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Die laterale Klavikulafraktur

Distal clavicle fracture

  • Operative Techniken
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Operative Orthopädie und Traumatologie Aims and scope Submit manuscript

Zusammenfassung

Operationsziel

Reposition und Stabilisierung von instabilen lateralen Klavikulafrakturen mittels winkelstabiler Plattenosteosynthese (Fa. Acumed, Hempshire, UK) in Kombination mit einer korakoklavikulären DogBone-Fibertape-Zuggurtung (Fa. Arthrex, Naples, USA).

Indikationen

Instabile laterale Klavikulafrakturen (Typ IIA nach Jäger und Breitner) beim Erwachsenen. Instabile laterale Klavikulafrakturen (Typ IV nach Jäger und Breitner) beim Kind. Laterale Klavikulafrakturen mit AC-Gelenkinstabilität. Laterale Klavikulafrakturen Typ I, IIB oder III nach Jäger und Breitner mit starker Fragmentdislokation, Gefäß-/Nervenbeteiligung oder bei hohem funktionellem Anspruch.

Kontraindikationen

Allgemeine Kontraindikationen gegen einen operativen Eingriff. Laterale Klavikula-Typ-I- oder -Typ-III-Frakturen ohne höhergradige Dislokation oder vertikale Instabilität. Weichteilinfektion.

Operationstechnik

Kombinationsverfahren: Zu Beginn erfolgt über einen ca. 4 cm langen Hautschnitt die Darstellung und Reposition der lateralen Klavikulafraktur, welche mittels winkelstabiler Plattenosteosynthese stabilisiert wird. Mit Hilfe eines speziellen Zielgeräts wird eine transklavikuläre-transkorakoidale Bohrung durchgeführt. Anschließend wird nach Anlage von 3 Arbeitsportalen unter arthroskopischer Sicht eine vertikale Stabilisierung mittels DogBone-Button und FibreTape-Zuggurtung durchgeführt. Hierzu werden FibreTapes, die mit dem DogBone-Button geladen sind, von lateral mit Hilfe eines Shuttle-Instruments durch die Platte und die transklavikuläre-transkorakoidale Bohrung nach kranial gezogen und über einer Plattenbrücke reponiert und verknotet, während der DogBone-Button subkorakoidal als Widerlager platziert wird.

Weiterbehandlung

Tragen einer Schultergelenksbandage für 6 Wochen.

Ergebnisse

Da es sich bei dieser Technik um ein neuartiges Verfahren handelt, können noch keine studiengerechten Langzeitergebnisse präsentiert werden. Kurzzeitig berichten die Patienten ausnahmslos über eine hohe postoperative subjektive Zufriedenheit ohne persistierende Schmerzen.

Abstract

Objective

Reposition and fixation of unstable distal clavicle fractures with a low profile locking plate (Acumed, Hempshire, UK) in conjunction with a button/suture augmentation cerclage (DogBone/FibreTape, Arthrex, Naples, FL, USA).

Indications

Unstable fractures of the distal clavicle (Jäger and Breitner IIA) in adults. Unstable fractures of the distal clavicle (Jäger and Breitner IV) in children. Distal clavicle fractures (Jäger and Breitner I, IIB or III) with marked dislocation, injury of nerves and vessels, or high functional demand.

Contraindications

Patients in poor general condition. Fractures of the distal clavicle (Jäger and Breitner I, IIB or III) without marked dislocation or vertical instability. Local soft-tissue infection.

Surgical technique

Combination procedure: Initially the lateral part of the clavicle is exposed by a 4 cm skin incision. After reduction of the fracture, stabilization is performed with a low profile locking distal clavicle plate. Using a special guiding device, a transclavicular–transcoracoidal hole is drilled under arthroscopic view. Additional vertical stabilization is arthroscopically achieved by shuttling the DogBone/FibreTape cerclage from the lateral portal cranially through the clavicular plate. The two ends of the FibreTape cerclage are brought cranially via adjacent holes of the locking plate while the DogBone button is placed under the coracoid process. Thus, plate bridging is achieved. Finally reduction is performed and the cerclage is secured by surgical knotting.

Postoperative management

Use of an arm sling for 6 weeks.

Results

Due to the fact that the described technique is a relatively new procedure, long-term results are lacking. In the short term, patients postoperatively report high subjective satisfaction without persistent pain.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. G. Seppel und A. Lenich geben an, dass kein Interessenkonflikt besteht. A.B. Imhoff ist Berater von Arthrex. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81657, München, Deutschland

    G. Seppel, A. Lenich &  A.B. Imhoff

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  1. G. Seppel
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  2. A. Lenich
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  3. A.B. Imhoff
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Correspondence to A.B. Imhoff.

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Seppel, G., Lenich, A. & Imhoff, A. Die laterale Klavikulafraktur. Oper Orthop Traumatol 26, 254–262 (2014). https://doi.org/10.1007/s00064-013-0280-1

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  • DOI: https://doi.org/10.1007/s00064-013-0280-1

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