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1.
Article in Spanish | LILACS, BINACIS | ID: biblio-1367135

ABSTRACT

Introducción: El 10-30% de las fracturas de clavícula ocurren en el tercio distal. El diagnóstico se realiza con radiografías de hombro (de frente y de perfil, y proyección de Zanca). La mayoría de estas fracturas se tratan de forma conservadora, pero aquellas con gran desplazamiento, patrones transversos o conminutos pueden requerir tratamiento quirúrgico debido a la alta tasa de seudoartrosis. Se han descrito diversos tipos de fijación para este grupo de fracturas. Si bien la osteosíntesis con placas logra resultados clínico-funcionales y de consolidación satisfactorios, no está exenta de complicaciones y las más frecuentes son: intolerancia al material de osteosíntesis (hasta un 30%), infección, lesión neurovascular y seudoartrosis. Sin embargo, según nuestro conocimiento, no existen reportes sobre la osteólisis de la apófisis coracoides secundaria a la osteosíntesis con placa LCP en fracturas del tercio distal de la clavícula. Conclusión: La erosión de la apófisis coracoides debido a la fijación con placa y tornillos es una complicación que no ha sido publicada previamente. Debe tenerse extrema precaución al realizar el túnel óseo y al medir la longitud de los tornillos para evitar potenciales complicaciones. Nivel de Evidencia: IV


Background: Several surgical techniques have been developed to reduce the nonunion rate and improve functional outcomes after displaced distal clavicle fractures, including the use of a tension band, the modified Weaver-Dunn procedure, coracoclavicular screw fixation, or locking plates. None of these techniques have been universally accepted, and each one has its own complications. To our knowledge, there are no previous publications describing osteolysis of the coracoid process caused by the tip of a cortical screw of a distal LCP plate. Case summary: We present the case of a 29-year-old male patient who had been treated with an anatomic pre-contoured plate for a distal clavicle fracture. Six months later he presented to our institution with limiting shoulder pain and tenderness upon the right coracoid process. Standard radiographs of the shoulder showed that the tip of a cortical screw was eroding the coracoid process. A surgery with hardware removal was then performed. One month after the surgery the patient was painless and with a full active shoulder ROM. Conclusion: Erosion of the coracoid process with plate screw fixation has never been described before. We suggest that extreme precaution should be taken in drilling and measuring the length of screws to avoid potential complications. Level of Evidence: IV


Subject(s)
Adult , Postoperative Complications , Clavicle/surgery , Fractures, Bone , Shoulder Injuries , Fracture Fixation, Internal
2.
Article in Chinese | WPRIM | ID: wpr-928296

ABSTRACT

OBJECTIVE@#To evaluate the efficacy and prognosis of double button plate combined with strengthened anchor technique and clavicular hook plate internal fixation for complete acromioclavicular joint dislocation.@*METHODS@#From July 2017 to September 2020, a total of 42 patients with acromioclavicular joint dislocation treated by surgery were choosen as study objects and divided into observation group (21 cases) and control group (21 cases). In the observation group, there were 14 males and 7 females, aged 21 to 63 years old, with an average of (45.05±8.70) years old. In the control group, there were 16 males and 5 females, aged 25 to 68 years old, with an average of(45.00±9.44) years old. The patients in the observation group were treated with double button plate combined with strengthened anchor technique, whereas those in the control group received clavicular hook plate internal fixation. The two groups were compared in terms of operating time, intraoperative blood loss, postoperative hospital stay, shoulder pain(visual analogue scale, VAS) score, shoulder function Constant-Murley score and postoperative complications.@*RESULTS@#There was no significant difference between the two groups in intraoperative blood loss or postoperative hospital stay(P>0.05). The operating time of double button plate combined with strengthened anchor technique group (65.24±5.36) min was significantly longer than that of the clavicular hook plate group (48.81±4.72) min, and the difference was statistically significant (P<0.05). There was no significant difference in shoulder function or pain degree between the two groups before operation (P>0.05). After 1 month, 3 months and 6 months, the Constant-Murley score of the observation group was 73.29±2.15, 85.43±1.47, 93.86±1.24 separately, which were significantly higher than those of the control group;and the VAS score was 2.76±0.62, 1.71±0.64, 0.57±0.51 separately, which were significantly lower than those of the control group (P<0.05). One instance of shoulder discomfort was found in the observation group, while 5 cases of shoulder pain, 2 cases of restricted shoulder mobility, and 1 case of subacromial bone absorption were found in the control group. In both group, there was no loss of reduction.@*CONCLUSION@#In the treatment of complete acromioclavicular joint dislocation double button plate combined with strengthened anchor technique achieves favorable clinical result. Internal fixation does not need to be removed. The recovery of shoulder joint function and pain relief are superior than clavicular hook plate internal fixation, which is more worthy of clinical promotion.


Subject(s)
Acromioclavicular Joint/surgery , Adult , Aged , Bone Plates , Clavicle/surgery , Female , Humans , Male , Middle Aged , Shoulder Dislocation/surgery , Treatment Outcome , Young Adult
3.
Article in Chinese | WPRIM | ID: wpr-888338

