한국인 성인 쇄골의 해부학적 계측 및 쇄골과 Pre-Contoured Anatomical Plate의 적합성에 대한 분석

김형준(Hyeungjune Kim),남경모(Kyoungmo Nam),강대명(Daemyung Kang),오성학(Sunghak Oh),고덕환(Dukhwan Kho) 대한정형외과학회 2013 대한정형외과학회지 Vol.48 No.5

목적: 쇄골은 복잡한 해부학적 특성으로 인해 수술 시 금속판과 적합성이 맞지 않는 경우가 있다. 본 연구에서는 한국인 쇄골의 해부학적 자료를 분석하여 pre-contoured anatomical plate와의 형태학적 적합성을 조사하였다. 대상 및 방법: 2010년 7월부터 2011년 7월까지 건국대학교 충주병원 응급실로 내원하여 3차원 흉부 컴퓨터 단층촬영을 시행한 300명을 대상으로 쇄골의 길이, 너비, 두께, 내, 외측 만곡의 깊이, 상방극점을 Andermahr의 방법을 이용하여 계측하였다. Precontoured anatomical plate의 적합성은 Adobe Photoshop를 이용하여 쇄골의 50%, 60%-70% 구간을 기준으로 적절함, 보통, 부적함으로 나누어 조사하였다. 결과: 쇄골의 평균 길이는 146.21±4.98 mm, 평균 폭은 9.63±1.67 mm, 평균 두께는 9.54±1.67 mm로 나타났다. 쇄골 상방극점은 쇄골 외측단에서 내측으로 평균 36.17±0.60 mm, 평균 위치에서 5.88±0.62 mm로 측정되었으며, 쇄골의 내측 만곡의 깊이는 평균 15.89±1.33 mm, 외측 만곡의 깊이는 평균 11.73±1.66 mm로 측정되었다. Pre-contoured anatomical plate의 적합성은 50% 지점에서 보통(fair) 이상의 적합성이 79%로 나타났고 60%-70% 영역에서는 48%로 나타났다. 60%-70% 영역에서 금속판의 내, 외측을 반대로 적용시켰을 때, 보통 이상의 적합성은 67%로 증가하였다. 결론: 서양인의 쇄골에 맞게 제작된 pre-contoured anatomical plate는 한국인의 쇄골과 해부학적으로 맞지 않아 금속판 적용을 하기 힘든 경우가 많으므로 향후 한국인의 쇄골에 알맞은 pre-contoured anatomical plate의 개발이 필요하다고 생각한다. Purpose: Due to the complex anatomy of clavicles, clavicular plates are not always compatible with clavicular fractures. The purpose of this study was to analyze basic data on the anatomy of the clavicle in order to determine compatibility between clavicles of Korean adults and pre-contoured anatomical plates. Materials and Methods: We analyzed the anatomy of 600 clavicles of 300 patients who underwent three-dimensional (3D) computed tomography of clavicles in the emergency room of Konkuk University Chungju Hospital, between July 2010 and July 2011, using Andermahr"s method; in addition, the compatibility between 3D axial images of clavicles and sectional images of pre-contoured anatomical plates was also examined using Adobe Photoshop. Results: The mean length of the clavicle was 146.21±4.98 mm, the mean width was 9.63±1.67 mm, and the mean thickness was 9.54±1.67 mm. The location of the maximum superior bow was 36.17±0.60 mm from the lateral end of the clavicle and the mean magnitude was 5.88±0.62 mm. The mean depth of medial curvature was 15.89±1.33 mm, and the mean depth of the lateral curvature of the clavicle was 11.73±1.66 mm. The compatibility between clavicles and plates was 79% as above a fair compatibility in the 50% range of clavicles and 48% as above a fair compatibility in the 60% to 70% range of clavicles. On the contrary, in application of medial and lateral plates in the 60% to 70% range of clavicles, above a fair compatibility had increased to 67%. Conclusion: A more adequate pre-contoured anatomical plate is required for satisfactory improvement of the compatibility of clavicles of Korean adults.

Clinical and Radiological Outcomes of Hook Plate Fixation in the Lateral End Fracture of the Clavicle and Acromioclavicular Dislocation

Young Kyoung Min,Jung Han Kim,Heui Chul Gwak 대한견주관절의학회 2016 대한견주관절의학회지 Vol.19 No.4

Background: The purpose of this study was to identify the clinical and radiological outcomes of hook plate fixation for lateral end fracture of the clavicle and acromioclavicular dislocation. Methods: There were a total of 20 cases with lateral end fracture of the clavicle and 16 cases with acromioclavicular dislocation. All patients were evaluated for range of motion, functional score by using Constant score, and American Shoulder and Elbow Surgeons shoulder index at just before implant removal and at final follow-up. Coracoclavicular distance was measured in acromioclavicular dislocation and bony union was evaluated in the lateral end fracture of the clavicle. Results: The clinical outcomes and range of motion were increased at the final follow-up compared with just before implant removal in both the lateral end fracture of the clavicle and acromioclavicular dislocation. In acromioclavicular dislocation, all cases—except one—showed maintenance of reduction after implant removal. Moreover, in the lateral end fracture of the clavicle, all cases—except one—showed bony union. Conclusions: Hook plate fixation in the lateral end fracture of the clavicle and acromioclavicular dislocation resulted in good clinical and radiological results.

