Fractura de clavícula. Técnica mínimamente invasiva. [Minimally invasive approach for clavicular fractures]
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Publicado:
feb 20, 2019
Palabras clave:
Técnica mínimamente invasiva, fractura, clavícula, minimally invasive technique, fracture, clavicle
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Resumen
Objetivo: Describir la técnica quirúrgica mínimamente invasiva con placa regional bloqueada para fracturas mediodiafisarias de clavícula y mostrar nuestros resultados clínicos y radiológicos.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, de 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 radiológicos satisfactorios se obtuvieron sin complicaciones mayores y sin disestesias en la zona de la herida. ABSTRACTObjectives: 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 the 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 the 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 or wound dysesthesia.
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Perrone, J. M., Petrucelli, E., Balmaceda, M., Sarmiento, H., Belluschi, G., Ferrando, Ángel A., & Andreozzi, R. (2019). Fractura de clavícula. Técnica mínimamente invasiva. [Minimally invasive approach for clavicular fractures]. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 84(1), 35-45. https://doi.org/10.15417/issn.1852-7434.2019.84.1.737
Número
Sección
Investigación Clínica
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Citas
1. Johnson EW, Collins HR. Non-union of the clavicle. Arch Surg 1963;87(6):963-6.
2. Paffen PJ, Jansen EW. Surgical treatment of clavicular fractures with Kirschner wires: a comparative study. Arch Chir Neerl 1978;30(1):43-53.
3. Khan LA, Bradnock TJ, Scott C, Robinson CM. Fractures of the clavicle. J Bone Joint Surg Am 2009;91:447-60.
DOI: 10.2106/JBJS.H.00034
4. Nowak J, Mallmin H, Larsson S. The aetiology and epidemiology of clavicular fractures. A prospective study during a two-year period in Uppsala, Sweden. Injury 2000;31:353-8. DOI: 10.1016/S0020-1383(99)00312-5
5. Zlowodzki M, Zelle BA, Cole PA, Jeray K, McKee MD. Treatment of acute midshaft clavicle fractures: systematic review of 2144 fractures: on behalf of the Evidence-Based OrthopaedicTraumaWorking Group. J Orthop Trauma 2005;19:504-7.
DOI: 10.1097/01.bot.0000172287.44278.ef
6. Ferran NA, Hodgson P, Vannet N, Williams R, Evans RO. Locked intramedullary fixation vs. plating for displaced and shortened mid-shaft clavicle fractures: a randomized clinical trial. J Shoulder Elbow Surg 2010;19:783-9.
https://insights.ovid.com/jort/199811000/00005131-199811000-00008
7. Nordqvist A, Petersson CJ, Redlund-Johnell I. Mid-clavicle fractures in adults: end result study after conservative treatment. J Orthop Trauma 1998;12:572-6.
8. Basamania CJ, Rockwood CA. Fractures of the clavicle. En: Rockwood CA (ed.). The shoulder, 4th ed., Philadelphia: WB Saunders; 2008:423-8.
9. Fernandez Dell Oca AA. The principle of helical implants. Unusual ideas worth considering. Injury 2002;33(Suppl 1):SA1-27. DOI: 10.1016/S0020-1383(02)00064-5
10. Zhiquan A, Bingfang Z, Yeming W, Chi Z, Peiyan H. Minimally invasive plating osteosynthesis (MIPO) of middle and distal third humeral shaft fractures. J Orthop Trauma 2007;21(9):628-33. DOI: 10.1097/BOT.0b013e31815928c2
11. Jung GH, Park CM, Kim JD. Biologic fixation through bridge plating for comminuted shaft fracture of the clavicle: technical aspects and prospective clinical experience with a minimum of 12-month follow-up. Clin Orthop Surg 2013;5:327-33. DOI: 10.4055/cios.2013.5.4.327
12. Lee HJ, Oh CW, Oh JK, Yoon JP, Kim JW, Na SB, et al. Percutaneous plating for comminuted midshaft fractures of
the clavicle: a surgical technique to aid the reduction with nail assistance. Injury 2013;44:465-70.
