Arthroscopic Stabilization for Displaced Lateral Clavicular Fractures

Prince Shanavas Khan,Yon-Sik Yoo,Byung-Su Kim,Seong-Jin Lee,Jong Mun Ha 대한견주관절의학회 2016 대한견주관절학회지 Vol.19 No.3

Background: The purpose of our study was to evaluate the accuracy of reduction based on postoperative computed tomography (CT) images after arthroscopic stabilization using tightrope system for unstable distal clavicle fracture. Methods: Twelve patients with distal clavicle fracture combined with coracoclavicular (CC) ligament injury (type II, V) who received arthroscopically assisted fixation using a flip button device were evaluated for accuracy of reduction using 3-dimensional postoperative CT scan by measuring the degree of distal clavicular angulation and clavicular shortening. Results: Immediate postoperative plain radiograph confirmed restoration of the CC distance (CCD) in 10 patients. At final follow-up, the CCD remained reduced anatomically on plain radiographs in these patients. All patients showed excessive posterior angulation and shortening compared to the opposite side. The average Constant score recovered to 94.8 at final follow-up. Conclusions: Indirect reduction and arthroscopic subacromial approach with flip button fixation of unstable distal clavicle fractures demonstrated favorable clinical results despite unavoidable posterior angulation of distal clavicle and shortening the total length of clavicle.

Wolter 금속판을 이용한 견봉 쇄골 관절 탈구 및 원위 쇄골 골절의 수술적 치료

김상림 ( Sang Rim Kim ),서규범 ( Kyu Bum Seo ),윤진호 ( Jin Ho Yoon ),박용근 ( Yong Keun Park ),남욱 ( Uk Nam ) 대한스포츠의학회 2009 대한스포츠의학회지 Vol.27 No.1

To evaluate the clinical and radiological results of acromioclavicular dislocation and distal clavicular fracture after a Wolter plate fixation. Surgical reduction and fixation using Wolter plate was done in 18 patients with acromioclavicular dislocation and the distal clavicular fracture from February 2004 to February 2007. Clinical results of all patients were assessed using UCLA score. Radiologic outcomes were evaluated by measuring the coracoclavicular distance between the normal and injured side, vertical displacement of clavicle and bony union of distal clavicle. The mean duration of follow up was 17.7 (12-39) months. Postoperative radiographs showed that vertical displacement of the clavicle was restored in all cases. The mean UCLA score at the final follow up was 31.7 (30-35) and a good bony union was obtained in all cases with distal clavicle fracture. Complications such as reduction loss after plate removal, osteolysis and the skin necrosis around the long hook were seen. We believe Wolter plate is useful for treating patients with acromioclavicular dislocation and the distal clavicle fracture because it provides enough stability for active postoperative rehabilitation. However, careful operative planning and familiarity with the technique are necessary to prevent complications including reduction loss, osteolysis and skin necrosis around the long hook.

쇄골 원위단에 발생한 골용해증

구정회(Jung Hoei Ku),김진완(Jin Wan Kim),고영철(Young Chul Ko),조형래(Hyung Lae Cho),안수한(Su Han Ahn) 대한정형외과학회 2005 대한정형외과학회지 Vol.40 No.6

쇄골 원위단의 골용해증은 드문 질환이며 그 원인이나 발병 기전에 대해서도 잘 알려져 있지 않다. 저자들은 각각 급성 및 만성 외상 후에 발생한 쇄골 원위단의 골용해증 2예를 진단하고 보존적 치료에 호전을 보이지 않아 쇄골 원위단 절제술로 치료하여 만족할 만한 결과를 얻었기에 이를 문헌 고찰과 함께 보고하며 본 증례를 통해 쇄골 원위단의 골용해증의 발병 기전과 감별 진단, 치료에 대해 검토해보고자 한다. Osteolysis of the distal clavicle is a rare disease and its etiology and pathogenesis are poorly understood. We report two cases of the osteolysis that were resulted from acute blunt shoulder trauma and chronic repetitive one. After diagnosis, the two patients did not have shown the response to conservative management, so we performed distal clavicle resection on them and the results were satisfactory. Through these cases, we discuss the pathogenic mechanism, differential diagnosis and treatment options for the osteolysis of the distal clavicle.