선천성 쇄골 가관절증의 22년 장기 추시 결과 - 증례 보고 -

이상명,이승구,허성우,김민업 대한수부외과학회 2011 대한수부외과학회지 Vol.16 No.1

Congenital pseudarthrosis of the clavicle is a rare condition, which rarely produces functional disabilities except for cosmetic problems. Surgical treatment involves autogenous iliac bone grafts and internal fixation. Few studies have reported long-term results of surgical treatment or morphological changes of the clavicle. We report a patient with a congenital pseudarthrosis of the clavicle, who demonstrated a near normal radiographic appearance of the clavicle and an excellent result 22 years after the operation performed at 4 years of age. 선천성 쇄골 가관절증은 매우 드문 질환으로 대부분 기능적 이상은 없으나 미용상의문제로 수술하는 경우가 많다. 수술은 대부분 가관절 절제 및 자가 골 이식의 방법을사용하는데 이에 대한 장기 추시 결과는 매우 드물다. 저자들은 4세 여아에서 자가 장골 분절 이식 수술을 시행하고 성장이 완료된 22년 후 내원한 환자를 평가하여 좋은결과를 얻었기에 보고하는 바이다.

Clinical Outcome after Clavicular Hook Plate Fixation for Displaced Medial-End Clavicle Fractures

Ki Bum Kim,Young Sang Lee,Sung Il Wang 대한정형외과학회 2023 Clinics in Orthopedic Surgery Vol.15 No.5

Background: Surgery of the medial end of the clavicle remains a challenge for orthopedic surgeons. Moreover, there is no standard surgical procedure for treating displaced fractures or dislocation of the medial clavicle. Thus, the present study aimed to evaluate the safety and efficacy of using a hook plate for treating medial-end clavicular fractures and present functional outcomes. Methods: We retrospectively investigated 18 patients who underwent surgery with a hook plate from July 2016 to December 2021. There were 14 men and 4 women with a mean age of 57.4 years. Fracture union was assessed at follow-up by computed tomography (CT). Other outcome parameters were complications, including implant failure, infection, nonunion, osteolysis of sternal manubrium, and migration of the hook portion. Range of motion (ROM), visual analog scale (VAS), Quick Disabilities of the Arm, Shoulder and Hand (Quick DASH), and American Shoulder and Elbow Society (ASES) scores were evaluated 6 months postoperatively and at the last follow-up. Results: The mean operation time was 43.8 minutes (range, 35–50 minutes) and the mean follow-up was 22.8 months (range, 12–42 months). Bone union was confirmed in all cases. The mean union time was 6.2 months (range, 6–7 months). Implant removal was performed routinely according to the clinical course in 17 cases. The mean implant removal time was 10.0 months (range, 6–14 months). Clinical and functional outcomes measured at the last follow-up were significantly improved compared to those at 6 months postoperatively (p < 0.05). Regarding complications, there were 6 cases (33.3%) of osteolysis of the sternal manubrium. Although the anteroposterior length of the manubrium and hook depth showed significant differences between the non-osteolysis group and the osteolysis group (p = 0.024), ROM, VAS, Quick DASH, and ASES scores were not significantly different between the two groups (all p > 0.05). Conclusions: Clavicle hook plating can be a safe and effective method that can be easily applied with good outcomes if it is used with appropriate surgical planning and technique for medial-end clavicle fracture. CT scans are useful for preoperative planning and postoperative evaluation of bone union or complications.

Supplementary Technique for Unstable Clavicle Shaft Fractures: Interfragmentary Wiring and Temporary Axial K-Wire Pinning

