Die anatomisch präkonturierte Platte nach Meves
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Zusammenfassung
Hintergrund
Klavikulapseudarthrosen nach Frakturen des mittleren Drittels werden häufig durch lokale Schmerzen, eine eingeschränkte Schulterfunktion oder neurovaskuläre Symptome manifest. Ziel einer operativen Behandlung ist die Wiederherstellung einer normalen Klavikulaanatomie mit solider knöcherner Durchbauung des ehemaligen Frakturspalts.
Methode
In dieser Studie wurden 24 Patienten mit einer anatomisch präkonturierten Platte nach Meves bei Klavikulapseudarthrose versorgt, bei 11 Patienten wurde eine zusätzliche Spongiosaplastik durchgeführt.
Ergebnisse
19 Patienten konnten nach einem mittleren Zeitraum von 74,5 Monaten nachuntersucht werden. Bei sämtlichen Patienten zeigte sich eine knöcherne Konsolidierung. Der Constant-Score verbesserte sich von präoperativen 70,4 auf postoperative 82,5 Punkte (89,3% altersadaptiert). 16 Patienten waren sehr zufrieden bzw. zufrieden mit dem operativen Ergebnis.
Schlussfolgerung
In unseren Händen zeigte sich eine sichere Ausheilung der Klavikulapseudarthrosen unter Verwendung der anatomisch präkonturierten Platte nach Meves bei guten bis sehr guten funktionellen Ergebnissen.
Schlüsselwörter
Klavikulapseudarthrose Präkonturierte Meves-Platte Kompressionsplatte Operative BehandlungThe anatomical precontoured Meves compression plate
Abstract
Background
Pseudarthroses of the clavicle after fractures of the medial third often present with local pain, compromised shoulder function, or neurovascular symptoms. Reconstruction of normal clavicular anatomy and solid fusion is a prerequisite for good clinical outcome after surgical treatment. In this study, 24 patients with clavicular pseudarthrosis were treated with the anatomical precontoured Meves plate. In 11 patients, additional bone grafting was done.
Method
Nineteen patients could be reexamined with a mean follow-up of 74.5 months. In all of them, solid fusion was achieved.
Results
The Constant score improved from 70.4 points preoperatively up to 82.5 points postoperatively (89.3% age-related). Sixteen patients were satisfied or very satisfied with the operative result.
Conclusion
In our patients, secure healing of clavicular nonunion was achieved with the anatomical precontoured Meves plate, with good or excellent clinical outcomes.
Keywords
Nonunion of the clavicle Precontoured Meves plate Compression plate Surgical treatmentNotes
Interessenkonflikt
Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.
Literatur
- 1.Allman Jr FL (1967) Fractures and ligamentous injuries of the clavicle and its articulation. J Bone Joint Surg Am 49: 774–784PubMedGoogle Scholar
- 2.Ballmer FT, Lambert SM, Hertel R (1998) Decortication and plate osteosynthesis for nonunion of the clavicle. J Shoulder Elbow Surg 7: 581–585PubMedCrossRefGoogle Scholar
- 3.Bauer R, Wasenbelz U (1986) Stable clavicular osteosynthesis using the Meves compression plate. Zentralbl Chir 111: 414–420PubMedGoogle Scholar
- 4.Bradbury N, Hutchinson J, Hahn D, Colton CL (1996) Clavicular nonunion. 31/32 healed after plate fixation and bone grafting. Acta Orthop Scand 67: 367–370PubMedCrossRefGoogle Scholar
- 5.Canadian Orthopaedic Trauma Society (2007) Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial. J Bone Joint Surg Am 89: 1–10CrossRefGoogle Scholar
- 6.Crenshaw AH (1992) Fractures of the shoulder girdle, arm and forearm. In: Crenshaw AH (ed) Campbell‘s operative orthopaedics, 8th edn. Mosby Year Book, St. Louis, pp 989–1053Google Scholar