ABSTRACT

OBJECTIVE@#To compare the clinical efficacy of distal radius T-plate combined with suture anchor and distal clavicle anatomical locking plate combined with suture anchor in the treatment of Neer Ⅱb distal clavicle fracture.@*METHODS@#From June 2014 to June 2018, 42 patients with Neer Ⅱb distal clavicle fractures were retrospectively analyzed. According to different surgical methods, they were divided into the observation group (T-shaped plate combined with suture anchor) and the control group (anatomical locking plate combined with suture anchor). There were 22 patients in the observation group and 20 patients in the control group. In the observation group, there were 13 males and 9 females, aged from 22 to 70 (45.78± 14.44) years old, 12 cases on the left side and 10 cases on the right side, 8 cases of traffic accident injury and 14 cases of fall. In the control group, there were 12 males and 8 females, aged from 24 to 66 (44.17±15.58) years, 13 cases on the left side and 7 cases on the right side, 6 cases of traffic accident injuryand 14 cases of fall. The operation time, intraoperative blood loss and fracture healing time were compared between the two groups, and Constant Murley score was used to evaluate shoulder joint function.@*RESULTS@#The patients in both groups were followed up for 18 to 24 (20.96±2.02) months. The incisions of both groups were healed at stageⅠ. The fracture ends of both groups were bony healed at the last follow up. There was no significant difference in operation time, intraoperative blood loss and fracture healing time between two groups (@*CONCLUSION@#The two methods can obtain satisfactory results in the treatment of Neer Ⅱb distal clavicle fractures, especially suitable for patients with comminuted distal clavicle fractures or osteoporosis; the clinical effect of the treatment of NeerⅡb distal clavicle fractures with T type distal radius plate combined with suture anchor is satisfactory, which provides another feasible treatment scheme for clinic.


Subject(s)
Aged , Aged, 80 and over , Bone Plates , Case-Control Studies , Clavicle/surgery , Female , Fracture Fixation, Internal , Fractures, Bone/surgery , Humans , Male , Middle Aged , Retrospective Studies , Suture Anchors , Treatment Outcome
4.
Rev. bras. ortop ; 55(1): 100-105, Jan.-Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1092673

ABSTRACT

Abstract Objective To evaluate the results of the surgical treatment of fractures of the middle third of the clavicle. Methods A retrospective cross-sectional study, in which 36 patients who suffered fractures of the middle third of the clavicle and who were surgically treated from January 2012 to February 2017 were evaluated. They were evaluated for types of fracture, age, smoking, osteosynthesis material, and Constant-Murley and Modified-University of California at Los Angeles Shoulder Rating Scale (UCLA-M) scores. Results The mean Constant-Murley and UCLA-M scores were 91.59 and 31.29 respectively. The mean age was 37.62 years, and it was statistically related to the type of osteosynthesis (p < 0.05), but the osteosynthesis material did not show significance with the improvement in the rates of the functional scores. Conclusion The surgical treatment provides good functional results after diaphyseal fractures of the clavicle, regardless of the line of the fracture, with a low rate of pseudarthrosis.


Resumo Objetivo Avaliar o resultado do tratamento cirúrgico de fraturas do terço médio da clavícula. Métodos Estudo transversal retrospectivo, em que foram avaliados 36 pacientes que sofreram fratura do terço médio da clavícula, que foram tratados cirurgicamente no período de janeiro de 2012 a fevereiro de 2017. Eles foram avaliados quanto aos tipos de fratura, idade, tabagismo, material de síntese, e escores de Constant-Murley e Modified-University of California at Los Angeles Shoulder Rating Scale (UCLA-M). Resultados As médias dos escores de Constant-Murley e UCLA-M foram de 91,59 e 31,29, respectivamente. A idade média foi de 37,62 anos, e apresentou relação estatística com o tipo de síntese (p < 0,05), mas o material de síntese não apresentou significância com a melhora de pontuação dos escores funcionais. Conclusão O tratamento cirúrgico ocasiona bons resultados funcionais após a fratura diafisária de clavícula, independente do traço da fratura, com baixa taxa de pseudoartrose.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Incidence , Treatment Outcome , Clavicle/surgery , Fractures, Bone , Cross-Sectional Studies
5.
Rev. bras. anestesiol ; 69(1): 99-103, Jan.-Feb. 2019. graf
Article in English | LILACS | ID: biblio-977428

ABSTRACT

Abstract Background and objectives: Ultrasound-guided upper limb blocks may provide great benefits to patients with serious diseases. Patients with Steinert's disease have muscle weakness and risk of triggering myotony or malignant hyperthermia due to the use of anesthetic agents and surgical stress. The objective of this report was to demonstrate a viable alternative for clavicle fracture surgery with upper trunk and supraclavicular nerve block, thus reducing the spread of local anesthetic to the phrenic nerve in a patient with muscular dystrophy. Case report: A 53-year-old male patient with Steinert's disease, associated with dyspnea, hoarseness and dysphagia, referred to the surgical theater for osteosynthesis of clavicle fracture. Upper limb (1 mL 0.75% ropivacaine) and supraclavicular nerve block (1 mL 0.75% ropivacaine in each branch) were combined with venous anesthesia with propofol under laryngeal mask (infusion pump target of 4 mcg.mL-1). Upon awakening, the patient had no pain or respiratory complaints. He was transferred to the ICU for immediate postoperative follow-up with discharge from this unit after 24 h without complications. Conclusions: The superior trunk and cervical plexus block associated with venous anesthesia under laryngeal mask, without the use of opioids, proved to be adequate in the case of a patient with clavicle fracture and Steinert's disease. With the use of ultrasonography in regional anesthesia it is possible to perform increasingly selective blocks, thus allowing greater security for the anesthetic-surgical procedure and lower morbidity for the patient.


Resumo Justificativa e objetivos: Bloqueios seletivos dos membros superiores guiados por ultrassom podem trazer grandes benefícios em pacientes portadores de doenças graves. Pacientes portadores da doença de Steinert apresentam fraqueza muscular e riscos de desencadear miotonia ou hipertermia maligna devido ao uso de agentes anestésicos e ao estresse cirúrgico. O objetivo deste relato foi mostrar uma opção viável para a cirurgia de fratura de clavícula com bloqueio do tronco superior e nervo supraclavicular, diminui-se assim a dispersão do anestésico local para o nervo frênico em paciente com distrofia muscular. Relato de caso: Paciente do sexo masculino, 53 anos, portador de doença de Steinert, associada a dispneia, rouquidão e disfagia. Encaminhado ao bloco cirúrgico para osteossíntese de fratura de clavícula. Feito bloqueio de tronco superior (1 mL ropivacaína a 0,75%) e de nervo supraclavicular (1 mL de ropivacaína 0,75 em cada ramificação) associado à anestesia venosa com propofol sob máscara laríngea (alvo de 4 mcg.mL-1 em bomba de infusão). Ao despertar, o paciente apresentava-se sem dor ou queixas respiratórias. Admitido em CTI para acompanhamento do pós-operatório imediato com alta dessa unidade após 24 horas sem intercorrências. Conclusões: O bloqueio do tronco superior e do plexo cervical associado à anestesia venosa sob máscara laríngea, sem uso de opioides, mostrou-se adequado no caso de fratura da clavícula em paciente com doença de Steinert. Com o uso da ultrassonografia em anestesia regional é possível fazer bloqueios cada vez mais seletivos e possibilitar assim maior segurança para o procedimento anestésico-cirúrgico e menor morbidade para o paciente.