단진명,김병국,이호재,김태호,김용근 대한정형외과학회 2018 Clinics in Orthopedic Surgery Vol.10 No.2

Background: Treatment of unstable clavicle fractures remains a challenge for orthopedic surgeons, but the evolution of treatment strategies has allowed for reliable results with minimal complications. Although several surgical options exist, open reduction with plating remains the treatment of choice for clavicle fractures. The purpose of this study is to determine an easy way to achieve successful preplating reduction while minimizing surrounding soft tissue damage during treatment of midshaft fractures of the clavicle. Methods: A retrospective study included all consecutive adult patients operated on by a single surgeon for acute displaced clavicular midshaft fracture between January 2010 and October 2014. Hybrid technique with interfragmentary cerclage wiring, temporary axial K-wire pinning, or their combination was used in all patients. The demographic data and clinical outcomes, including operation time, union time, restoration of anatomy, shoulder functional score, and complications were evaluated. Results: There were 54 male and 19 female patients, with an average age of 39.3 years (range, 18 to 77 years) for males and 58.3 years (range, 39 to 77 years) for females. They were followed up for 24 months (range, 12 to 44 months). All patients had reliable bone union after surgery using interfragmentary cerclage wiring and temporary axial K-wire fixation; fracture union was obtained at an average of 11.7 weeks (range, 8 to 21 weeks) postoperatively. Additionally, there was no postoperative loss of fracture reduction or plate loosening. At the final follow-up, all patients had regained excellent functional outcomes. Conclusions: The cognizant effort to achieve anatomic reduction without surrounding soft tissue insult before definitive plating allows excellent radiologic and functional outcomes. Interfragmentary cerclage wiring and temporary axial K-wire pinning can overcome difficulties associated with unstable clavicle fractures to allow proper fracture reduction. In this article, we introduce a concise technique for achieving the desired outcomes reliably and efficiently when treating unstable clavicle midshaft fractures.

Arthroscopic Stabilization for Displaced Lateral Clavicular Fractures

Prince Shanavas Khan,Yon-Sik Yoo,Byung-Su Kim,Seong-Jin Lee,Jong Mun Ha 대한견주관절의학회 2016 대한견주관절학회지 Vol.19 No.3

Background: The purpose of our study was to evaluate the accuracy of reduction based on postoperative computed tomography (CT) images after arthroscopic stabilization using tightrope system for unstable distal clavicle fracture. Methods: Twelve patients with distal clavicle fracture combined with coracoclavicular (CC) ligament injury (type II, V) who received arthroscopically assisted fixation using a flip button device were evaluated for accuracy of reduction using 3-dimensional postoperative CT scan by measuring the degree of distal clavicular angulation and clavicular shortening. Results: Immediate postoperative plain radiograph confirmed restoration of the CC distance (CCD) in 10 patients. At final follow-up, the CCD remained reduced anatomically on plain radiographs in these patients. All patients showed excessive posterior angulation and shortening compared to the opposite side. The average Constant score recovered to 94.8 at final follow-up. Conclusions: Indirect reduction and arthroscopic subacromial approach with flip button fixation of unstable distal clavicle fractures demonstrated favorable clinical results despite unavoidable posterior angulation of distal clavicle and shortening the total length of clavicle.

Coracoclavicular Ligament Suture Augmentation with Anatomical Locking Plate Fixation for Distal Clavicle Fracture

Tae Kang Lim,Min Soo Shon,Hyung Gon Ryu,Jae Sung Seo,Jae Hyun Park,Young Ko,Kyoung-Hwan Koh 대한견주관절의학회 2014 대한견주관절의학회지 Vol.17 No.4

Background: For Neer type IIB fracture of distal clavicle with coracoclavicular ligament injury, various surgical treatments have been used in literatures. However, there was no consensus on the optimal treatment. The aim of this study is to report the clinical and radiological results of open reduction and internal fixation of unstable distal clavicle fracture and suture augmentation of disrupted coracoclavicular ligament. Methods: A prospective study was performed in 23 patients with Neer type IIB distal clavicle fracture in Seoul Medical Center, Eulji Hospital, and National Medical Center. Firstly, suture anchors are inserted in the base of coracoid process and preliminary reduction was achieved by tie-off of three suture limbs around the clavicle. Then, the final fixation was completed with anatomical locking plate. Bony union and the distance between coracoclavicular ligaments were evaluated. Clinical results and complications including stiffness and secondary procedures were evaluated. Results: Bony union was achieved in all cases except one (22 of 23). At mean 14.9 months, no significant difference in the mean coracoclavicular distance was observed compared to uninjured shoulder (8.2 ± 7.9 mm versus 7.3 ± 3.4 mm, p=0.14). Pain visual analogue scale, American Shoulder and Elbow Surgeons score, Constant score, and Disabilities of the Arm, Shoulder and Hand score were 0.5, 83.4, 78.5, and 6.2, respectively. Revision surgery was performed in one case of nonunion. Four patients who complained of skin irritation underwent implant removal. Conclusions: In cases of an unstable distal clavicle fracture with coracoclavicular ligament disruption, satisfactory clinical results were obtained by locking plate fixation and coracoclavicular ligament suture augmentation concurrently.

