INNOVATION IN THE TREATMENT OF FRACTURES OF THE CLAVICLE USING A PIVOT

N.M.Lapin,Y.B.Semcin, V.M. Voronin, A.S. Peshcov
City Hospital 1 Belgorod Russia.

Annotation

The analysis of 108 operative measures was carried out on fractured Clavicles. In the control group 85 (78,4 percent) patients were under observation, to whom the Bogdanow pivot was applied; 9 patients (10,6 percent) had 2 pivots. There were 21 cases (24,7% percent) of pivot migration during the post - operation period, including 12 cases (14.1 percent) of skin perforation, 4 of which (4,7 percent) were accompanied by the formation of a false joint.

Out of 85 patients (16,5 percent) the Osteosynthesis of a fractured Clavicle was performed with a wave - like pivot. Ten patients (71,4 percent) were diagnosed with fragmented Clavicle fractures.

Nine patients had the pivot removed as a result of a fusion of the Clavicle fracture within a period of three to six months.

Five patients are undergoing outpatient treatment. No pivot migration or false joint formation was observed.

Therefore, the pivot creates a stable Osteosynthesis in the Clavicle fracture area interacting in the Marrow channel caused by strained condition of the pivot with the elastic forces and physiological bends and unevenness of the Clavicle.

There is no pivot migration in the early and late post - operation period, so there is no false joint formation.

Pivot selection during the operation is simplified, its duration is reduced.

A comparative analysis of the control group indicates a considerable positive effect of using the wave - like pivot.

There are quite few works about the innerosseous fixation of fragments of the Clavicle in modem medical literature. However, a broader approach to the operative treatment of these fractures has been adopted in the recent years.

In spite of a lot of offered methods, the constructions designed for Osteosynthesis of fractures of the Clavicle, none of them do not exclude complications during the post operation period.

None the less a stable Osteosynthesis made by a flat or a round pivot is not always possible. It can be explained by the fact that the Marrow channel is characterized by both narrowing and widening at the middle third of the Clavicle due to certain age, anatomical and physiological peculiarities.

A P. Krysuk defined that the minimum width of the Marrow cavity of the Clavicle is 0,25 centimeters and the maximum width is 1,6 centimeters; minimum height of the Marrow cavity of the Clavicle is 0,25 centimeters and the maximum height is 1,4 centimeters. It is necessary to take into consideration that there is a narrowing of the Marrow channel of the Clavicle in the area of the Acromial bend.

After the Osteosynthesis of the Clavicle a flat or a round pivot tends to migrate while in motion. It is not unusual for the pivot to migrate during the early and the late post-operation period before removing the plaster. This results in instability and migration at the fractured area of the Clavicle, and sometimes it results in the formation of a false joint. According to various authors this phenomenon can be observed in the 1,5 - 7,6 percent of cases and takes one of the first places among the false joints of other localizations. B.G. Apanasenko and his co-authors have written that after investigating 39 patients, on whom the innerosseous metallic Osteosynthesis was carried out, unsatisfactory results were observed involving eleven patients (28 percent).

The treatment of such patients is very complicated especially when the false joint is accompanied by a bone defect, and conservative methods are not effective.

The undulated pivot of Bogdanov is used in the traumatdogical department for the Osteosynthesis of fractures of the Clavicle, thus excluding the following complications. The Patent number for the invention is 2142756, dated 26/02/1999. The main idea of this inncwation is that the flat pivot is given an undulated form with the help of a tod during the operation. It is done on its whde length with an equal pitch between apexes and hollows of the waves or with a different pitch between them in the plane of the wide side of the rectangular section, with the exception of the distal end. Moreover, the minimum height between apexes and hdlows of the waves exceeds the diameter of the Marrow channel. Then the cfistal end of the pivot is inserted into the Marrow channel of the external fragment protruding through the skin in the area of the Acromial appendix. After repositioning of the fragments of the Clavicle the pivot is inserted into the central fragment for the length of the Marrow channel. In the case of slanting fractures of the Clavicle it is necessary that the undulated pivot should be settled down with its wide side should be perpendicular to the plane of the line of the fracture. Besides, the diameter of the marrow channel does not affect the stability of the Osteosynthesis of fractures of the Clavicle. The surplus of the pivot, protruding from the skin is cut off. The fragments are positioned and fixed by catgut.

During five years 108 operations of the Osteosynthesis of fractures of the Clavicle have been done in the traumatdogical department. There were seventy-nine men (73,2 percent) and twenty-eight women (26,8 percent) among the patients. The age of men ranged from fifteen to seventy years and the age of women ranged from twenty to sixty-five years. Ninety-four of them (87 percent) were domestic injuries, the rest (fourteen patients or 12,5 percent) were industrial traumas. Eighty-nine patients (82,4 percent) were characterized as being able-bodied, while eighteen patients (17,6 percent) were beyond that age. There were nine (8,3 percent) cases of polytraumatic nature (brain injuries, other fractures). Eighty-five patients (78,7 percent) were operated on using the pivot of Bogdanov. Nine patients (10,6 percent) had two pivots each. There were five (4,6 percent) cases of Osteosynthesis of fractures of the Clavicle using a plate; four patients (3,6 percent) had Osteosynthesis using spokes; fourteen patients (13 percent) had Osteosynthesis using screws. They were operated during a period from 5 to 30 days. The treatment was complicated by the formation of a Hematoma, Seroma, ligature Fistula in fourteen cases (13 percent) of the examined group. Rvot migration was observed involving twenty-one patients (24,7 percent) during the early and the late post-operation period; twelve patients (14,1 percent) suffered damage of skin layers. There were four cases (4,7 percent) with the formation of a false joint. The Osteosynthesis of fractures of the Clavicle by the undulated pivot was made in fourteen cases out of 85 patients. Thirteen (16,5 percent) male patients were in the age from 15 to 65 years and one female patient was 64. Ten (71,4 percent) patients of the examined group had fragmented fractures. Not a single case of pivot migration, or false joint formation was observed. In 9 out of 14 cases the pivots were extracted in connection with a knotted fraction of the Clavicle. The period of those operations took from 3 to 6 months.

Thus, firstly, the pivot permits additionally to increase the force of friction between the waves and walls of the Marrow channel at the expense of creating a strained condition of the pivot, interacting by its elastic forces with physiological bends and unevenness of the Clavicle in the cavity of the channel. Secondly, the pivot simplifies the process of making the choice and the insertion of the pivot during the operation. Thirdly, the pivot reduces the standard sizes and the number of pivots, because it is possible to make an undulated profile with dfferent height of dimensions of the waves, exceeding the diameter of the Marrow channel, on the basis of the pivot of the minimum section.

 

Conclusions:

  1. The Osteosynthesis of fractures of the Clavicle by the undulated pivot helps to fix the fragments in reposition compared to a flat pivot at the expense of elastic forces of the compression in the cavity of the channel.
  2. It practically excludes migration of the pivot in the early and the late post-operation period and consequently, it excludes the formation of a false joint.
  3. The traumatism and the period of surgical intervention are considerably reduced, the operative techniques are made simple.

Literature:

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