Subject(s)
Humans , Male , Clavicle/surgery , Clavicle/injuries , Fractures, Bone/surgery , Brachial Plexus Block , Cervical Plexus Block , Myotonic Dystrophy/complications , Fractures, Bone/complications , Middle Aged
6.
Rev. Asoc. Argent. Ortop. Traumatol ; 84(1): 35-45, 2019. ilus, tab
Article in Spanish | LILACS, BINACIS | ID: biblio-1003006

ABSTRACT

Objetivo: Describir la técnica quirúrgica mínimamente invasiva con placa regional bloqueada para fracturas mediodiafisarias de clavícula y mostrar nuestros resultados clínicos y radiográficos. Materiales y Métodos: Se evaluó, en forma retrospectiva, a 15 pacientes (12 hombres y 3 mujeres, media de la edad, 32.4 años [rango 17-51]) con fractura de clavícula, tratados con reducción y osteosíntesis con placa superior bloqueada anatómica mediante una técnica mínimamente invasiva. Según la clasificación de Allman, 12 pacientes tenían fractura de clavícula tipo I y tres, tipo II. Resultados: El tiempo promedio de cirugía fue de 53 minutos (rango 51-65). Se logró la consolidación de todas las fracturas en un promedio de 13.3 semanas (rango 12-15). No hubo seudoartrosis ni consolidaciones viciosas. El puntaje promedio de Constant fue de 98 (rango 95-100). Todos los pacientes se manifestaron satisfechos con los resultados estéticos y funcionales. Conclusiones: Este estudio demuestra que la técnica mínimamente invasiva para las fracturas mediodiafisarias de clavícula, utilizando placas regionales anatómicas bloqueadas superiores, puede ser un procedimiento reproducible y una alternativa a las técnicas quirúrgicas convencionales. Además, los resultados clínicos y radiográficos satisfactorios se obtuvieron sin complicaciones mayores y sin disestesias en la zona de la herida. Nivel de Evidencia: IV


Objectives: To describe the minimally invasive locking plate approach for midshaft clavicular fractures, and report our radiographic and clinical results. Methods: We retrospectively evaluated fifteen patients (12 men and 3 women, mean age: 32.4 years [range 17-51]) with clavicular fractures who underwent minimally invasive superior locking plate osteosynthesis and reduction. According to Allman classification of clavicular fractures, 12 patients had a type I fracture, while 3 had a type II fracture. Results: The average operating time was 53 minutes (range 51-65). Union was achieved in all patients in an average of 13.3 weeks (range 12-15). Patients were satisfied with cosmetic and functional results. Conclusions: This study shows that minimally invasive superior locking plate approach for midshaft clavicular fractures can be a reproducible procedure and an alternative to conventional surgical approaches. Clinical and radiological results were achieved without major complications and wound dysesthesia. Level of Evidence: IV


Subject(s)
Adult , Clavicle/surgery , Clavicle/injuries , Minimally Invasive Surgical Procedures/methods , Fractures, Bone/surgery , Treatment Outcome
7.
Rev. Asoc. Argent. Ortop. Traumatol ; 83(2): 124-130, jun. 2018. []
Article in Spanish | LILACS, BINACIS | ID: biblio-956428

ABSTRACT

La seudoartrosis de clavícula es una causa infrecuente de síndrome del opérculo torácico. Se describe un caso de plexopatía braquial por seudoartrosis previamente infectada de clavícula. La paciente fue sometida a una claviculectomía total para aliviar los síntomas. Del análisis de la literatura citada, se concluye en que la claviculectomía total es una opción por considerar si se han agotado las opciones terapéuticas. Los resultados funcionales pueden ser satisfactorios cuando se la indica por infección, plexopatía o sarcoma. Nivel de Evidencia: IV


Clavicle non-union is an uncommon cause of thoracic outlet syndrome. A case of brachial plexopathy by previously infected clavicle pseudarthrosis is described. Total claviculectomy was performed for symptom relief. From literature analysis we conclude that total claviculectomy is an option to be taken into account when therapeutic options have exhausted. Functional results could be adequate when total claviculectomy is indicated in cases of infection, plexopathy or sarcoma. Level of Evidence: IV


Subject(s)
Aged , Pseudarthrosis , Shoulder Joint/surgery , Cervical Rib Syndrome/surgery , Clavicle/surgery , Clavicle/pathology
8.
Artrosc. (B. Aires) ; 25(3): 110-114, 2018. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-972521

ABSTRACT

La fractura de clavícula representa 35 a 45 % de las fracturas de la cintura escapular, y de ellas el 15-25% comprometen el extremo distal de ella. El objetivo de esta publicación es describir nuestra técnica de reconstrucción artroscópica de las fracturas del extremo distal de clavícula con sistema AC TigthRope o sistema DogBone con sutura fibertape. La reconstrucción y estabilización artroscópica de las fracturas inestables del extremo distal de la clavícula con sistema AC TigthRope o sistema Dogbone ambos con sutura FiberTape mas la estabilización del fragmento distal de la fractura mediante suturas transósea permite una fijación estable para la consolidación de la misma. La técnica descripta permite rápida recuperación funcional y el retorno a las actividades de la vida diaria. Tipo de Trabajo: Técnica Quirúrgica. Nivel de Evidencia: V.


