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: 29~64명/10만
Mid 69~82%, lateral 21~28%, medial 2~3%
Various treatment options
Conservative treatment
Intramedullary nailing
Open reduction & internal fixation c
plating
Conservative Tx
Nonunion rate< 1%
수술적 치료시 불유합: 3times
환자의 만족도
Stanley D. The mechanism of clavicular fracture. JBJS Br 1988
Andersen K. Treatment of clavicular fracture. Acta ortho Scan 1987.
Eskola. Outcome of clavicular fracture in 89 patients. Arch ortho Trau
sur. 1986
Neer. Nonunion of the clavicle. JAMA.1960
Conservative vs Operative
JOT 2005
 2144 명을 대상으로 한 metaanalysis
 Nonunion rate: op 2.2% vs nonop 5.9%
(displaced fx.: 15.1%)
Conservative vs Operative
JBJS 2007
 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
 Adolescents often have high functional demands
 Remodeling potential is limited
Surgical Indication
개방형 골절
신경 혈관의 손상이 동반
다발성 손상
부유 견관절, 피부의 tenting
 젊고 활동적인 환자에서 단축이 1.5cm 이
상
 심한 외관상의 문제
 더 좋은 기능적 결과를 빠른 시간내에 얻
길 원하는 경우
Minimal Invasive Plate
Osteosynthesis(MIPO)
- clavicle
Advantage
수술절개가 작다-미용적으로 우수
골막 및 연부조직의 박리가 적다
-생리학적으로 골유합에 유리
생역학적으로 강력한 고정력
Operative technique
position
Operative technique
Design
Operative technique
2-small incision
Operative technique
Reduction technique
– Reduction forcep I
Operative technique
Reduction technique
– Reduction forceps II
Operative technique
Reduction technique
– Temporary external fixator
Operative technique
Reduction technique
– Temporary external fixator
Operative technique
Reduction technique
– IM nail(TEN)
Operative technique
Reduction technique
– Mixed or miniopen
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 malalignment may occur during fracture
reduction and should be corrected before
definitive fracture fixation takes place.
Postop management
ROM start early
Load-bearing activities should be delayed
until there are radiological signs of fx
healing
Case 1
M/19
Case 1
M/19 Postop
Case 1
M/19 Postop 3M
Case 2
M/24
Case 2
M/24 Postop
Case 2
M/24 Postop 3M
Case 3
M/18
Case 3
M/18 Postop
Case 4
F/23 Initial
Case 4
F/23 TD 1wk
Case 4
F/23 TD 2wks
Case 4
F/23 Postop
Case 4
F/23 Postop 2M
Other Case
M/25
감사합니다.