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Clavicle fracture operative treatment(MIPO)

Clavicle fracture operative treatment(MIPO). Department of Orthopaedic surgery Inha University Hospital Kwon Dae Gyu , M.D. Epidemiology. 2~5% of all fracture 35~44% of shoulder girdle injury Incidence: 29~64 명 /10 만 Mid 69~82%, lateral 21~28%, medial 2~3%. Various treatment options .

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Clavicle fracture operative treatment(MIPO)

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  1. Clavicle fractureoperative treatment(MIPO) Department of Orthopaedic surgery Inha University Hospital Kwon DaeGyu, M.D.

  2. Epidemiology • 2~5% of all fracture • 35~44% of shoulder girdle injury • Incidence: 29~64명/10만 • Mid 69~82%, lateral 21~28%, medial 2~3%

  3. Various treatment options • Conservative treatment • Intramedullary nailing • Open reduction & internal fixation c plating

  4. Conservative Tx • Nonunion rate< 1% • 수술적 치료시불유합: 3times • 환자의만족도 Stanley D. The mechanism of clavicular fracture. JBJS Br 1988 Andersen K. Treatment of clavicular fracture. Actaortho Scan 1987. Eskola. Outcome of clavicular fracture in 89 patients. Arch orthoTrau sur. 1986 Neer. Nonunion of the clavicle. JAMA.1960

  5. Conservative vs Operative • 2144 명을 대상으로 한 metaanalysis • Nonunion rate: op 2.2% vsnonop 5.9% (displaced fx.: 15.1%) JOT 2005

  6. Conservative vs Operative • 132 patients( non-op 65, op 67) • Radiographic union: 28.4wks vs 16.4wks • Nonunion: 7 vs 2 • Symptomatic malunion: 9 vs 0 • Functional score: improved in op group at all time point JBJS 2007

  7. Adolescents often have high functional demands • Remodeling potential is limited

  8. Surgical Indication • 개방형골절 • 신경 혈관의 손상이 동반 • 다발성 손상 • 부유 견관절, 피부의 tenting • 젊고활동적인 환자에서 단축이 1.5cm 이상 • 심한 외관상의 문제 • 더 좋은 기능적 결과를 빠른 시간내에 얻길 원하는 경우

  9. Minimal Invasive Plate Osteosynthesis(MIPO) - clavicle

  10. Advantage • 수술절개가작다-미용적으로 우수 • 골막 및 연부조직의 박리가 적다 -생리학적으로 골유합에 유리 • 생역학적으로 강력한 고정력

  11. Operative technique • position

  12. Operative technique • Design

  13. Operative technique • 2-small incision

  14. Operative technique • Reduction technique • Reduction forcep I

  15. Operative technique • Reduction technique • Reduction forceps II

  16. Operative technique • Reduction technique • Temporary external fixator

  17. Operative technique • Reduction technique • Temporary external fixator

  18. Operative technique • Reduction technique • IM nail(TEN)

  19. Operative technique • Reduction technique • Mixed or miniopen

  20. Operative technique • Pitfalls • Care should be exercised when using sharp tools such as drill bits, Schanz screws, and K-wires in this region in order to avoid injury to the lung, vessels, and the brachial plexus. • Tunneling should be done with care so that the periosteum is not stripped off from the bone. • Rotational malalignmentmay occur during fracture reduction and should be corrected before definitive fracture fixation takes place.

  21. Postop management • ROM start early • Load-bearing activities should be delayed until there are radiological signs of fx healing

  22. Case 1 M/19

  23. Case 1 M/19 Postop

  24. Case 1 M/19 Postop 3M

  25. Case 2 M/24

  26. Case 2 M/24 Postop

  27. Case 2 M/24 Postop 3M

  28. Case 3 M/18

  29. Case 3 M/18 Postop

  30. Case 4 F/23 Initial

  31. Case 4 F/23 TD 1wk

  32. Case 4 F/23 TD 2wks

  33. Case 4 F/23 Postop

  34. Case 4 F/23 Postop 2M

  35. Other Case M/25

  36. 감사합니다.

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