Fractures of the clavicle represent between 35 to 45% of all the fractures of the shoulder girdle, and 15 to 25% of these are of the distal clavicle. The purpose of this study is to describe our arthroscopic reconstruction technique of the distal clavicle using the AC Tightrope or DogBone Systems with fibertape. The arthroscopic reconstruction and stabilization of ustable distal clavicle fractures with the AC TightRope or DogBone Systems both with Fibertape with stabilization of the unstable bone fragments with trans oseous sutures allow a stable fixation until it consolidates. The technique described allows a fast recovery and retour to the activities of daily living. Type of Study: Surgical Technique. Level of Evidence: V.


Subject(s)
Arthroscopy/methods , Clavicle/injuries , Clavicle/surgery , Fractures, Bone/surgery , Reconstructive Surgical Procedures/methods , Shoulder Joint/surgery , Treatment Outcome
9.
Rev. chil. ortop. traumatol ; 58(3): 89-94, dic. 2017. ilus, tab
Article in Spanish | LILACS | ID: biblio-910044

ABSTRACT

INTRODUCCIÓN Las fracturas de clavícula distal desplazadas son manejadas generalmente de manera quirúrgica dada la alta probabilidad de no-unión con el tratamiento ortopédico. El propósito de este trabajo es evaluar el uso del sistema de fijación con doble botón cortical para la reducción y estabilización de la fractura de clavícula distal que presenten indemnidad de la cortical superior. MÉTODOS: Estudio retrospectivo observacional clínico-imagenológico de pacientes con fractura desplazada de clavícula distal operados con técnica mínimamente invasiva mediante reducción con sistema de fijación con doble botón cortical. Se describe como criterio radiológico de "Cortical Superior Indemne (CSI)" la presencia del rasgo de fractura a 1cm o más, hacia distal desde el tubérculo conoide, identificándose ese criterio como característica necesaria para la indicación del tratamiento propuesto. Se describen las complicaciones post-operatorias, progresión radiológica y resultados funcionales. RESULTADOS: 21 pacientes fueron tratados con esa técnica con un seguimiento promedio de 23,4 meses. No hubo casos de no unión, infección o herida dehiscente y ningún paciente requirió el retiro del dispositivo. Se encontró un Simple Shoulder Test (SST) promedio de 79,4 (66 - 91,7) y QuickDASH de 11 (6,8 - 15,9). El 87,5% de las fracturas desplazadas de clavícula distal tenían indemnidad de la cortical superior. CONCLUSIÓN: La técnica mínimamente invasiva para la reducción y fijación de la fractura de clavícula distal desplazada con botones corticales es una alternativa simple, reproducible, con pocas complicaciones y excelentes resultados funcionales.


BACKGROUND: Displaced distal clavicle fractures are commonly managed through surgery due to a high probability of nonunion with conservative treatments. The purpose of this study is to evaluate the use of Flip-buttons as a minimally invasive method for fixing and stabilizing displaced distal clavicle fractures when the upper cortical it́s intact. METHODS: A retrospective observational study of radiological and clinical results of patients with displaced distal clavicle fracture that were treated with the Flip-button technique. The indication for using this surgical method was based on the radiological criteria of "Intact Upper Cortical (IUC)" described by the authors as the presence of the fracture 1cm or more, distally to de conoid tubercle. Post-operative complications, radiologic and functional progress were recorded. RESULTS: 21 patients were treated with this technique, all with complete bony union. No patients presented infection or wound dehiscence and implant removal was not necessary in any case. The mean follow-up was of 23,4 months. The mean score in Simple Shoulder Test (SST) was 79,4 (66 - 91,7) and a mean QuickDASH of 11 (6,8 - 15,9). 87,5% of all the displaced distal clavicle fractures had IUC. CONCLUSION: The minimally invasive technique for the reduction and fixation of the displaced distal clavicle fracture with cortical buttons is a simple and reproducible alternative, with few complications and excellent functional results.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Clavicle/surgery , Fracture Fixation, Internal/methods , Fractures, Bone/surgery , Clavicle/diagnostic imaging , Clavicle/injuries , Follow-Up Studies , Fractures, Bone/diagnostic imaging , Minimally Invasive Surgical Procedures , Observational Studies as Topic , Postoperative Complications , Recovery of Function , Retrospective Studies , Treatment Outcome
10.
Rev. bras. ortop ; 52(4): 410-416, July-Aug. 2017. tab, graf
Article in English | LILACS | ID: biblio-899159

ABSTRACT

ABSTRACT OBJECTIVE: To evaluate the decision of orthopedics surgeons regarding which cases they would indicate surgery or non-surgical treatment. METHODS: 20 images of radiographs with fracture in the middle third of the collar bone (AO/OTA 15-B) in anteroposterior view were analyzed, and divided into four groups: group 1 - fracture type AO/OTA 15-B1 without displacement; group 2 - fracture type AO/OTA 15-B1 with displacement; group 3 - fracture type AO/OTA 15-B2; group 4 - fracture type AO/OTA 15-B3. The evaluator was requested to indicate the choice of treatment, surgical or non-surgical. RESULTS: There was no strong correlation between the amount of surgical indications and the working experience or age of the medical evaluator. It was observed that the average of surgical indications in the total sample was 52%. When indications were studied in different areas of Brazil, there was no significant difference among them. No pattern for the Brazilian regions studied was observed in the case analysis. Even within a group (cases of the same complexity), no specific pattern of surgical indication was observed. CONCLUSION: No association between surgical indication and the length of professional experience was found. The Southern and Southeastern regions were those that most recommended surgeries in groups 2, 3, and 4. In no region the same level of surgical indication for cases of the same complexity rate was kept.


