锁骨骨折手术治疗-科罗拉多-锁骨骨折肩外科手术

                               
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In this video, Dr. Millett demonstrates plate fixation of midshaft clavicle fractures. The prevalence of a broken collarbone can be between 2.6% and 5% of all adult fractures and 35% to 44% of all shoulder girdle fractures. The incidence of a broken collarbone is approximately 29 to 64 per  100,000 of population per year. The injury commonly occurs due to moderate to high-energy traumatic impact to the shoulder.

A direct impact injury to the clavicle is rarely seen to be the cause of a broken collarbone. Type 1 fractures are those of the medial 1/3rd and type 3 of the lateral 1/3rd. Type 2 fractures include the various midshaft fractures.

The indications for collarbone surgery include healthy, active patients between the ages of 16-60 with completely displaced midshaft fracture with shortening of 2 cm or more. Also, superior displacement with skin tenting and/or impending open.

In a study by Drs. Hurst and Millet in 2009 found in 61 patients a complication rate of 30% and nonunions at 9.8%. Currently, Dr. Millet's preference for simple displaced fractures with or without inferior butterfly pieces is intramedullary fixation. This is a minimally invasive technique and is shown to have a low complication rate. However, for more segmental and/or severely comminuted fractures a plate fixation is the collarbone surgery of choice. This technique gives a more stable construct.

This video shows a superior plate fixation technique. After soft tissue preparation the fracture is reduced using clamps, sutures and k-wires.  The reduction is then assessed with fluoroscopy. The superior side of the bone is then prepared for the plate placement. The plate is then screwed into the bone.

Post-operative x-rays can show the full length of the bone being restored. The rehabilitation following broken collarbone treatment is active and passive range of motion from the first day after removal. No heavy lifting or loading for 4 weeks. Once clinically and radiographically stable patient can return to full activities in 4 weeks.