- 7.Demiralp B, Atesalp AS, Sehirlioglu A et al. (2006) Preliminary results of the use of Ilizarov fixation in clavicular non-union. Arch Orthop Trauma Surg 126: 401–405PubMedCrossRefGoogle Scholar
- 8.Echtermeyer V, Zwipp H, Oestern H-J (1984) Fehler und Gefahren in der Behandlung der Frakturen und Pseudarthrosen des Schlüsselbeins. Langenbecks Arch Chir 364: 351–354PubMedCrossRefGoogle Scholar
- 9.Erdmann D, Pu CM, Levin LS (2004) Nonunion of the clavicle: a rare indication for vascularized free fibula transfer. Plast Reconstr Surg 114: 1859–1863PubMedCrossRefGoogle Scholar
- 10.Evans RO, Goldberg JA, Bruce WJ, Walsh W (2004) Reoperated clavicular nonunion treated with osteogenic protein 1 and electrical stimulation. J Shoulder Elbow Surg 13: 573–575PubMedCrossRefGoogle Scholar
- 11.Fuchs B, Steinmann SP, Bishop AT (2005) Free vascularized corticoperiosteal bone graft for the treatment of persistent nonunion of the clavicle. J Shoulder Elbow Surg 14: 264–268PubMedCrossRefGoogle Scholar
- 12.Fuchs M, Losch A, Sturmer KM (2002) Surgical treatment of fractures of the clavicle–Indication, surgical technique and results. Zentralbl Chir 127: 479–484PubMedCrossRefGoogle Scholar
- 13.Hill JM, McGuire MH, Crosby LA (1997) Closed treatment of displaced middle-third fractures of the clavicle gives poor results. J Bone Joint Surg Br 79: 537–539PubMedCrossRefGoogle Scholar
- 14.Huang JI, Toogood P, Chen MR et al. (2007) Clavicular anatomy and the applicability of precontoured plates. J Bone Joint Surg Am 89: 2260–2265PubMedCrossRefGoogle Scholar
- 15.Kabak S, Halici M, Tuncel M et al. (2004) Treatment of midclavicular nonunion: comparison of dynamic compression plating and low-contact dynamic compression plating techniques. J Shoulder Elbow Surg 13: 396–403PubMedCrossRefGoogle Scholar
- 16.Klonz A, Hockertz T, Reilmann H (2001) Klavikulafrakturen. Unfallchirurg 104: 70–81PubMedCrossRefGoogle Scholar
- 17.Laursen MB, Dossing KV (1999) Clavicular nonunions treated with compression plate fixation and cancellous bone grafting: the functional outcome. J Shoulder Elbow Surg 8: 410–413PubMedCrossRefGoogle Scholar
- 18.McKee MD, Wild LM (2003) Schemitsch EH. Midshaft malunions of the clavicle. J Bone Joint Surg Am 85: 790–797PubMedGoogle Scholar
- 19.Meves H (1973) Stabile und funktionsgerechte Osteosynthese von Klavikulaschaftfrakturen und Pseudarthrosen mit einer neuen Kompressionsplatte. Acta Chir Austr 4: 78–81CrossRefGoogle Scholar
- 20.Neer CS (1984) Fractures of the clavicle. In: Rockwood CA Jr, Green DP (eds) Fractures in adults. 1st edn. Lippincott-Raven, Philadelphia, pp 686–691Google Scholar
- 21.Nordqvist A, Petersson C (1994) The incidence of fractures of the clavicle. Clin Orthop 300: 127–132PubMedGoogle Scholar
- 22.Olsen BS, Vaesel MT, Sojbjerg JO (1995) Treatment of midshaft clavicular nonunion with plate fixation and autologous bone grafting. J Shoulder Elbow Surg 4: 337–344PubMedCrossRefGoogle Scholar
- 23.Robinson CM, Court-Brown CM, McQueen MM, Wakefield AE (2004) Estimating the risk of nonunion following nonoperative treatment of a clavicular fracture. J Bone Joint Surg Am 86: 1359–1365PubMedGoogle Scholar
- 24.Rosenberg N, Neumann L, Wallace AW (2007) Functional outcome of surgical treatment of symptomatic nonunion and malunion of midshaft clavicle fractures. J Shoulder Elbow Surg 16(5): 510–513PubMedCrossRefGoogle Scholar
- 25.Tetreault P, Ouellette HA (2007) Healing of a clavicle fracture nonunion with bone marrow injection. J Shoulder Elbow Surg 16: 23–24CrossRefGoogle Scholar