RESUMO OBJETIVO: Avaliar a decisão de cirurgiões ortopédicos sobre em que casos indicariam a cirurgia ou tratariam não cirurgicamente. MÉTODOS: Foram analisadas 20 imagens de radiografias com fratura do terço médio da clavícula (AO/OTA 15-B) em incidência anteroposterior, que foram divididas em quatro grupos: 1 - fratura do tipo AO/OTA 15-B1 sem desvio; 2 - fratura do tipo AO/OTA 15-B1 com desvio; 3 - fratura do tipo AO/OTA 15-B2; 4 - fratura do tipo AO/OTA 15-B3. Ao avaliador, foi solicitado que indicasse o tipo de tratamento: cirúrgico ou não cirúrgico. RESULTADOS: Não houve correlação forte entre a quantidade de indicações cirúrgicas e o tempo de atuação do médico avaliador ou sua idade. Verificou-se que a média de indicação de cirurgias no total da amostra foi de 52%. Quando estudadas as indicações por diferentes regiões do Brasil, não houve diferença significativa. Não foi verificado qualquer padrão para as regiões brasileiras na análise por caso. Mesmo dentro de um grupo (casos de mesma complexidade), não foi verificado um padrão específico de indicação cirúrgica. CONCLUSÃO: Não foi verificada associação entre a indicação cirúrgica e o tempo de atuação do profissional. As regiões Sul e Sudeste são as que mais recomendam a cirurgia dos grupos 2, 3 e 4. Verificou-se que em nenhuma região foi mantido o mesmo nível de indicação de cirurgias para casos do mesmo grau de complexidade.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Bone Plates , Clavicle/diagnostic imaging , Clavicle/surgery , Fractures, Bone/diagnostic imaging , Fractures, Bone/surgery
11.
Rev. Asoc. Argent. Ortop. Traumatol ; 82(2): 129-135, jun. 2017. []
Article in Spanish | LILACS, BINACIS | ID: biblio-896261

ABSTRACT

Introducción: Las fracturas mediodiafisarias de clavícula representan hasta el 10% de las fracturas del esqueleto. El tratamiento conservador brinda buenos resultados con baja incidencia de complicaciones. Sin embargo, en trazos desplazados, multifragmentarios o con deformidad significativa, se debe considerar la cirugía. El propósito de esta serie retrospectiva es exponer nuestra experiencia en el tratamiento de fracturas cerradas, desplazadas y mediodiafisarias de clavícula con placas precontorneadas mediante la técnica MIPO, describir la técnica y los resultados funcionales preliminares. Materiales y Métodos: Serie retrospectiva de 13 pacientes (11 varones [84,6%] y 2 mujeres [15,4%]), media de la edad: 31 años, con fracturas diafisarias cerradas desplazadas de clavícula de tipo 2B de Robinson (Edimburgo), tratadas mediante reducción y osteosíntesis con placas precontorneadas con MIPO, entre abril de 2010 y noviembre de 2013. Seguimiento promedio: 13 meses (rango 11-25). Se realizaron controles radiográficos y tomografías computarizadas, valorando la funcionalidad mediante las escalas de Constant-Murley modificada, QuickDASH y el dolor con la escala analógica visual. Resultados: El tiempo promedio hasta la cirugía fue de 8 días; la cirugía duró 35 minutos y el tiempo de internación posoperatoria fue de 1.28 días. La consolidación clínico-radiológica se registró en una media de 15.2 semanas. El puntaje promedio de Constant-Murley modificado fue 88; el de QuickDASH, 26,9 y la escala analógica visual arrojó un valor de 0,3. No hubo complicaciones sistémicas ni cosméticas. Conclusión: La osteosíntesis mínimamente invasiva en fracturas cerradas mediodiafisarias desplazadas de clavícula representó una técnica reproducible con un tiempo quirúrgico reducido y puntajes funcionales aceptables, sin complicaciones de relevancia. Nivel de Evidencia: IV


Introduction: Midshaft clavicular fractures represent up to 10% of skeleton fractures. Conservative treatment usually provides good results with low incidence of complications. However, surgical treatment should be considered in displaced, multifragmentary fractures or cases with significant deformity. The purpose of this retrospective case series is to report our experience in the treatment of closed and displaced midshaft clavicular fractures with pre-contoured plates using MIPO technique, to describe the technique and report preliminary functional results. Methods: Retrospective series of 13 patients (11 males [84.6%] and 2 females [15.4%], mean age: 31 years), with closed and displaced midshaft clavicle fractures classified as type 2B according to Robinson (Edinburgh) treated by reduction and internal fixation with pre-contoured plates osteosynthesis using minimally invasive technique (MIPO) between April 2010 and November 2013. Mean follow-up: 13 months (range 11-25). Radiographic and tomographic controls were carried out to assess function using modified Constant-Murley scale, QuickDASH Questionnaire and the visual analogue scale to evaluate pain. Results: Average time to surgery was 8 days, surgical time: 35 minutes, days in hospital after surgery: 1.28. Clinical and radiological consolidation was recorded at 15.2 weeks on average. The average modified Constant-Murley score was 88, QuickDASH 26.9 and visual analogue scale 0.3. No systemic or cosmetic complications were recorded. Conclusion: Minimally invasive plate osteosynthesis (MIPO) in displaced and closed midshaft clavicle fractures represented a reproducible technique with reduced surgical time and acceptable functional scores. Level of Evidence: IV


Subject(s)
Adult , Clavicle/surgery , Clavicle/injuries , Minimally Invasive Surgical Procedures , Fractures, Bone/surgery , Time Factors , Retrospective Studies , Follow-Up Studies , Treatment Outcome , Recovery of Function
12.
Rev. bras. ortop ; 52(3): 270-277, May.-June 2017. graf
Article in English | LILACS | ID: biblio-899150