DOI: 10.1016/j.injury.2012.09.030
13. Sohn HS, Kim BY, Shin SJ. A surgical technique for minimally invasive plate osteosynthesis of clavicular midshaft fractures. J Orthop Trauma 2013;27:e92-6. DOI: 10.1097/BOT.0b013e31826579c7
14. Sohn HS, Shin SJ, Kim BY. Minimally invasive plate osteosynthesis using anterior–inferior plating of clavicular midshaft fractures. Arch Orthop Trauma Surg 2011;132:239-44. DOI: 10.1007/s00402-011-1410-6
15. Jubel A. Minimally invasive operative treatment of displaced midclavicular fractures with a titanium elastic nail. Minimally Invasive Orthopaedic Trauma 2013:65.
16. Neer CS 2nd. Non-union of the clavicle. J Am Med Assoc 1960;172:1006-11.
17. Rowe CR. An atlas of anatomy and treatment of mid-clavicular fractures. Clin Orthop Relat Res 1968;58:29-42.
DOI:10.1097/00003086-196805000-00006
18. Robinson CM, Goudie EB, Murray IR, Jenkins PJ, Ahktar MA, Read EO, et al. Open reduction and plate fixation versus nonoperative treatment for displaced midshaft clavicular fractures. J Bone Joint Surg Am 2013;95:1576-84. http://dx.doi.org/10.2106/jbjs.l.00307
19. McKee RC, Whelan DB, Schemitsch EH, Mcknee MD. Operative versus nonoperative care of displaced midshaft clavicular fractures: a meta-analysis of randomized clinical trials. J Bone Joint Surg Am 2012;94:675-84. http://dx.doi.org/10.2106/JBJS.J.01364
20. Der Tavitian J, Davison JN, Dias JJ. Clavicular fracture non-union surgical outcome and complications. Injury 2002;33:135-43. DOI: 10.1016/S0020-1383(01)00069-9
21. Duncan SF, Sperling JW, Stenimann S. Infection after clavicle fractures. Clin Orthop Relat Res 2005;439:74-8.
DOI: 10.1097/01.blo.0000183088.60639.05
22. Liu PC, Hsieh CH, Chen JC, Lu CC, Chuo CY, Chien SH. Infection after surgical reconstruction of a clavicle fracture using a reconstruction plate: a report of seven cases. Kaohsiung J Med Sci 2008;24:45-9. DOI: 10.1016/S1607-551X(08)70073-1
23. Wijdicks FJ, Van der Meijden OA, Millett PJ, Verleisdonk EJ, Houwert RM. Systematic review of the complications of plate fixation of clavicle fractures. Arch Orthop Trauma Surg 2012;132:617-25. DOI: 10.1007/s00402-011-1456-5
24. Perren SM. Editorial: The technology of minimally invasive percutaneous osteosynthesis (MIPO). Injury 2002;33(Suppl 1):VI-VII. DOI:10.1016/S0020-1383(02)00063-3
25. Al-Sadek TA, Niklev D, Al-Sadek A. Midshaft clavicular fractures - Osteosynthesis with minimally invasive technique. Open Acces Maced J Med Sci 2016;4(4):647-9. DOI: 10.3889/oamjms.2016.136
26. Zhang Y, Xu J, Zhang C, Sun Y. Minimally invasive plate osteosynthesis for midshaft clavicular fractures using superior anatomic plating. J Shoulder Elbow Surg 2016;25(1):e7-12. DOI: 10.1016/j.jse.2015.06.024
27. Sohn HS, Kim WJ, Shon MS. Comparison between open plating versus minimally invasive plate osteosynthesis for acute displaced clavicular shaft fractures. Injury 2015;46:1577-84.
