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Clavicle fractureoperative treatment(MIPO)
Department of Orthopaedic surgeryInha University Hospital
Kwon Dae Gyu, M.D.
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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%
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Various treatment options
Conservative treatment
Intramedullary nailing
Open reduction & internal fixation c plat-ing
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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
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Conservative vs Operative
2144 명을 대상으로 한 metaanalysisNonunion rate: op 2.2% vs nonop 5.9%
(displaced fx.: 15.1%)
JOT 2005
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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
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Adolescents often have high functional demands Remodeling potential is limited
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Surgical Indication
개방형 골절신경 혈관의 손상이 동반다발성 손상부유 견관절 , 피부의 tenting
젊고 활동적인 환자에서 단축이 1.5cm 이상 심한 외관상의 문제 더 좋은 기능적 결과를 빠른 시간내에 얻길 원하는 경우
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Minimal Invasive Plate Osteosynthesis(MIPO) - clavicle
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Advantage
수술절개가 작다 - 미용적으로 우수
골막 및 연부조직의 박리가 적다 - 생리학적으로 골유합에 유리
생역학적으로 강력한 고정력
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Operative technique
position
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Operative technique
Design
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Operative technique
2-small incision
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Operative technique
Reduction technique– Reduction forcep I
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Operative technique
Reduction technique– Reduction forceps II
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Operative technique
Reduction technique– Temporary external fixator
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Operative technique
Reduction technique– Temporary external fixator
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Operative technique
Reduction technique– IM nail(TEN)
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Operative technique
Reduction technique– Mixed or miniopen
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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, ves-sels, and the brachial plexus.
– Tunneling should be done with care so that the pe-riosteum is not stripped off from the bone.
– Rotational malalignment may occur during fracture reduction and should be corrected before definitive fracture fixation takes place.
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Postop management
ROM start early
Load-bearing activities should be delayed until there are radiological signs of fx heal-ing
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Case 1M/19
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Case 1M/19 Postop
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Case 1M/19 Postop 3M
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Case 2M/24
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Case 2M/24 Postop
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Case 2M/24 Postop 3M
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Case 3M/18
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Case 3M/18 Postop
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Case 4F/23 Initial
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Case 4F/23 TD 1wk
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Case 4F/23 TD 2wks
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Case 4F/23 Postop
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Case 4F/23 Postop 2M
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Other Case M/25
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감사합니다 .