ABSTRACT

ABSTRACT OBJECTIVE: The aim of this study is to analyze the functional outcome following titanium elastic stable intra-medullary nailing (ESIN) for displaced mid-shaft clavicular fractures (DMCF). METHODS: A retrospective study of 60 patients between March 2009 and March 2015 was conducted. Patients were selected based on the inclusion criteria. Six patients were lost during follow up. Out of the remaining 54 patients, there were 39 males and 15 females. The mean age was 30.6 years. The functional outcome was analyzed using the Constant score, rate of bone union, complication, and earliest time of return to work. RESULTS: All fractures united well, with an average time of 7.5 weeks. Follow-up period ranged between 12 months and 18 months (average, 14 months). 24 out of 54 patients had closed nailing, while 30 had minimal open reduction. The average size of ESIN was 2 mm (range, 1.5-3 mm). The average Constant score was 97.8 (range, 95-99). There were no major complications, but minor complications occurred, viz. skin irritation in 15 patients, temporary paresthesia in five patients, and three patients who developed superficial infections. One case had implant migration and perforation at the lateral cortex, and one case had delayed union. There were few implant-related problems, as the authors used a standard protocol to remove it after radiological union. All patients returned to work within 10 weeks of the post-operative period. CONCLUSION: ESIN is a safe, minimally invasive, engenders rapid healing with good cosmesis, and provides an excellent functional outcome in terms of patient satisfaction, with fewer complications.


RESUMO OBJETIVO: Analisar o desfecho funcional após o uso de haste intramedular estável elástica de titânio (HIEET) em fraturas deslocadas do terço médio da clavícula (FDMC). MÉTODOS: Fez-se um estudo retrospectivo de 60 pacientes, selecionados com base nos critérios de inclusão, entre março de 2009 e março de 2015. Houve perda de seguimento de seis. Dos 54 restantes, 39 eram homens e 15 mulheres. A média de idade foi de 30,6 anos. O desfecho funcional foi analisado pela escala de Constant, taxa de união óssea, taxa de complicação e pelo tempo de retorno ao trabalho. RESULTADOS: Todas as fraturas apresentaram boa união, em uma média de 7,5 semanas. O período de acompanhamento variou entre 12 e 18 meses (média: 14). Em 24 dos 54 pacientes usou-se redução fechada com hastes intramedulares; nos outros 30, foi usada a redução aberta com fixação mínima. O tamanho médio da HIEET foi de 2 mm (variação: 1,5-3 mm). A média da escala de Constant foi de 97,8 (variação: 95-99). Nenhum paciente apresentou complicações de grande porte, mas algumas complicações de pequeno porte foram observadas, a saber: irritação da pele em 15, parestesia temporária em cinco e infecções superficiais em três. Observou-se um caso de migração do implante e perfuração no córtex lateral; um caso teve união atrasada. A taxa de problemas relacionados ao implante foi baixa, uma vez que os autores usaram um protocolo padrão para removê-lo após a união radiológica. Todos os pacientes retornaram ao trabalho em até dez semanas após a cirurgia. CONCLUSÃO: A HIEET é um método seguro, minimamente invasivo, que gera cicatrização rápida com boa cosmesis e proporciona um excelente resultado funcional em termos de satisfação do paciente, com menos complicações.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Bone Nails , Clavicle/surgery , Fracture Fixation , Fracture Fixation, Intramedullary , Titanium
13.
Rev. cuba. ortop. traumatol ; 30(1): 103-115, ene.-jun. 2016. ilus
Article in Spanish | LILACS, CUMED | ID: lil-794185

ABSTRACT

La osteolisis postraumática de la clavícula es una entidad de presentación rara que consiste en una osteopenia severa del extremo distal de este hueso, causada por un trauma agudo o por microtraumas a repetición. Se presenta un caso de osteolisis postraumática de la clavícula en deportista de alto rendimiento practicante de lucha grecorromana al que se realizó como tratamiento una resección del extremo distal de la clavícula. La evolución del paciente fue muy satisfactoria, recuperó íntegramente el movimiento del hombro, y el dolor desapareció. A los 2 meses de la cirugía comenzó el entrenamiento progresivo y a los 4 meses ya estaba incorporado totalmente al programa de competencias de su deporte(AU)


Post traumatic osteolysis of the clavicle is a rare presentation entity consisting of a severe osteopenia of the distal end of the bone, caused by acute trauma or microtrauma to repeat. A case of post-traumatic osteolysis of the clavicle is presented in a high performance wrestling athlete who received as treatment resection of the distal end of his clavicle. Patient outcome was very satisfactory, shoulder movement was fully recovered, and the pain disappeared. Two months after surgery, progressive training began. Four months after, he was fully incorporated into the competitions program of his sport(AU)


L'ostéolyse post-traumatique de clavicule est une affection rare consistant à une ostéopénie sévère de l'extrémité distale de cet os, causée par un traumatisme aigu ou par microtraumatismes répétés. Un cas d'ostéolyse post-traumatique de clavicule chez un athlète de lutte gréco-romaine, traité par résection de l'extrémité distale de la clavicule, est présenté. L'évolution du patient a été très satisfaisante, il a complètement récupéré le mouvement de l'épaule et la douleur a disparu. Deux mois après la chirurgie, il a commencé progressivement à entraîner, et au bout de quatre mois il s'est tout à fait réincorporé au programme de compétitions de son sport(AU)


Subject(s)
Humans , Male , Adult , Athletic Performance , Clavicle/surgery , Clavicle/injuries , Shoulder Pain/rehabilitation
14.
Article in Spanish | LILACS, BINACIS | ID: biblio-835465

