Author/Editor		Andoljšek, Matej; Rupel, Andrej; Rupar, Petra
Title		Operativno zdravljenje zlomov srednje tretjine ključnice - je odlog pomemben?
Translated title		Operative treatment of the midshaft fractures of the clavicle - does delay matter?
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 76, št. 11
Publication year		2007
Volume		str. 715-23
Language		slo
Abstract		Background Fractures of the clavicle are common injuries and mostly treated non-operatively. Nearly always the fracture is clinically united within three to four weeks and functional recovery should be completed within two months. Traditionally thinking has been that operative treatment is indicated exceptionaly and that delayed surgery is less successful. In retrospective comparative study authors have asked ‐ whether delay of surgery in middle-third clavicular fractures negatively affects functional results and ‐ whether after delayed surgery complications are more frequent. Patients and methods Thirty-seven of 733 fractures of the clavicle were treated operatively. Among these, 11 were fresh Allman Type I fractures (early procedure), 9 delayed- or non-unions and one malunion (late procedure). All fractures were fixed with plates and screws. In none of the reconstructive procedures composite bone grafting was performed, twice spongiotic bone graft and twice morsilized calus grafts were used. DASH and Constant scores were used for outcome evaluation. Results Twenty-one of 22 patients were evaluated (one foreign turist missed) on average 21 month after surgery. Average DASH scores for early operated patients were 14.4 and for late operated 18.5; an average Quich DASH were 16.4 and 20.5 respectively. Average Constant scores were 85.6 and 76.0. Statistically differences are not important. Three patients had early complications (two from early, one from late group). Five patients had late complications (four skin paresthesias, one non-union). Conclusions In retrospective study, functional results of surgically treated fresh Type I fractures and after reconstructive surgery for delayed-, non- and mal-union of the midshaft of the clavicle were comparable. No significant differences in complication rates were confirmed.
Summary		Izhodišča Zlomi ključnice so pogoste poškodbe. Praviloma jih zdravimo konzervativno. Na splošno velja, da je operativno zdravljenje zloma ključnice potrebno samo izjemoma in da so odloženi posegi manj uspešni. V retrospektivni primerjalni študiji zgodaj in pozno operiranih so se avtorji vprašali: Ali odlog operativnega zdravljenja zloma s premikom v srednji tretjini ključnice pomembno vpliva na funkcionalni rezultat zdravljenja? In/ali je pri odloženih posegih pomembno več zapletov? Poškodovanci in metode V letih 2000‐2006 (VI) so v Splošni bolnišnici Jesenice zdravili 733 poškodovancev z zlomom ključnice. Sedemintrideset poškodovancev (22 z zlomom v srednji, 15 z zlomom v zunanji tretjini ključnice) je bilo zdravljenih operativno (5%). Enajst zlomov srednje tretjine ključnice (tip I po Allmanu) so učvrstili s ploščo in vijaki (»zgodnje operirani«). Na enak način so oskrbeli deset zlomov srednje tretjine s podaljšanim zaraščanjem, nezaraščanjem ali nepravilnim zaraščanjem (»pozno operirani«); v nobenem od teh primerov ni bil uporabljen kortiko-spongiozni kostni transplantat, dvakrat je bil uporabljen spongiozni, dvakrat pa transplantat iz kalusa. Funkcionalne rezultate zdravljenja so ocenili z dvema vprašalnikoma (DASH, Constant). Rezultati Ocenjenih je bilo 21od 22 poškodovancev z zlomom ključnice v srednji tretjini. Povprečni score DASH zgodaj operiranih je bil 14,4, pozno operiranih 18,5; povprečen »hitri« score DASH 16,4 oziroma 20,5. Povprečni score Constant zgodnje operiranih je bil 85,6, pozno operiranih 76,0. V vseh treh primerih razlika statistično ni pomembna. Zgodnje pooperativne zaplete so imeli trije poškodovanci, dva iz skupine zgodaj in eden iz skupine pozno operiranih. Pozne zaplete je imelo pet poškodovancev, štirje so imeli moten občutek za dotik v predelu operativne brazgotine (eden iz skupine zgodnje, trije iz skupine pozno operiranih); nezarasla je ena psevdoartroza. (Izvleček prekinjen pri 2000 znakih)
Descriptors		CLAVICLE FRACTURES FRACTURE FIXATION, INTERNAL TREATMENT OUTCOME