1년 이상 추시가 가능하였던 24명을 대상으로 하였다. 경견봉 강선 고정술(group I)을 시행한 경우가 12명, 갈고리형 금속판 고정술(group II)을 시행한 경우가 12명이었다. 정복 및 골유합의 평가는 수술 직후 및 최종 방사선 사진을 이용하였고, 기능적 평가는 최종 추시 시의 UCLA score 및 Constant-Murley score를 측정하여 비교하였다. 결과: 수술 뒤 group I은 평균 10주, group II는 평균 11.7주에 모든 예에서 골유합을 관찰할 수 있었다. 최종 추시 시의 평균 UCLA score는 group I은 33점, group II는 32.8점이었으며, 평균 Constant score는 group I은 88.5점, group II는 88.8점으로 두 기능적 평가 결과 통계적으로 유의한 차이는 없었다. 결론: Neer 분류 제 2형 원위 쇄골 골절에서 경견봉 강선 고정술과 갈고리형 금속판 고정술은 만족할 만한 결과를 얻을 수 있어 모두 유용한 방법으로 생각된다.

Keywords

References

  1. Nordqvist A, Petersson C, Redlund-Johnell I. The natural course of lateral clavicle fracture. 15 (11-21) year follow-up of 110 cases. Acta Orthop Scand. 1993;64:87-91.
  2. Neer CS II. Fractures of the distal third of the clavicle. Clin Orthop Relat Res. 1968;58:42-50.
  3. Kona J, Bosse MJ, Staeheli JW. Type II distal clavicle fractures: A retrospective review of surgical trauma. J Orthop Trauma. 1990;4:115-20. https://doi.org/10.1097/00005131-199004020-00002
  4. Kao FC, Chao EK, Chen CH, Yu SW, Chen CY, Yen CY. Treatment of distal clavicle fractures using Kirschner wires and tension bend wires. J Trauma. 2001;51:522-5. https://doi.org/10.1097/00005373-200109000-00016
  5. Ballmer FT, Gerber C. Coracoclavicular screw fixation for unstable fractures of the distal clavicle; a report of five cases. J Bone Joint Surg Br. 1991;73: 291-4.
  6. Mizue F, Shirai Y, Ito H. Surgical treatment of comminuted fractures of the distal clavicle using Wolter clavicular plates. J Nippon Med Sch. 2007;6: 32-4.
  7. Muramatsu K, Shigetomi M, Matsunaga T, Murata Y, Taguchi T. Use of the AO hook-plate for treatment of unstable fractures of the distal clavicle. Arch Orthop Trauma Surg. 2007;127:191-4. https://doi.org/10.1007/s00402-006-0284-5
  8. Anderson JR, Willis MP, Nelson R, Mighell MA. Precontoured superior locked plating of distal clavicle fractures: A new strategy. Clin Orthop Relat Res. 2011;469:3344-50. https://doi.org/10.1007/s11999-011-2009-5
  9. Anderson K. Evaluation and treatment of distal clavicle fractures. Clin Sports Med. 2003;22:319-26. https://doi.org/10.1016/S0278-5919(02)00108-4
  10. Fann CY, Chiu FY, Chuang TY, Chen CM, Chen TH. Transacromial Knowles pin in the treatment of Neer type 2 distal clavicle fractures: a prospective evaluation of 32 cases. J Trauma. 2004;56:1102-5. https://doi.org/10.1097/01.TA.0000082649.57981.F9
  11. Mall JW, Jocobi CA, Philipp AW, Peter FJ. Surgical treatment of unstable fractures of the distal clavicle with polydioxanone suture tension band wiring: an alternative osteosynthesis. J Orthop Sci. 2002;7: 535-7. https://doi.org/10.1007/s007760200095
  12. Goldberg JA, Bruce WJ, Sonnabend DH, Walsh WR. Type 2 fractures of the distal clavicle: a new surgical technique. J Shoulder Elbow Surg. 1997;6: 380-2. https://doi.org/10.1016/S1058-2746(97)90006-9
  13. Kim KC, Shin HD, Cha SM, Jeon YS. Hook plate fixation for unstable distal clavicle fractures:a prospective study. Clin Shoulder Elbow. 2011;14:6-12. https://doi.org/10.5397/CiSE.2011.14.1.006
  14. Edwards DJ, Kavanagh TG, Flannery MC. Fractures of the distal clavicle: a case for fixation. Injury. 1992;23:44-6. https://doi.org/10.1016/0020-1383(92)90125-C
  15. Yamaguchi H, Arakawa H, Kobayashi M. Result of the Bosworth method for unstable fractures of the distal clavicle. Int Orthop. 1998;22:366-8. https://doi.org/10.1007/s002640050279
  16. Neer CS II. Fractures of the distal clavicle with detachment of the coracoclavicular ligaments in adults. J Trauma. 1963;3:99-110. https://doi.org/10.1097/00005373-196303000-00001
  17. Eskola A, Vainiopaa S, Patiala H, Rokkanen P. Outcome of operative treatment in fresh lateral clavicular fracture. Ann Chir Gynaecol. 1987;76:167-9.
  18. An SH, Kim HC, Kim KY, Lee JH, Yoon SH. Complications of Hook-plate fixation for distal clavicle fractures. J Korean Fracture Soc. 2012;25:38-45. https://doi.org/10.12671/jkfs.2012.25.1.38
  19. Nadarajah R, Mahaluxmivala J, Amin A, Goodier DW. Clavicular hook-plate: complications of retaining the implant. Injury. 2005;36:681-3. https://doi.org/10.1016/j.injury.2004.08.010
  20. Meda PV, Machani B, Sinopidis C, Braithwaite I, Brownson P, Frostick SP. Clavicular hook plate for lateral end fractures: a prospective study. Injury. 2006;37:277-83. https://doi.org/10.1016/j.injury.2005.10.017
  21. Renger RJ, Roukema GR, Reurings JC, Raamas PM Font J, Verleisdonk EJ. The clavicle hook plate for Neer type II lateral clavicle fractures. J Orthop Trauma. 2009;23:570-4. https://doi.org/10.1097/BOT.0b013e318193d878
  22. Klein SM, Badman BL, Keating CJ, Devinney DS, Frankle MA, Mighell MA. Result of surgical treatment for unstable distal clavicle fractures. J Shoulder Elbow Surg. 2010;19:1049-55. https://doi.org/10.1016/j.jse.2009.11.056
  23. Flinkkila T, Ristiniemi J, Hyvonen P, Hamalainen M. Surgical treatment of unstable fractures of the distal clavicle: a comparative study of Kirschner wire and clavicular hook plate fixation. Acta Orthop Scand. 2002;73:50-3. https://doi.org/10.1080/000164702317281404
  24. Naidoo P. Migration of a Kirschner wire from the clavicle into the abdominal aorta. Arch Emerg Med. 1991;8:292-5. https://doi.org/10.1136/emj.8.4.292
  25. Tsai CH, Hsu HC, Huan CY, Chen HT, Fong YC. Late migration of threaded wire (Schanz screw) from right distal clavicle to the cervical spine. J Chin Med Assoc. 2009;72:48-51. https://doi.org/10.1016/S1726-4901(09)70021-8

Cited by

  1. Treatment of Acute Acromioclavicular Joint Injuries Using AO Hook Locking Plate vol.17, pp.3, 2014, https://doi.org/10.5397/cise.2014.17.3.114