ABSTRACT

Introducción: La unión temprana y el rápido retorno a la función previa son la prioridad en los atletas jóvenes con fracturas desplazadas de clavícula distal. Además es esencial evitar la pseudoartrosis en este grupo de pacientes ya que la misma se asocia a dolor persistente, restricción del movimiento y pérdida de la fuerza y resistencia del hombro Diseño: Serie de casos Nivel de evidencia IV Materiales y Métodos: Un total de 21 deportistas con fracturas desplazadas de clavícula distal fueron tratados con reducción cerrada y fijación con doble botón a través de un abordaje mínimamente invasivo entre marzo de 2008 y octubre de 2013. Los pacientes respondieron un cuestionario focalizado en el tiempo de vuelta al deporte. Los resultados funcionales se evaluaron con el score de Constant y la versión corta del score de Discapacidad del brazo, del hombro y de la mano (Quick DASH). El dolor se evaluó con la escala visual análoga. (EVA). Se evaluaron las radiografías postoperatorias para identificar tiempo de consolidación, pseudoartosis y consolidaciones viciosas. Resultados: De los 21 pacientes, 20 retornaron al deporte. Todos retornaron al mismo nivel. El tiempo promedio de vuelta al deporte fue de 78 días (rango 41 -120 días). Cuatro pacientes (19%) volvieron al deporte antes de las seis semanas luego de la cirugía, 14 (67%) retornaron entre las seis y las 12 semanas luego de la cirugía y tres (14%) retornaron luego de las 12 semanas. El score de Constant promedio fue 89,1 ± 4,2 (rango, 79-100). El Quick-DASH promedio fue 0,4 ± 2,6 (rango, 0-7,1). El dolor según la EVA fue de 0,4 ± 1,0 (rango, 0-3) al final del seguimiento. La única complicación fue una pseudoartrosis asintomática. No se requirió retiro del material en ningún paciente. Conclusiones: La reducción cerrada y la fijación con doble botón de las fracturas desplazadas de clavícula a travé...


Background: Early union and rapid return to prior function is the priority in young athletes with lateral clavicular fractures. Furthermore it is essential to avoid nonunion in this subgroup of patients since it is frecuently associated with persistent pain, restriction of movement and loss of strength and endurance of the shoulder. Purpose: The aim of this study was to analyze the time to return-to-sport, functional outcomes and complications of a group of athletes with displaced lateral clavicular fractures treated using close reduction and minimally invasive double button fixation. Study Design: Case series; Level of evidence, 4. Methods: A total of 21 athletes with displaced lateral clavicle fractures were treated with closed reduction and minimally invasive double button fixation between March 2008 and October 2013. Patients completed a questionnaire focused on the time to return-to-sport and treatment course. Functional outcomes were assessed with the Constant score and short version of the Disabilities of the Arm, Shoulder, and Hand (Quick DASH) questionnaire. Pain was evaluated with the visual analog scale (VAS). Radiographs were reviewed to identify radiographic union time, malunion, and nonunion. Results: Of the 21 patients, 20 returned to sports after closed reduction and minimally invasive double button fixation; 100 % returned to the same level. The mean time to return to play was 78 days (range, 41 - 120 days). Four patients (19%) returned to sports in less than 6 weeks after surgery Fourteen (67%) returned to sports between 6 and 12 weeks after surgery and three (14%) returned to sports after 12 weeks. The mean Constant was 89.1 ± 4.2 (range, 79-100) The average Quick-DASH was 0.4 ± 2.6 (range, 0-7.1). Pain was 0.4 ± 1.0 (range, 0-3) at final follow-up according to VAS. The only...


Subject(s)
Humans , Male , Female , Adult , Clavicle/surgery , Clavicle/injuries , Fracture Fixation, Internal , Fractures, Bone , Minimally Invasive Surgical Procedures , Athletic Injuries , Treatment Outcome
15.
Rev. otorrinolaringol. cir. cabeza cuello ; 75(3): 261-264, dic. 2015. ilus
Article in Spanish | LILACS | ID: lil-771699

ABSTRACT

En el siguiente artículo se presenta un caso clínico de un adolescente de 14 años que consulta por presentar un aumento de volumen supraclavicular derecho y cuyo diagnóstico final realizado mediante estudio histológico luego de exéresis de la masa, concluye ser un hibernoma. Considerando la infrecuencia con la que se presentan este tipo de tumores benignos de los tejidos blandos, presentamos una descripción, mediante revisión bibliográfica, de dicha patología.


In this article, we present a clinical case of a 14 years old teen who presented a su-pracavicular growing mass and whose diagnosis made by histologic examination after performing excision, proves to be a hibernoma. Given the infrequency with wich these types of benign tumors of the soft tissues occur, we present a description, based on a literature review of such pathology.


Subject(s)
Humans , Male , Adolescent , Head and Neck Neoplasms/diagnosis , Head and Neck Neoplasms/surgery , Lipoma/diagnosis , Lipoma/surgery , Biopsy , Clavicle/surgery , Soft Tissue Neoplasms/diagnosis , Soft Tissue Neoplasms/surgery , Tomography, X-Ray Computed
16.
Rev. bras. ortop ; 50(3): 270-273, May-Jun/2015. tab, graf
Article in English | LILACS | ID: lil-753146

ABSTRACT

OBJETIVO:Estabelecer uma zona de segurança neurovascular no acesso cirúrgico do terço médio da clavícula por dissecção em cadáveres.MÉTODOS:Foram dissecados 20 ombros de 10 cadáveres, foi feita a dissecção profunda do terço médio da clavícula e identificaram-se as seguintes estruturas: veia subclávia, tronco superior do plexo braquial (divisão anterior e posterior) e nervo supraescapular. Essas estruturas foram demarcadas para mensuração de suas distâncias até os pontos mais próximos do terço médio da clavícula.RESULTADOS:A distância média do terço médio da clavícula ao nervo supraescapular, à veia subclávia, ao tronco superior, à divisão anterior do tronco superior e à divisão posterior do tronco superior foi, respectivamente, do lado direito: 15,92 cm; 10,77 cm; 23,68 cm; 14,60 cm e 15,42 cm; do lado esquerdo: 12,69 cm; 9,82 cm; 22,19 cm; 12,16 cm e 13,46 cm.CONCLUSÃO:Houve diferença estatística entre as distâncias do nervo supraescapular e a divisão anterior do tronco superior comparativa entre os lados direito e esquerdo. As estruturas neurovasculares mais próximas ao terço médio da clavícula foram o nervo supraescapular e a veia subclávia.


