08.50 09.05 Pamudji Utomo When and How Lateral Clavicle1
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Transcript of 08.50 09.05 Pamudji Utomo When and How Lateral Clavicle1
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Dr Pamudji Utomo SpOT (K)
WHEN AND HOW TO OPERATE
A DISPLACED LATERAL
CLAVICLE FRACTURE
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Epidemiology
Clavicle fractures --> 2.6 % - 12 % of all fractures
Clavicle fractures --> 44 % - 66 % of shoulder fractures Middle third fractures --> 8 % of all clavicle fractures
!ro"imal third fractures # %
Latra! " di#ta! t$ird %& '
$oval & 'uc(erma) *+. 21,
Background
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Topographic Anatomy
he clavicle is
)arroest i) its
midportio)& high
i)cide)ce offractures i) this
area.
$/a0arus M+& eo) C. 26,
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he clavicle fu)ctio) as a strut& raci)g the shoulder from the tru)(
a)d alloi)g the shoulder to fu)ctio) at optimal stre)gth. he
medial o)e third protect the rachial ple"us& the suclavia) a)d
a"illary vessels& a)d the superior lu)g. $oval & 'uc(erma) *+. 21,
Clavicle Functions
$https3o)li)e .epocrates.com,
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Mechanism of Injury
5 fall o) the shoulder or
the outstretched ha)d
5 fall directly o) the
shoulder $8%,
eco)dary to muscle
co)tractio) sei0ure or
stress fracture $rare,
$Cole 5& pavlou !& 7aric( +.
21,
$*ac(so) *. 211,
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Fracture Classication
eer Classificatio)
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59 Classificatio) %&C Lo*atio+ Latra! E+d
,roup#
%&C- C!a.i*!/ Latra! E+d/ I+traarti*u!ar %&C% C!a.i*!/ Latra! E+d/ E0tra Arti*u!ar
Su12roup#
%&C%3% Impa*td (CC Li2am+t I+ta*t)
%&C%3- No+*ommi+utd (CC Li2am+t di#ruptd)
%&C%34 Commi+utd (CC Li2am+t di#ruptd) %&C-34 Commi+utd (CC Li2am+t di#ruptd)
%&C-3- No+*ommi+utd (CC Li2am+t di#ruptd)
%&C-3% Wit$ #!i2$t di#p!a*m+t
(CC Li2am+t I+ta*t)
$:uedi !& Murphy 7M. 2,
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Treatment of lateral clavicle
fractures
Co)servative or 9perative
!rolem3
raditio)ally& )o)surgical ma)ageme)t has ee) favored as
the i)itial treatme)t.
:ece)t evide)ce suggests that specific susets of patie)ts
may e at high ris( for )o)u)io)& shoulder dysfu)ctio)& or
residual pai) after )o)surgical ma)ageme)t.
$ire) +& ;roeme) *!5M. 21
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reatme)t of type = a)d type === eer Classificatio)fractures does )ot appear to e deated
Mostly co)servative physiotherapy
eer type ==3
7ide variety of treatme)t
!articular deformity lac( of staility
?igh ris( of complicatio)s
9:=@
$+ugdale + et al. 1AA,
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Treatment Options
o)operative
li)g
Brace
urgical
!late @i"atio)
cre or !i) @i"atio)-7ire
uture a)d sli)g tech)iues
$;a) der MeiDde) 95& as(ill :& Millett !*. 211,
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urgical treatme)t i)dicatio) of lateral-third clavicle
fracture3
CC ligame)t disruptio)
displaceme)t of themedial clavicle lead to high ris( of )o)u)io)
$28%,
9pe) @ractures or ith oft-tissue compromise
Multiple trauma
FFfloati)g shoulderGG i)Duries are prese)t.
$;a) der MeiDde) 95& as(ill :& Millett !*. 211,
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!late a)d cre
everal plates have ee) descried i) the literature
i)cludi)g the Balser plate& the 7olter plate& the 59
clavicular hoo( plate
Surgical Treatment Options
7olter !late$http3eorif.com,
Balser !late$Ba)sal M& et al. 21,
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staility of the fracture is preserved ithout disturi)g the
iomecha)ics of the 5C Doi)t
Complicatio)s3 fracture of the plateGs hoo(& cut-out&
e)largeme)t of the hoo(Gs hole i) the acromio).
Hook Plate
$Charity :M& ?aidar & hosh & illu 5B. 2,
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Madse) et al.
5dditio) of a suture a)chor forcoracoclavicular fi"atio) to a superior loc(i)g plate
improves staility of type ==B distal clavicle fractures.
Locking Plate
$Madse)&21
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Screw or Pin Fixation
Coracoclavicular creBelmer a)d eler $1AA1, Coracoclavicular fi"atio)
provided a)d mai)tai)ed reductio) of the fracture.
5ccordi)g to their study& heali)g occurred u)eve)tfully
ithi) )i)e ee(s i) all cases.
$@a0al M5& a(se)a *& ?addad @.2,
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Coracoclavicular
cre a)d /oop
suture
$/a0arus M+& eo) C. 26,
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/i) ?? et al $21
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=M !i) @i"atio)
$7heeles C:. 21
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olima) et al3 H)der-coracoid-arou)d-clavicle $HC5C,loop rigid fi"atio) a)d lead to o)y u)io)& provides
adeuate staility ith e"celle)t results.
$olima) 9& et al. 21
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eith M. Baumgarte) $28, prese)ted a) arthroscopic
fi"atio) of type ==-varia)t& u)stale distal clavicle fracture.
Fi2ur - 5rthroscopic vie through the a)terolateral portal shoi)g the ase of
the coracoid ith the i)ferior utto) of the ight:ope device deployed. Fi2ur4 5! radiograph 6 mo)ths postoperatively& reveali)g osseous u)io) of the distal
clavicle. Fi2ur 5 ymmetric a)atomic appeara)ce of the right acromioclavicular
Doi)t a)d distal clavicle 6 mo)ths postoperatively
$Baumgarte) M. 28,
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-ire a)d e)sio) Ba)d 7iri)g
$7u et al. 21
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K-wire by closed tecni!ue
" i S d
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"omparison StudyBishop *I et al o sig)ifica)t differe)ce i) ultimate load to
failure as fou)d i) a iomecha)ic compariso) study amo)g
4 groups 3 suture fi"atio) ith a cerclage suture a)dcoracoclavicular suture& distal clavicle loc(i)g plate& distal
clavicle loc(i)g plates ith suture augme)tatio)& a)d distal
clavicle hoo( plate.
$Bishop *I. et al& 21
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arl 7u et al hoo( plate fi"atio) of u)stale lateral
clavicle fractures as associated ith statistically etter
shoulder fu)ctio) a)d earlier impla)t removal tha) -ire
te)sio) a)d fi"atio).
"omparison Study
$7u et al. 21
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ylvia et al. reported a meta a)alysis of urgical
treatme)t of eer type-== fractures of the distal clavicle
$21 studies&
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"onclusion
/ateral clavicle fracture ca) e treated co)servatively or
operatively.
Ma)y surgical tech)iues has ee) proposed for lateral
clavicle fracture.
pecific treatme)t should e i)dividuali0ed ased o)
fracture characteristics a)d patie)t e"pectatio)s
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TH#$K %O&