08.50 09.05 Pamudji Utomo When and How Lateral Clavicle1

8/17/2019 08.50 09.05 Pamudji Utomo When and How Lateral Clavicle1

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Dr Pamudji Utomo SpOT (K)

WHEN AND HOW TO OPERATE

A DISPLACED LATERAL

CLAVICLE FRACTURE


2/27

Epidemiology

Clavicle fractures --> 2.6 % - 12 % of all fractures

Clavicle fractures --> 44 % - 66 % of shoulder fractures Middle third fractures --> 8 % of all clavicle fractures

!ro"imal third fractures # %

Latra! " di#ta! t$ird %& '

$oval & 'uc(erma) *+. 21,

Background


3/27

Topographic Anatomy

he clavicle is

)arroest i) its

midportio)& high

i)cide)ce offractures i) this

area.

$/a0arus M+& eo) C. 26,


4/27

he clavicle fu)ctio) as a strut& raci)g the shoulder from the tru)(

a)d alloi)g the shoulder to fu)ctio) at optimal stre)gth. he

medial o)e third protect the rachial ple"us& the suclavia) a)d

a"illary vessels& a)d the superior lu)g. $oval & 'uc(erma) *+. 21,

Clavicle Functions

$https3o)li)e .epocrates.com,


5/27

Mechanism of Injury

5 fall o) the shoulder or

the outstretched ha)d

5 fall directly o) the

shoulder $8%,

eco)dary to muscle

co)tractio) sei0ure or

stress fracture $rare,

$Cole 5& pavlou !& 7aric( +.

21,

$*ac(so) *. 211,


6/27

Fracture Classication

eer Classificatio)


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59 Classificatio) %&C Lo*atio+ Latra! E+d

,roup#

%&C- C!a.i*!/ Latra! E+d/ I+traarti*u!ar %&C% C!a.i*!/ Latra! E+d/ E0tra Arti*u!ar

Su12roup#

%&C%3% Impa*td (CC Li2am+t I+ta*t)

%&C%3- No+*ommi+utd (CC Li2am+t di#ruptd)

%&C%34 Commi+utd (CC Li2am+t di#ruptd) %&C-34 Commi+utd (CC Li2am+t di#ruptd)

%&C-3- No+*ommi+utd (CC Li2am+t di#ruptd)

%&C-3% Wit$ #!i2$t di#p!a*m+t

(CC Li2am+t I+ta*t)

$:uedi !& Murphy 7M. 2,


8/27

Treatment of lateral clavicle

fractures

Co)servative or 9perative

!rolem3

raditio)ally& )o)surgical ma)ageme)t has ee) favored as

the i)itial treatme)t.

:ece)t evide)ce suggests that specific susets of patie)ts

may e at high ris( for )o)u)io)& shoulder dysfu)ctio)& or

residual pai) after )o)surgical ma)ageme)t.

$ire) +& ;roeme) *!5M. 21


9/27

reatme)t of type = a)d type === eer Classificatio)fractures does )ot appear to e deated

Mostly co)servative physiotherapy

eer type ==3

7ide variety of treatme)t

!articular deformity lac( of staility

?igh ris( of complicatio)s

9:=@

$+ugdale + et al. 1AA,


10/27

Treatment Options

o)operative

li)g

Brace

urgical

!late @i"atio)

cre or !i) @i"atio)-7ire

uture a)d sli)g tech)iues

$;a) der MeiDde) 95& as(ill :& Millett !*. 211,


11/27

urgical treatme)t i)dicatio) of lateral-third clavicle

fracture3

CC ligame)t disruptio)

displaceme)t of themedial clavicle lead to high ris( of )o)u)io)

$28%,

9pe) @ractures or ith oft-tissue compromise

Multiple trauma

FFfloati)g shoulderGG i)Duries are prese)t.

$;a) der MeiDde) 95& as(ill :& Millett !*. 211,


12/27

!late a)d cre

everal plates have ee) descried i) the literature

i)cludi)g the Balser plate& the 7olter plate& the 59

clavicular hoo( plate

Surgical Treatment Options

7olter !late$http3eorif.com,

Balser !late$Ba)sal M& et al. 21,


13/27

staility of the fracture is preserved ithout disturi)g the

iomecha)ics of the 5C Doi)t

Complicatio)s3 fracture of the plateGs hoo(& cut-out&

e)largeme)t of the hoo(Gs hole i) the acromio).

Hook Plate

$Charity :M& ?aidar & hosh & illu 5B. 2,


14/27

Madse) et al.

5dditio) of a suture a)chor forcoracoclavicular fi"atio) to a superior loc(i)g plate

improves staility of type ==B distal clavicle fractures.

Locking Plate

$Madse)&21


15/27

Screw or Pin Fixation

Coracoclavicular creBelmer a)d eler $1AA1, Coracoclavicular fi"atio)

provided a)d mai)tai)ed reductio) of the fracture.

5ccordi)g to their study& heali)g occurred u)eve)tfully

ithi) )i)e ee(s i) all cases.

$@a0al M5& a(se)a *& ?addad @.2,


16/27

Coracoclavicular

cre a)d /oop

suture

$/a0arus M+& eo) C. 26,


17/27

/i) ?? et al $21


18/27

=M !i) @i"atio)

$7heeles C:. 21


19/27

olima) et al3 H)der-coracoid-arou)d-clavicle $HC5C,loop rigid fi"atio) a)d lead to o)y u)io)& provides

adeuate staility ith e"celle)t results.

$olima) 9& et al. 21


20/27

eith M. Baumgarte) $28, prese)ted a) arthroscopic

fi"atio) of type ==-varia)t& u)stale distal clavicle fracture.

Fi2ur - 5rthroscopic vie through the a)terolateral portal shoi)g the ase of

the coracoid ith the i)ferior utto) of the ight:ope device deployed. Fi2ur4 5! radiograph 6 mo)ths postoperatively& reveali)g osseous u)io) of the distal

clavicle. Fi2ur 5 ymmetric a)atomic appeara)ce of the right acromioclavicular

Doi)t a)d distal clavicle 6 mo)ths postoperatively

$Baumgarte) M. 28,


21/27

-ire a)d e)sio) Ba)d 7iri)g

$7u et al. 21


22/27

K-wire by closed tecni!ue

" i S d


23/27

"omparison StudyBishop *I et al o sig)ifica)t differe)ce i) ultimate load to

failure as fou)d i) a iomecha)ic compariso) study amo)g

4 groups 3 suture fi"atio) ith a cerclage suture a)dcoracoclavicular suture& distal clavicle loc(i)g plate& distal

clavicle loc(i)g plates ith suture augme)tatio)& a)d distal

clavicle hoo( plate.

$Bishop *I. et al& 21


24/27

arl 7u et al hoo( plate fi"atio) of u)stale lateral

clavicle fractures as associated ith statistically etter

shoulder fu)ctio) a)d earlier impla)t removal tha) -ire

te)sio) a)d fi"atio).

"omparison Study

$7u et al. 21


25/27

ylvia et al. reported a meta a)alysis of urgical

treatme)t of eer type-== fractures of the distal clavicle

$21 studies&


26/27

"onclusion

/ateral clavicle fracture ca) e treated co)servatively or

operatively.

Ma)y surgical tech)iues has ee) proposed for lateral

clavicle fracture.

pecific treatme)t should e i)dividuali0ed ased o)

fracture characteristics a)d patie)t e"pectatio)s


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TH#$K %O&

08.50 09.05 Pamudji Utomo When and How Lateral Clavicle1

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