OBJECTIVE: The aim of this study was to establish a neurovascular safety zone for surgical access in the middle third of the clavicle, by means of dissection on cadavers. METHODS: Twenty shoulders were dissected in 10 cadavers, with deep dissection of the middle third of the clavicle. The following structures were identified: subclavian vein, upper trunk of the brachial plexus (anterior and posterior divisions) and suprascapular nerve. These structures were marked out in order to measure their distances from the most proximal point of the middle third of the clavicle. RESULTS: The mean distances from the middle third of the clavicle to the suprascapular nerve, subclavian vein, upper trunk, anterior division of the upper trunk and posterior division of the upper trunk were respectively, for the right side: 15.92 cm, 10.77 cm, 23.68 cm, 14.60 cm and 15.42 cm; and for the left side: 12.69 cm; 9.82 cm; 22.19 cm; 12.16 cm and 13.46 cm. CONCLUSION: There was a statistical difference in the distances to the suprascapular nerve and anterior division of the upper trunk, in comparing between the right and left sides. The closest neurovascular structures to the middle third of the clavicle were the suprascapular nerve and subclavian vein.


Subject(s)
Cadaver , Clavicle/anatomy & histology , Clavicle/surgery
17.
Article in Spanish | LILACS, BINACIS | ID: lil-776009

ABSTRACT

Diferentes trabajos recientes prospectivos randomizados apoyan la osteosíntesis con placas de las fracturas mediodiafisarias de clavícula. Sin embargo la seguridad y eficacia de este tratamiento así como la vuelta al deporte no está bien documentado en atletas. El objetivo del siguiente trabajo es analizar los resultados funcionales, el porcentaje de vuelta al deporte y las complicaciones de un grupo de atletas tratados por fracturas mediodiafisarias desplazadas de clavícula con placas precontorneadas bloqueadas. Materiales y Métodos: Un total de 54 atletas con fracturas desplazadas mediodiafisarias de clavícula fueron tratados mediante osteosíntesis con placas precontorneadas entre Noviembre del 2008 y Diciembre del 2012. El promedio de seguimiento fue de 22,4 meses. Los pacientes completaron un cuestionario sobre el momento de la vuelta al deporte y la evolución del tratamiento. Los resultados funcionales se evaluaron con el score de Constant y la versión abreviada del DASH (quick DASH). El dolor se evaluó con la escala visual análoga. (VAS). Se evaluaron las rx en forma seriada para identificar el tiempo hasta la consolidación, la pseudoartrosis y las consolidaciones viciosas. Resultados: De los 54 pacientes, 53 pudieron volver al deporte, 94% retornaron al mismo nivel que tenían previo a la lesión. El tiempo promedio de vuelta al deporte fue de 68 días (rango 5-180 días) Nueve (16,6%) de los pacientes volvieron antes de las 6 semanas, 40 (74%) volvieron entre las 6 y las 12 semanas y 5 pacientes (92%) volvieron luego de las 12 semanas. El score de Constant promedio fue de 94.l±5.2 (rango 78 a 100), el Quick DASH promedio fue de DA ± 4.7 (rango 0-7.1). El promedio de la EVA durante el seguimiento fue de 0.29 ± 1 (rango 0-5)...


Subject(s)
Adult , Young Adult , Shoulder Joint/surgery , Shoulder Joint/injuries , Clavicle/surgery , Clavicle/injuries , Fracture Fixation, Internal , Fractures, Bone/surgery , Athletic Injuries , Follow-Up Studies , Bone Plates , Recovery of Function
18.
Rev. bras. ortop ; 48(1): 108-110, Jan-Feb/2013. graf
Article in English | LILACS | ID: lil-674580

ABSTRACT

The purpose is to present a very unusual case of the acromioclavicular joint inferior dislocation associated with the clavicle fracture. It concerns to a young patient who had a bike fall and had this type of pathology, had been operated and obtained excellent clinic result. The literature mentions many cases of subcoracoide dislocation, but there are only two subacromial similar to ours. The case is described, a literary revision is done and discussed and the treatment is discussed.


O objetivo é apresentar um caso muito raro de luxação inferior da articulação acromioclavicular (AAC) associada à fratura da clavícula. Trata-se de um paciente jovem que sofreu queda de bicicleta e evoluiu com esse tipo de patologia. Foi operado e obtido ótimo resultado clínico. A literatura cita vários casos de luxação subcoracoide, mas existem somente dois casos subacromiais semelhantes ao nosso. É descrito o caso, feita uma revisão literária e discutido o tratamento.


Subject(s)
Humans , Male , Young Adult , Acromioclavicular Joint/surgery , Acromioclavicular Joint/physiopathology , Acromioclavicular Joint/injuries , Clavicle/surgery , Clavicle/injuries , Joint Dislocations , Shoulder Dislocation
19.
Rev. venez. cir. ortop. traumatol ; 45(1): 26-33, 2013. ilus, tab, graf
Article in Spanish | LILACS, LIVECS | ID: biblio-1281796

ABSTRACT

La luxación acromioclavicular es una patología condicionada por problemas traumáticos y aplicación de sobrecarga, que da como resultado una lesión del sistema capsulo-ligamentario y muscular, que conlleva a una lesión incapacitante al individuo que la padece; por lo general son del sexo masculino y por un mecanismo de lesión con contusión directa en la punta del hombro. La técnica de Copeland Kessel, es una alternativa para su estabilización, basándonos en la baja tasa de complicaciones y la reincorporación del paciente a su vida normal al cabo de 12 semanas(AU)


Acromioclavicular dislocation is a condition influenced by trauma and application problems of overload that results in injury to the capsular ligamentous system and muscle that leads to a disabling injury to the person who suffers it, usually are male and the mechanism is a direct contusion injury on the tip of the shoulder. Copeland Kessel technique is an alternative for stabilization, based on the low rate of complications and the patient return to normal alter 12 weeks(AU)


Subject(s)
Humans , Male , Female , Clavicle/surgery , Joint Dislocations , Ligaments, Articular , Wounds and Injuries , Organic Matter Stabilization
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