포괄적 경부곽청술, 대흉근피판술과 술후 방사선 치료후 발생한 쇄골골절 3예

최은창,김동영,고윤우,김현준 대한이비인후과학회 1999 대한이비인후과학회지 두경부외과학 Vol.42 No.8

Wolter 금속판을 이용한 견봉 쇄골 관절 탈구 및 원위 쇄골 골절의 수술적 치료

김상림 ( Sang Rim Kim ),서규범 ( Kyu Bum Seo ),윤진호 ( Jin Ho Yoon ),박용근 ( Yong Keun Park ),남욱 ( Uk Nam ) 대한스포츠의학회 2009 대한스포츠의학회지 Vol.27 No.1

To evaluate the clinical and radiological results of acromioclavicular dislocation and distal clavicular fracture after a Wolter plate fixation. Surgical reduction and fixation using Wolter plate was done in 18 patients with acromioclavicular dislocation and the distal clavicular fracture from February 2004 to February 2007. Clinical results of all patients were assessed using UCLA score. Radiologic outcomes were evaluated by measuring the coracoclavicular distance between the normal and injured side, vertical displacement of clavicle and bony union of distal clavicle. The mean duration of follow up was 17.7 (12-39) months. Postoperative radiographs showed that vertical displacement of the clavicle was restored in all cases. The mean UCLA score at the final follow up was 31.7 (30-35) and a good bony union was obtained in all cases with distal clavicle fracture. Complications such as reduction loss after plate removal, osteolysis and the skin necrosis around the long hook were seen. We believe Wolter plate is useful for treating patients with acromioclavicular dislocation and the distal clavicle fracture because it provides enough stability for active postoperative rehabilitation. However, careful operative planning and familiarity with the technique are necessary to prevent complications including reduction loss, osteolysis and skin necrosis around the long hook.

쇄골 간부 분쇄골절의 수술적 치료 시 환 강선 고정은 골절의 유합을 방해하는가?

염재광 ( Jae Kwang Yum ),신용운 ( Yong Woon Shin ),이희성 ( Hee Sung Lee ),박재구 ( Jae Gu Park ) 대한골절학회 2011 대한골절학회지 Vol.24 No.2

목 적: 쇄골 간부 분쇄 골절에 대하여 금속판과 나사를 이용한 내고정 시 연부조직 박리를 최소화 하면서 골편들을 환 강선 고정(cerclage wire fixation)으로 정복 후 금속 내고정을 시행하는데 있어서 환 강선 고정이 쇄골 골절의 유합을 방해하는지 여부를 방사선적 및 임상적 결과를 통해 알아보고자 한다. 대상 및 방법: 2005년 2월에서 2009년 4월까지 쇄골 간부 분쇄 골절로 내원하여 관혈적 정복 및 금속판과 나사 고정을 시행한 경우에 2개 이상의 환 강선 고정을 시행한 후 1년 이상 추시 관찰이 가능하였던 18예 (남자 15예, 여자 3예)를 대상으로 하였다. 수술 후 골유합 기간, 견관절 기능 평가, 합병증 등에 대해 후향적으로 조사하였다. 결 과: 방사선학적 골유합은 평균 13.3주 (12∼16주)에 이루어졌으며 불유합, 지연유합 또는 감염 등의 합병증은 없었다. 최종 추시에서 동측 견관절 운동범위는 1예를 제외하고는 모든 예에서 정상으로 회복된 소견을 보였다. 결 론: 쇄골 간부 골절에서 금속판 고정술에 환 강선 고정을 추가하는 수술 방법은 골편에 대해 혈류를 차단하지 않도록 연부 조직박리를 최소화한다면, 금속판과 나사 삽입 전에 골절의 정복 유지를 쉽게 할 수 있어 수술을 용이하게 할 수 있고 해부학적 정복이 가능하며 골유합을 방해하지 않는 것으로 보아 유용한 수술 방법의 하나로 생각된다. Purpose: A technique of cerclage wire fixation in comminuted fracture of the clavicle shaft is thought to interfere the fracture healing, so authors studied radiographically and clinically about the cases of cerclage wiring of the fracture fragments with the plate and screws fixation in the comminuted fracture of the shaft of the clavicle. Materials and Methods: According to following inclusion criteria, total 18 patients (male: 15, female: 3) were investigated; Patients who visited hospital due to clavicle shaft comminuted fracture from February 2005 to April 2009, who underwent surgery utilizing more than 2 cerclage wire fixation for the fragments when open reduction and plate fixation were operated and who could be follow-up over one year. The duration for fracture union, functional outcome and complications were investigated retrospectively. Results: Radiological bone union was accomplished in average 13.3 weeks (12∼16 weeks) and there was no complication such as nonunion, delayed union or infection. Range of motion of ipsilateral shoulder joint was recovered in all patients except one at the final follow-up. Conclusion: The clinical and radiographical results of the plate and screws fixation with cerclage wiring of the fragments in comminuted clavicle shaft fracture showed that the cerclage wiring does not interfere the fracture healing, so authors think that this method is a good alternative operation if it is performed carefully to minimize soft tissue dissection.