DOI: 10.1016/j.injury.2015.05.038
28. Jiang H, Qu W. Operative treatment of clavicle midshaft fractures using a locking compression plate: comparison between mini-invasive plate osteosynthesis (MIPPO) technique and conventional open reduction. Orthop Traumatol Surg Res 2012;98:666-71. DOI: 10.1016/j.otsr.2012.02.011
29. Smekal V, Deml C, Irenberger A, Niedewanger C, Lutz M, Blauth M, et al. Length determination in midshaft clavicle fractures: validation of measurement. J Orthop Trauma 2008;22:458-62. DOI: 10.1097/BOT.0b013e318178d97d
.
2. Paffen PJ, Jansen EW. Surgical treatment of clavicular fractures with Kirschner wires: a comparative study. Arch Chir Neerl 1978;30(1):43-53.
3. Khan LA, Bradnock TJ, Scott C, Robinson CM. Fractures of the clavicle. J Bone Joint Surg Am 2009;91:447-60.
DOI: 10.2106/JBJS.H.00034
4. Nowak J, Mallmin H, Larsson S. The aetiology and epidemiology of clavicular fractures. A prospective study during a two-year period in Uppsala, Sweden. Injury 2000;31:353-8. DOI: 10.1016/S0020-1383(99)00312-5
5. Zlowodzki M, Zelle BA, Cole PA, Jeray K, McKee MD. Treatment of acute midshaft clavicle fractures: systematic review of 2144 fractures: on behalf of the Evidence-Based OrthopaedicTraumaWorking Group. J Orthop Trauma 2005;19:504-7.
DOI: 10.1097/01.bot.0000172287.44278.ef
6. Ferran NA, Hodgson P, Vannet N, Williams R, Evans RO. Locked intramedullary fixation vs. plating for displaced and shortened mid-shaft clavicle fractures: a randomized clinical trial. J Shoulder Elbow Surg 2010;19:783-9.
https://insights.ovid.com/jort/199811000/00005131-199811000-00008
7. Nordqvist A, Petersson CJ, Redlund-Johnell I. Mid-clavicle fractures in adults: end result study after conservative treatment. J Orthop Trauma 1998;12:572-6.
8. Basamania CJ, Rockwood CA. Fractures of the clavicle. En: Rockwood CA (ed.). The shoulder, 4th ed., Philadelphia: WB Saunders; 2008:423-8.
9. Fernandez Dell Oca AA. The principle of helical implants. Unusual ideas worth considering. Injury 2002;33(Suppl 1):SA1-27. DOI: 10.1016/S0020-1383(02)00064-5
10. Zhiquan A, Bingfang Z, Yeming W, Chi Z, Peiyan H. Minimally invasive plating osteosynthesis (MIPO) of middle and distal third humeral shaft fractures. J Orthop Trauma 2007;21(9):628-33. DOI: 10.1097/BOT.0b013e31815928c2
11. Jung GH, Park CM, Kim JD. Biologic fixation through bridge plating for comminuted shaft fracture of the clavicle: technical aspects and prospective clinical experience with a minimum of 12-month follow-up. Clin Orthop Surg 2013;5:327-33. DOI: 10.4055/cios.2013.5.4.327
12. Lee HJ, Oh CW, Oh JK, Yoon JP, Kim JW, Na SB, et al. Percutaneous plating for comminuted midshaft fractures of
the clavicle: a surgical technique to aid the reduction with nail assistance. Injury 2013;44:465-70.
DOI: 10.1016/j.injury.2012.09.030
13. Sohn HS, Kim BY, Shin SJ. A surgical technique for minimally invasive plate osteosynthesis of clavicular midshaft fractures. J Orthop Trauma 2013;27:e92-6. DOI: 10.1097/BOT.0b013e31826579c7
14. Sohn HS, Shin SJ, Kim BY. Minimally invasive plate osteosynthesis using anterior–inferior plating of clavicular midshaft fractures. Arch Orthop Trauma Surg 2011;132:239-44. DOI: 10.1007/s00402-011-1410-6
15. Jubel A. Minimally invasive operative treatment of displaced midclavicular fractures with a titanium elastic nail. Minimally Invasive Orthopaedic Trauma 2013:65.
