Klavikula orta þaft kýrýklarýnýn giriþ kýlavuzu ile minimal invaziv plak osteosentezi

AMAÇ: Minimal invaziv plak osteosentez (MIPO) cerrahi tekniðini basitleþtirmek üzere distal femur ve proksimal lateral tibia için daha az invaziv stabilizasyon sistemleri geliþtirilmiþtir. Bununla birlikte MIPO, klavikula orta þaft kýrýklarýnda giriþ kýlavuzunun yardýmý olmadan fiksasyonda kullanýma sunulmuþtur ve ciddi komplikasyonlar olmaksýzýn tatmin edici klinik ve radyolojik sonuçlar görülmüþtür. Bu çalýþmanýn amacý, giriþ kýlavuzunu kullanarak klaviküler orta þaft kýrýklarýnda MIPO sonuçlarýný belirlemekti.
GEREÇ VE YÖNTEM: Eylül 2016 ile Eylül 2018 arasýnda MIPO ile giriþ kýlavuzu kullanýlarak tedavi edilen klaviküler orta þaft kýrýðý olan 15 hasta dahil edildi. Ortalama 15.4 aylýk takipte (aralýk: 12–24 ay) kemik kaynamasý, Constant skor ile omuz fonksiyonu ve komplikasyonlarý deðerlendirdik.
BULGULAR: Ortalama cerrahi süre 55.9±9.4 dakika (aralýk: 50–70 dakika) ve floroskopi süresi 146.5±29.0 saniye (aralýk: 110–190 saniye) idi. Tüm hastalarda, gecikmeli kaynama veya kaynamama olmadan 8.8±1.0 haftada (aralýk: 8–10 hafta) kemik kaynamasý saðlandý. Takipte ortalama Constant skoru 99.1±1.2 (aralýk: 96–100) idi. Enfeksiyonlar, vidanýn dýþarý çýkmasý, donaným çýkýntýsý ve nörovasküler yaralanma gibi ameliyat sonrasý komplikasyonlar gözlenmedi, ancak bir hastada hafif plak rahatsýzlýðý þikayeti görüldü.
TARTIÞMA: Giriþ kýlavuzu kullanýlarak uygulanan MIPO’nun klavikula orta þaft kýrýklarýnýn operatif tedavisinde kabul edilebilir ve etkili bir seçenek olduðu düþünülmektedir.

Minimally invasive plate osteosynthesis of clavicular midshaft fractures under insertion guide

BACKGROUND: The less invasive stabilization systems for the distal femur and proximal lateral tibia have been developed to simplify the surgical technique of minimally invasive plate osteosynthesis (MIPO). MIPO, however, has simply been introduced into clavicular midshaft fixation without the aid of insertion guide though the procedure for midshaft clavicular fractures was found to produce satisfactory clinical and radiologic outcomes without serious complications. The purpose of this study was to determine the outcome of MIPO of clavicular midshaft fractures using an insertion guide.
METHODS: A total of 15 patients with clavicular midshaft fractures treated by MIPO using insertion guide between September 2016 and September 2018 were included. We assessed bony union, shoulder function by the Constant score, and complications at a mean follow-up of 15.4 months (ranged from 12 to 24 months).
RESULTS: The mean surgical time 55.9±9.4 min (ranged from 50 to 70 min) and the fluoroscopic time was 146.5±29.0 s (ranged from 110 to 190 s). In all patients, the bony union was achieved at 8.8±1.0 weeks (ranged from 8 to 10 weeks) with no delayed unions or nonunions. The average Constant score was 99.1±1.2 (ranged from 96 to 100) at follow-up. Postoperative complications including infections, screw pull-out, hardware prominence, and neurovascular injury were not observed, however, one patient complained of mild plate discomfort.
CONCLUSION: MIPO using insertion guide is believed to be an acceptable and effective choice in the operative treatment of clavicular midshaft fractures.