Author/Editor		Drobnič, Matej; Iskra, Blaž; Povhe, Primož; Drobnič, Franc
Title		Učvrstitev prelomov srednjega dela ključnice s titanijevim elastičnim žebljem pri odraslih - prvi rezultati
Translated title		Fixation of the midclavicular fractures with the titanium elastic nails in adults - preliminary results
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 74, št. 6
Publication year		2005
Volume		str. 359-63
Language		slo
Abstract		Background. Elastic intramedullary fixation is an established operative treatment for fractures in childhood, which is only exceptionally used in adults. A modified intramedullary fixation of midclavicular fractures in adults with titanium elastic nails is presented. Methods. The group was comprised of five adult patients with shortened midclavicular fractures. The prior conservative treatment had been ineffective in three cases, whereas poor functional outcome was expected in the other two, as a result of fracture shortening or instability. According to the new technique titanium elastic nails were first placed into the intramedullar channel of the distal fragment through the fracture, using a mini-open exposure. The nails were advanced retrogradely into the proximal fragment to achieve a stable fixation. The initial post-operative rehabilitation included pendulary exercises in a sling. Active exercises in the range of pain allowance were introduced after the oparative wounds had been healed. Results. All fractures were consolidated in the physiological position. The patients were capable of painless movements with the shoulder on the operated side in the full range of motion after six weeks. One transitory complication in the form of skin and subcutaneous decubitus over the protruded nail tip was noted without an influence on the end result. Conclusions. The preliminary results in a limited number of patients showed efficient consolidation of the midclavicular fractures in adults treated with intramedullar titanium elastic nails. (Abstract truncated at 2000 characters)
Summary		Izhodišča. Elastična intramedularna učvrstitev je uveljavljena operativna metoda zdravljenja otroških prelomov, ki se pri odraslih redko uporablja. Prikazujemo prilagojeno intramedularno tehniko učvrstitve prelomov srednjega dela ključnice pri odraslih z uporabo titanijevih elastičnih žebljev. Metode. V letu dni smo z elastično intramedularno učvrstitvijo zdravili pet odraslih poškodovancev, ki so imeli prelom ključnice v srednjem delu s prikrajšavo. Trije so bili prej neuspešno zdravljeni konzervativno, pri ostalih dveh poškodovancih pa smo zaradi prikrajšave oz. nestabilnega preloma že v izhodišču pričakovali neustrezno preraščanje kosti. Titanijeve elastične žeblje smo uvedli intramedularno v distalni odlomek skozi prelom z minimalnim odprtim pristopom. Po repoziciji smo proksimalni odlomek učvrstili retrogradno. Pooperativna rehabilitacija je vključevala nihajne vaje v miteli do zacelitve ran, nato pa aktivno razgibavanje v mejah bolečine. Rezultati. Vsi prelomi so se zarasli v fiziološkem položaju. Poškodovanci so bili po šestih tednih sposobni aktivno gibati ramenski sklep na operirani strani brez bolečin v celotnem obsegu giba. Imeli smo en zaplet v obliki omejenega draženja kože in podkožja zaradi konice žeblja brez vpliva na končni rezultat. Zaključki. Prvi rezultati na omejenem številu poškodovancev so pokazali uspešno preraščanje prelomov, zdravljenih z intramedularno učvrstitvijo z elastičnimi titanijevimi žeblji. Dobri funkcionalni rezultati in majhna invazivnost operativne metode kažejo, da je takšno zdravljenje primerno pri prelomih srednjega dela ključnice, ki so konzervativno zdravljeni neuspešno ali pa se pričakuje preraščanje s slabimi funkcionalnim in kozmetičnim rezultatom zaradi prikrajšave oz. nestabilnosti preloma.
Descriptors		CLAVICLE FRACTURE FIXATION, INTRAMEDULLARY BONE NAILS TITANIUM ADULT TREATMENT OUTCOME