MID-SHAFT CLAVICLE FRACTURES IN ADULTS – ANALYSIS OF FAILURES AFTER PLATING
Authors:
Peter Wendsche; Ján Kužma; Radek Veselý
Authors‘ workplace:
Trauma Hospital in Brno, Department of Traumatology, Faculty of Medicine, Masaryk University, Brno
; Úrazová nemocnice v Brně, Klinika traumatologie LF MU v Brně
Published in:
Úraz chir. 24., 2017, č.1
Overview
AIM:
The aim of this retrospective study was to evaluate by radiological documentation the bone healing of mid-shaft clavicle fractures in adults, which have been stabilized with different plates using different principles (absolute or relative stability).
MATERIAL AND METHODS:
178 patients (155 males and 23 females) with mid-shaft clavicle fractures were treated in our hospital between 2011 and 2013, 158 patients were operatively stabilized, 154 of them with different plates (reconstruction plates, 1/3 tubular plates, LCP). Only these patients were included into this study. The fracture type (modified Allmann classification) has been determined by radiographs (X-Vision software) and by the description in the operation protocol. The surgical technique following the Principles of osteosyntheses (absolute or relative stability) has been analyzed by the surgical protocol, by per-operative or postoperative X-rays. Bone healing was analyzed on X-rays in two projections 3 to 4 months after surgery, in cases of prolonged bone healing adequate later.
RESULTS:
In majority we found three- and more fragment fractures (70, 2 %). In 35 cases it does not occur bone healing during 3-4 months (20, 8 %), in 3 patients (1, 9 %) pseudarthrosis occurred. In all cases with delayed bone healing (32 cases) plate deformation (bending) occurred, in one case, the plate broke (reconstructional plate). Each case of delayed bone healing was analyzed according to surgical technique and respecting the “Principles”.
DISCUSSION:
Discussed is the question of implant position. The anterior position seems related to biomechanical properties superior to the proximal positioned plate. Discussed are also pro and contras for using reconstructional plates vs. the so-called “autocompressional” plates (DCP). Even though plate osteosyntheses is recommended from many authors, none of them does reflect on the question related to using the “Principles”. It is recommended the case-by-case based solution.
CONCLUSION:
No guidelines for the practice of plate osteosynthesis do exist. From the biomechanical point of view stronger plates (DCP) are superior to reconstructional plates. Horizontal bended reconstructional plates are more predisposed to break in cases with prolonged bone healing. When ever possible, the principle of “absolute” stability should be used. Postoperative immobilization of the shoulder should not be underestimated.
KEY WORDS:
Clavicle bone, osteosynthesis, pseudarthrosis, plating, failure of plates, Angle stable plates (LCP).
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Trauma Surgery
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