증례 보고 : 동측 쇄골의 내측 및 외측 동시 골절: 이중 쇄골 골절

박경준 ( Kyoung Jun Park ),손훈상 ( Hoon Sang Sohn ),백경영 ( Kyoung Young Baek ) 대한골절학회 2011 대한골절학회지 Vol.24 No.1

쇄골 골절은 임상에서 흔히 접할 수 있는 상지 손상의 하나이나, 동측 쇄골의 내측, 외측 혹은 간부 골절이 동시에 일어나는 경우는 매우 드물다. 현재까지 전세계적으로 7예가 보고되고 있으나, 국내에서는 보고된 바가 없다. 이에 저자들은 낙상 후 발생한 쇄골 외측골절과 동반된 쇄골 내측 골절 1예를 경험하였기에 문헌 고찰과 함께 손상 기전과 진단 및 치료에 대해 보고하고자 한다. Clavicular fracture is common injury in the upper extremity, but ipsilateral proximal, distal or middle-third clavicular fractures which occur simultaneously are an extremely rare. Seven cases have been reported in the English and Japanese literatures, but it has never been reported in Korea. We report a case of ipsilateral proximal and distal clavicular fracture caused by fall from height and describe its presumed mechanism, diagnosis, treatment with a review of literatures.

견봉 쇄골 관절 병변에 대한 관절경 보조 하 원위 쇄골 en bloc 절제술

박태수(Tae-Soo Park),이광현(Kwang-Hyun Lee),박기철(Kee-Chul Park),조재림(Jae-Lim Cho) 대한정형외과학회 2005 대한정형외과학회지 Vol.40 No.7

목적: 회전근 개 병변이 동반된 견봉 쇄골 관절 병변에 대하여 관절경 보조하에 수술을 시행한 후 그 임상 결과를 알아보고자 하였다. 대상 및 방법: 회전근 개 병변이 동반된 견봉 쇄골 관절 병변의 치료로써 관절경 보조 하에 피부 소절개를 이용한 원위 쇄골 en bloc 절제술 및 관절경적 견봉 성형술을 시행한 18예를 대상으로 하였으며, 견봉 쇄골 관절은 모두 골 관절염 소견을 보였다. 수술당시 평균 나이는 56세였다. 평균 추시 기간은 1년 10개월이었으며, 임상적 결과 판정은 UCLA 견관절 평가지수를 이용하였다. 결과: 동통 지수는 수술 전 2.1±1.1에서 수술 후 9.2±1.0으로, 기능지수는 4.2±1.7에서 9.4±0.9로, 능동적 전방 굴곡은 3.7±0.5에서 5로, 근력 지수는 4.0±0.9에서 4.9±0.2로 각각 증가하였다. 추시 방사선 사진상 모든 예에서 이소골 형성이나 부적절한 골 절제로 인한 잔여 골편의 존재, 그리고 원위 쇄골의 상방 전위 등은 발생하지 않았다. 결론: 관절경 보조 하에 시행한 원위 쇄골의 en bloc 절제술 및 견봉 성형술은 증상이 동반된 견봉 쇄골 관절 병변 및 회전 근개 병변에 대하여 만족스러운 치료 결과를 나타내었기에 권장할 만한 술식으로 사료된다. Purpose: To evaluate the clinical results of arthroscopically assisted operation of the acromioclavicluar joint lesion with the rotator cuff lesion. Materials and Methods: We evaluated the clinical results in eighteen consecutive patients with osteoarthritis of the acromioclavicular joint and rotator cuff lesion, who were treated arthroscopically assisteded en bloc resection of the distal clavicle and arthroscopic acromioplasty. The average age of the patients at the time of operation was fifty six years. The average duration of follow-up was one year and ten months. The UCLA shoulder rating scale was used to evaluate the clinical results. Results: Pain score was improved from 2.1±1.1 preoperatively to 9.2±1.0 postoperatively. Function score was improved from 4.2±1.7 to 9.4±0.9, active forward flexion score, from 3.7±0.5 to 5 and strength score, from 4.0±0.9 to 4.9±0.2. On follow-up radiographic examination, there was no specific complication, including heterotopic ossification, remnant bony fragment of distal clavicle, and superior migration of the clavicle. Conclusion: It is considered that arthroscopically assisted en bloc resection of the distal clavicle and acromioplasty is recommendable method for symptomatic acromioclavicular joint lesion and rotator cuff lesion, which could get the satisfactory clinical results.

