Orthopaedics & traumatology, surgery & research : OTSR · 2019
Surgical treatment of mid-shaft clavicle fractures by minimally invasive internal fixation facilitated by intra-operative external fixation: A preliminary study.
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Delvaque Jean-Gabriel, Bégué Thierry, Villain Benoit, Mebtouche Nasser, Aurégan Jean-Charles
Аннотация
BACKGROUND: Mid-shaft clavicle fractures are common and may require surgery. The objective of this study in adults with high-risk mid-shaft clavicle fractures was to evaluate the clinical and radiological outcomes of a minimally invasive surgical technique involving a minimally invasive approach, fracture reduction, temporary intra-operative external fixation, and locking plate internal fixation.
HYPOTHESIS: This minimally invasive surgical technique for mid-shaft clavicle fractures ensures satisfactory radiographic fracture healing and medium-term functional outcomes, with a short immobilisation, rapid return to sports, and low complication rate.
MATERIAL AND METHOD: A retrospective review was performed of patients managed using our minimally invasive surgical technique between 1 January 2012 and 31 December 2016. The primary outcome measure was the 3-month radiographic healing rate. The secondary outcome measures were duration of post-operative immobilisation, 3- and 6-month QuickDASH scores, and post-operative complications.
RESULT: A total of 19 patients were included, 18 males and 1 female with a mean age of 37 years. Radiographic healing was consistently achieved within 3 months. Immobilisation duration was 3 weeks. The mean QuickDASH score was 23.75 after 3 months and 7.5 after 6 months. Return to sports occurred after 3 months. The only complication was transient paraesthesia in the distribution of the C8 nerve root in 1 patient.
DISCUSSION: The management of mid-shaft clavicle fractures remains controversial. The high complication rates associated with conventional surgical techniques make treatment decisions difficult. A surgical technique characterised by temporary intra-operative external fixation to facilitate minimally invasive internal fixation may have a lower complication rate and shorter immobilisation requirements compared to conventional surgery.
LEVEL OF EVIDENCE: IV, retrospective observational study.
HYPOTHESIS: This minimally invasive surgical technique for mid-shaft clavicle fractures ensures satisfactory radiographic fracture healing and medium-term functional outcomes, with a short immobilisation, rapid return to sports, and low complication rate.
MATERIAL AND METHOD: A retrospective review was performed of patients managed using our minimally invasive surgical technique between 1 January 2012 and 31 December 2016. The primary outcome measure was the 3-month radiographic healing rate. The secondary outcome measures were duration of post-operative immobilisation, 3- and 6-month QuickDASH scores, and post-operative complications.
RESULT: A total of 19 patients were included, 18 males and 1 female with a mean age of 37 years. Radiographic healing was consistently achieved within 3 months. Immobilisation duration was 3 weeks. The mean QuickDASH score was 23.75 after 3 months and 7.5 after 6 months. Return to sports occurred after 3 months. The only complication was transient paraesthesia in the distribution of the C8 nerve root in 1 patient.
DISCUSSION: The management of mid-shaft clavicle fractures remains controversial. The high complication rates associated with conventional surgical techniques make treatment decisions difficult. A surgical technique characterised by temporary intra-operative external fixation to facilitate minimally invasive internal fixation may have a lower complication rate and shorter immobilisation requirements compared to conventional surgery.
LEVEL OF EVIDENCE: IV, retrospective observational study.
Предметные рубрики MeSH
AdolescentAdultAgedBone PlatesClavicleDiaphysesFemaleFracture Fixation, InternalFracture HealingFractures, BoneHumansImmobilizationIntraoperative PeriodMaleMiddle AgedMinimally Invasive Surgical ProceduresPostoperative ComplicationsRadiographyRadiologyRetrospective StudiesReturn to SportTime FactorsTreatment OutcomeYoung Adult