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

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.

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.

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.

쇄골 부속물의 변이:흉부 방사선 촬영과 마른뼈의 소견

정민석 대한영상의학회 1995 대한영상의학회지 Vol.32 No.4

Purpose : To evaluate normal variations and thus to avoid confusion in differentiation form lesions of theaccessory structures (rhomboid fossa, foramen for supraclavicular nerve, conoid tubercle) of the clavicle in chestradiographs. Materials and Methods : We studied the variations of the clavicle in 300 chest radiographs (134 men,166 women) and 355 dry bones (right 166, left 189 ; 151 men, 74 women, 130 unknown sex). Results : In chestradiographs, the incidence of the depressed rhomboid fossa was 229 cases (39.5%;male 52.0%, female 29.9%); theflat type was 329 cases (56.9%;male 45.7%, female 65.7%); and the elevated type was 20 cases (3.5%;male 2.4%,female 4.3%). In the dry bones, the incidence of the depressed rhomboid fossa was 129 cases (57.3%;male 59.6%,female 52.7%); the flat type was 65 cases (28.9%;male 24.5%, female 37.8%) and the elevated type was 31 cases(13.8%;male 15.9%, female 9.5%). The incidence of the foramen for supraclavicular nerve was 0.8% in chestradiographs, and 1.4% in the dry bones. The incidence of the elevated conoid tubercle was 64.1% (male 64.0%,female 65.9%) in chest radiographs, and 96.9% (male 95.4%, female 100.0%) in the dry bones. Conclusions : Theincidence of the depressed rhomboid fossa in chest radiographs was higher in men and the right clavicle. Theincidence of flat rhomboid fossa in chest radiographs decreased according to increase of age. The foramen forsupraclavicular nerve was occasionally found (0.8% in chest radiographs; 1.4% in the dry bones).

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.

Arthroscopic Stabilization for Displaced Lateral Clavicular Fractures

Prince Shanavas Khan,Yon-Sik Yoo,Byung-Su Kim,Seong-Jin Lee,Jong Mun Ha 대한견주관절의학회 2016 대한견주관절의학회지 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.

쇄골의 불유합에 대한 수술적 치료

조덕연(Duck Yun Cho),이종범(Jong Beom Lee) 대한골절학회 1991 대한골절학회지 Vol.4 No.2

Fracture of the clavicle, one of the most common bony injuries, rarely requires open reduction. We experienced 6 cases of clavicle nonunion, treated at the Department of Orthopedic Surgery of Seoul National Medical Center from JuL 1987 to Feb. 1990. This study focused on predisposing factors in relation to nonunion of clavicle and surgical treatment. Among the six patients, four patients were male and two patients were female, and their ages ranged from 20 to 63 years. All six patients were treated with semitubular plating with bone graft. All patients achieved good union by the average 13 weeks postoperatively and symptoms disappeared. It was concluded that symptomatic nonunion of clavicle could be treated by operation, and internal fixation with compression plate is thought to be a reliable treatment for the nonunion of the 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.

A Retrospective Analysis of Anterior-Posterior Chest X-rays and Misplacement of Subclavian Central Venous Catheters: A Clue to Preventing Misplacement

( Jung Hoon Yoon ),( Young Gi Min ),( Yoon Seok Jung ),( Je Hwan Won ),( Joon Pil Cho ),( Sang Cheon Choi ) 대한응급의학회 2013 대한응급의학회 학술대회초록집 Vol.2013 No.2

Objective: Determining anterior-posterior chest radiograph radiologic characteristics of misplaced subclavian central venous (SCV) catheters. Methods: A retrospective case-control study was conducted for 51 adult patients who had misplaced SCVs from the emergency department during a 12-month period. The collected data included age, gender, diagnosis, side of catheterization, catheter misplacement, department and physicians` residency year, ipsilateral transverse length of thorax, clavicle angle, and thickness of clavicle. Results: The subclavian route was used 981 times (61.39%) out of all central venous catheterizations (n=1,599). There were 51(5.2%) SCV catheter misplacements. Misplacement into the ipsilateral internal jugular vein happened 43 times (right: 41, left: 2), and into the contralateral brachiocephalic vein 8 times (right: 8, left: 0). In the anterior-posterior chest X-rays, clavicle angle of the misplacement group was 28.5±7.3° and that of the control group was 22.6±6.3°(95% CI 3.6 to 8.1, p=0.00). (Fig. 1) (Table 1) Conclusion: Since the clavicle angle of the misplacement group was larger than that of the control group in the anterior-posterior chest X-rays, we infer that keeping minimizing the clavicle angle would be better for decreasing SCV catheter misplacement.