동측 쇄골의 내측 및 외측 동시 골절: 이중 쇄골 골절 - 증례 보고 -

박경준,손훈상,백경영 대한골절학회 2011 대한골절학회지 Vol.24 No.1

쇄골 골절은 임상에서 흔히 접할 수 있는 상지 손상의 하나이나, 동측 쇄골의 내측, 외측 혹은 간부 골절이 동시에 일어나는 경우는 매우 드물다. 현재까지 전세계적으로 7예가 보고되고 있으나, 국내에서는 보고된 바가 없다. 이에 저자들은 낙상 후 발생한 쇄골 외측 골절과 동반된 쇄골 내측 골절 1예를 경험하였기에 문헌 고찰과 함께 손상 기전과 진단 및 치료에 대해 보고하고자 한다.

원위 요골 2.4 mm 수장측 잠김 압박 금속판을 이용한 불안정성 원위 쇄골 골절의 수술적 치료 결과

주석규 ( Suk Kyu Choo ),남지호 ( Ji Ho Nam ),김영우 ( Young Woo Kim ),오형근 ( Hyoung Keun Oh ) 대한골절학회 2015 대한골절학회지 Vol.28 No.1

Purpose: This study evaluated the surgical outcomes of unstable distal clavicular fractures treated with a 2.4 mm volar distal radius locking plate. Materials and Methods: From August 2009 to August 2012, 16 patients with distal clavicle fractures underwent surgical treatment. Mean age was 36 years (18-62 years) and mean follow-up period was 12.9 months (6-32 months). Two cases were Neer type I, six cases IIa, three cases IIb, three cases III, and two cases V. For the radiologic assessment, union time and metal failure were evaluated, and coracoidiologic assessment, union time and metal failure were evaluatethe acromioclavicular joint. The clinical results were evaluated by range of motion, postoperative complication, and University of California at Los Angeles (UCLA) score. Results: Mean time to fracture union was 7.4 weeks (6-14 weeks) in all cases. No statistical difference in coracoid-clavicle distance was observed between immediate post-operation group and contra-lateral group (p=0.6), but an increase of 2.1 mm was observed in the last follow up group compared with the contra-lateral group (p<0.01). The UCLA scoring system showed excellent results in 15 cases and good results in one case. Acromial-clavicle instability occurred in one case so that metal removal and distal clavicle resection were performed. Conclusion: A 2.4 mm volar distal radius locking plate can provide rigid fixation through several screw fixation in the short distal fragment and lead to satisfactory clinical outcomes in unstable distal clavicular fractures.

Internal Fixation Using Clavicle Hook Plates for Distal Clavicle Fractures

Kwang-Yul Kim,Hyung-Chun Kim,Sung-Jun Cho,Su-Han Ahn,Dong-Seon Kim 대한견주관절의학회 2015 대한견주관절의학회지 Vol.18 No.1

Background: To report the radiological and clinical outcomes of internal fixation using distal clavicle hook plates for distal clavicle fractures. Methods: From April 2008 to December 2012, 32 patients with distal clavicle fractures underwent surgery using an AO hook plate. The reduction was qualified and evaluated according to the radiological findings. The evaluation of the clinical outcomes was performed with the University of California at Los Angeles (UCLA) score, the Korean Shoulder score, and the visual analogue scale (VAS) pain score. Results: By radiological evaluation, we found that 31 of 32 patients showed anatomical reduction and solid bone union. Although we obtained satisfactory UCLA scores, Korean Shoulder Scale scores, and VAS pain scores, 12 cases of complications were present. We found 4 cases of osteolysis of the acromion, 1 case of nonunion, 3 cases of periprosthetic fractures, 3 cases of subacromial pain, and 1 case of skin irritation. We performed re-operations in 2 patients. Conclusions: To avoid complications associated with clavicle hook plates, choosing the appropriate hook size and bending of the hook according to the slope of the acromion undersurface is critical. Also, we believe that early removal of clavicle plates may help reduce complications.

원위 쇄골 골절의 치료에서 Hook 금속판의 이용

김형천 ( Hyung Chun Kim ),김광열 ( Kwang Yeol Kim ),안수한 ( Su Han Ahn ),윤형조 ( Hyeong Jo Yoon ),김인열 ( In Yeol Kim ) 대한골절학회 2011 대한골절학회지 Vol.24 No.1