16. Neer CS 2nd. Non-union of the clavicle. J Am Med Assoc 1960;172:1006-11.
17. Rowe CR. An atlas of anatomy and treatment of mid-clavicular fractures. Clin Orthop Relat Res 1968;58:29-42.
DOI:10.1097/00003086-196805000-00006
18. Robinson CM, Goudie EB, Murray IR, Jenkins PJ, Ahktar MA, Read EO, et al. Open reduction and plate fixation versus nonoperative treatment for displaced midshaft clavicular fractures. J Bone Joint Surg Am 2013;95:1576-84. http://dx.doi.org/10.2106/jbjs.l.00307
19. McKee RC, Whelan DB, Schemitsch EH, Mcknee MD. Operative versus nonoperative care of displaced midshaft clavicular fractures: a meta-analysis of randomized clinical trials. J Bone Joint Surg Am 2012;94:675-84. http://dx.doi.org/10.2106/JBJS.J.01364
20. Der Tavitian J, Davison JN, Dias JJ. Clavicular fracture non-union surgical outcome and complications. Injury 2002;33:135-43. DOI: 10.1016/S0020-1383(01)00069-9
21. Duncan SF, Sperling JW, Stenimann S. Infection after clavicle fractures. Clin Orthop Relat Res 2005;439:74-8.
DOI: 10.1097/01.blo.0000183088.60639.05
22. Liu PC, Hsieh CH, Chen JC, Lu CC, Chuo CY, Chien SH. Infection after surgical reconstruction of a clavicle fracture using a reconstruction plate: a report of seven cases. Kaohsiung J Med Sci 2008;24:45-9. DOI: 10.1016/S1607-551X(08)70073-1
23. Wijdicks FJ, Van der Meijden OA, Millett PJ, Verleisdonk EJ, Houwert RM. Systematic review of the complications of plate fixation of clavicle fractures. Arch Orthop Trauma Surg 2012;132:617-25. DOI: 10.1007/s00402-011-1456-5
24. Perren SM. Editorial: The technology of minimally invasive percutaneous osteosynthesis (MIPO). Injury 2002;33(Suppl 1):VI-VII. DOI:10.1016/S0020-1383(02)00063-3
25. Al-Sadek TA, Niklev D, Al-Sadek A. Midshaft clavicular fractures - Osteosynthesis with minimally invasive technique. Open Acces Maced J Med Sci 2016;4(4):647-9. DOI: 10.3889/oamjms.2016.136
26. Zhang Y, Xu J, Zhang C, Sun Y. Minimally invasive plate osteosynthesis for midshaft clavicular fractures using superior anatomic plating. J Shoulder Elbow Surg 2016;25(1):e7-12. DOI: 10.1016/j.jse.2015.06.024
27. Sohn HS, Kim WJ, Shon MS. Comparison between open plating versus minimally invasive plate osteosynthesis for acute displaced clavicular shaft fractures. Injury 2015;46:1577-84.
DOI: 10.1016/j.injury.2015.05.038
28. Jiang H, Qu W. Operative treatment of clavicle midshaft fractures using a locking compression plate: comparison between mini-invasive plate osteosynthesis (MIPPO) technique and conventional open reduction. Orthop Traumatol Surg Res 2012;98:666-71. DOI: 10.1016/j.otsr.2012.02.011
29. Smekal V, Deml C, Irenberger A, Niedewanger C, Lutz M, Blauth M, et al. Length determination in midshaft clavicle fractures: validation of measurement. J Orthop Trauma 2008;22:458-62. DOI: 10.1097/BOT.0b013e318178d97d
.