Bülent DAĞLAR, Emre MİNARECİ, Bülent A. TAŞBAŞ, Kenan BAYRAKCI, Uğur GÜNEL, Önder Murat DELİALİOĞLU

Distal klavikula ayrışmalı kırıkları için yeni bir tespit yöntemi: Kilitli distal radius uç plağı

Amaç: Ayrışmalı distal klavikula kırıkları için uygulanan cerrahi tedavinin komşu eklem hareketlerinde kısıtlamaya yol açmaması gerekir. Bu çalışmada, ayrışmalı klavikula distal uç kırıklarında kilitli distal radius uç plağı kullanarak uyguladığımız cerrahi tedavinin sonuçları değerlendirildi. Çalışma planı: Çalışmada, ayrışmalı klavikula distal uç kı- rığı nedeniyle açık düzeltme ve kilitli radius distal uç plağı ile tedavi edilen ardışık 14 hasta (11 erkek, 3 kadın; ort. yaş 30±9; dağılım 19-51) incelendi. Bir hastaya daha önce başka bir merkezde K-teli ve gergi bandı yöntemiyle cerrahi uygu- lanmış ve kaynama sağlanamamıştı. İki olgu dışında, ame- liyata kadar geçen süre ortalama 5.3 gündü (dağılım 1-17 gün). Yeni kırıklar Neer sınıﬂamasına göre 10 olguda tip II, üç olguda tip III olarak sınıﬂandırıldı. Omuz muayenesi ve işlevsel değerlendirme ameliyat sonrası 3, 6 ve 12. aylarda yapıldı. İşlevsel değerlendirmede Değiştirilmiş Omuz Puanı ve Constant omuz puanı kullanıldı. Sonuçlar: Tüm olgularda ameliyat sonrası altıncı haftada omuz ekleminde tam hareket açıklığı elde edildi. On ikin- ci aydaki değiştirilmiş omuz puanı ortalaması 18.7±1.5, Constant omuz puanı ortalaması 95.4±3.0 bulundu. Hiçbir olguda plak vida yetersizliği, düzeltme kaybı, yara açılma- sı veya enfeksiyon gibi komplikasyonlarla karşılaşılmadı. Çıkarımlar: Distal radius kilitli plağı, seçilmiş distal kla- vikula taze kırıkları ve kaynamamalarında, cihazın çıkarıl- ması gerekmeden, erken dönemde aktif omuz hareketlerine izin verebilecek bir tespit sağlamaktadır. Bu teknik kullanı- larak mükemmel klinik sonuçlar elde edilebilir.

Anahtar Kelimeler:

Klavikula, Kırık tespiti, internal, Kemik plakları, Kemik vidaları, Omuz kırıkları, Omuz eklemi, İnternal fiksatörler

An alternative ﬁxation method for the treatment of unstable distal clavicle fractures: Locked distal radius plate

Objectives: Optimal surgical ﬁxation method for displaced distal clavicle fractures should not impose limitations on neighboring joint movements. We evaluated the results of surgical treatment of displaced distal clavicle fractures us- ing locked distal radius plates. Methods: Displaced distal clavicle fractures of 14 consecutive patients (11 men, 3 women; mean age 30±9 years; range 19 to 51 years) were treated using open reduction and locked distal radius plates. Before ﬁnal ﬁxation, one patient underwent K- wire ﬁxation with tension band at another center, resulting in nonunion. Except for two cases with late presentation, the mean time to surgery was 5.3 days (range 1 to 17 days). Ac- cording to the Neer classiﬁcation, fresh fractures were type II in 10 patients and type III in three patients. Shoulder exami- nations and functional evaluations were made at 3, 6, and 12 months postoperatively. Functional assessment included the Modiﬁed Shoulder Rating Scale and Constant score. Results: All patients achieved full range of motion of the shoulder at six weeks postoperatively. The mean modiﬁed shoulder score was 18.7±1.5 and the mean Constant score was 95.4±3.0 at 12 months. None of the patients devel- oped implant failure, loss of reduction, skin breakdown, or infection. Conclusion: In selected acute fractures and nonunions of the distal clavicle, excellent clinical results are easily achievable with locked distal radius plate ﬁxation because it allows early shoulder movements without necessitating implant removal.

Keywords:

Clavicle, Fracture Fixation, Internal, Bone Plates, Bone Screws, Shoulder Fractures, Shoulder Joint, Internal Fixators,

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