목적: 본 연구는 원위 쇄골 골절 치료에서 Hook 금속판을 이용한 수술적 치료의 임상적 결과를 평가하고자 하였다. 대상 및 방법: 2008년 4월부터 2010년 3월까지 원위 쇄골 골절로 Hook 금속판을 이용하여 수술한 10명의 환자를 대상으로 하였으며, 수술 후 평균 추시 기간은 10 (4∼26)개월이었다. 정복 및 골유합의 평가는 수술 직후 및 최종 방사선 소견을 이용하였고, 기능적 평가는 Kona의 기능적 평가 기준 및 UCLA score를 사용하였다. 결과: 방사선학적 평가에서는 10예 모두에서 해부학적 정복 및 골유합을 확인하였으며, Kona의 기능적 평가기준에 의해 우수 7예, 양호 3예였고, UCLA 평균점수는 33.3 (29∼35)점으로 우수 6예, 양호 4예였다. 합병증으로는 1예에서 술 후 쇄골 간부 골절이 발생하였고, 1예에서 골 용해가 발생하였다. 그 외 피부자극, 감염증, 나사못의 이완, 금속판의 파단 등 다른 합병증은 관찰되지 않았다. 결론: Hook 금속판을 이용한 고정법은 원위 쇄골 골절의 치료에서 만족스런 정복과 견고한 고정을 얻을 수 있고, 불유합의 발생이 적으며, 임상적 결과가 우수한 수술 방법이라고 사료된다. Purpose: To evaluate the result of distal clavicle fracture treated by Hook plate (LCP clavicle hook plate, Synthes(R), Paoli, Switzerland). Materials and Methods: 10 patients with distal clavicle fracture treated by Hook plate from April 2008 to March 2010 were analyzed. The average follow-up period was 10 (range 4 to 26) months. The reduction was qualified and evaluated according to the immediate post-operative, final radiographs. We analyze the result by UCLA score and Kona`s functional evaluation. Results: By radiologic evaluation, all cases showed anatomical reduction and solid union. By Kona`s functional evaluation, there are 7 cases with excellent results, 3 cases with good results. The UCLA score was average 33.3 (range 29 to 35) points followed by 6 excellent cases, 4 good cases. As complication, 1 case showed post-operative clavicle shaft fracture and 1 case showed acromial osteolysis on X-rays. We found no complications such as skin irritation, infection, loosening of screws, and plate failure. Conclusion: The Hook plate fixation for distal clavicle fracture is considered effective method for satisfactory reduction and rigid fixation, a lower incidence of nonunion and excellent clinical result.

K 강선 및 긴장대 강선을 이용한 원위 쇄골 제 2형 골절의 치료

정환용,이우석,전택수,김대환,김광균,임재우 대한골절학회 2003 대한골절학회지 Vol.16 No.2

목 적: 쇄골 윈위부 제 Ⅱ형 골절의 치료에 있어 견봉 쇄골 관절을 통과하지 않고 직접 골편을 고정시키는 K 강선 및 긴장대 강선을 이용한 고정술로 치료한 환자에서 임상 결과를 후향적으로 분석하여 보고하고자 한다. 대상 및 방법: 2000년 5월부터 2001년 5월까지 쇄골 원위부 제 Ⅱ형 골절로 관혈적 정복술 및 K 강선 및 긴장대 강선을 이용한 고정술을 실시한 12례 중 최소 1년 이상 추시가 가능한 11례를 대상으로 하였다. 임상적 평가를 위해 최종 추시에서 변형된 견관절 기능 평가법을 사용하여 결과를 분석하였고 골유합 상태, 합병증, 견관절 운동범위를 측정하였다. 결 과: 전례에서 골유합을 얻었으며, 수술 후 골 유합까지의 기간은 평균 10주 (8~12주)였다. 최종 추시 상 견관절의 운동범위는 모두 정상 소견이었고, 변형된 견관절 기능 평가상 우수 9례, 양호 2례였다. 결 론: 쇄골 원위부 제 Ⅱ형 골절에서 K 강선 및 긴장대 강선을 이용한 고정술은 좋은 치료 방법 중 하나로 사료된다. Purpose: This is retrospective study to analyze the clinical results of the usefulness of K-wires and tension band wiring that fix the fracture fragment directly without passing the acromioclavicular joint in distal clacivle type Ⅱ fractures. Materials and Methods: From May 2000 to May 2001, eleven patients with distal clavicle type Ⅱ fracture were treated by open reduction and internal fixation with K-wires and tension band wiring. The clinical results were analyzed according to modified shoulder rating scale for distal clavicle freacture. Radiological union, complication, and range of motion of the shoulder were assessed. Results: All fractures were united at 10 weeks (8~12 weeks) in average. Finally, full range of motion of the shoulder joint was achieved in all patients. No complication was found and the modified shoulder rating scale for distal clavicle fracture were as follows: excellent 9 and good 2. Conclusion: K-wires and tension band wiring can be a good treatment method for distal clavicle type Ⅱ fractures.