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Die intramedulläre Nagelung der diaphysären Klavikulafraktur in minimal-invasiver Repositionstechnik

Intramedullary nailing in diaphyseal clavicle fractures using minimally invasive percutaneous reduction

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Zusammenfassung

Operationsziel

Die Versorgung diaphysärer Klavikulaschaftfrakturen durch minimal-invasive Stabilisierung mittels elastisch stabiler intramedullärer Nagelung (ESIN) ermöglicht die Frakturschienung bei Weichteilschonung und geringer kosmetischer Beeinträchtigung.

Indikationen

Bei erfolgloser, geschlossener Reposition stellt das Repositionsmanöver mit Hilfe von zwei perkutan platzierten Repositionszangen ein alternatives Operationsverfahren zur offenen Versorgung/Einstellung dar.

Kontraindikationen

Offene, mehrfragmentäre oder nicht dislozierte Frakturen, Schrägfrakturen wegen postoperativer Dislokations- und Verkürzungsgefahr, drohende Durchspießung, neurovaskuläre Begleitverletzungen, Pseudarthrosen.

Operationstechnik

Der Patient wird in Beach-chair-Position gelagert. Nach Hautschnitt am medialen Ende der Klavikula wird der Markraum eröffnet. Vier Stichinzisionen, jeweils am lateralen und medialen Frakturende kranial und kaudal der Klavikula ermöglichen das perkutane Anbringen zweier Repositionszangen, um so die Reposition zu realisieren und den elastischen Titannagel in das laterale Fragment einzubringen. Das Frakturhämatom wird somit weitestgehend nicht kompromittiert.

Weiterbehandlung

Die Nachbehandlung ist frühfunktionell, Abduktion und Anteversion bis max. 90° für 6 Wochen.

Ergebnisse

Bei kosmetisch geringer Beeinträchtigung lässt sich eine regelhafte knöcherne Konsolidierung erreichen.

Abstract

Objective

Closed reduction and intramedullary nailing is common in diaphyseal clavicle fractures. The aim of this report is to demonstrate a surgical method with minimally invasive percutaneous reduction in cases where closed reduction fails. The procedure is associated with good cosmetic results.

Indications

Percutaneous reduction using two reduction forceps enables intramedullary nailing without an open procedure.

Contraindications

Open, multifragmented or non-dislocated fractures, oblique fractures due to postoperative dislocation or shortening risk, fracture having potential to become compound fractures, neurovascular complications, pseudoarthroses.

Surgical technique

The patient is in beach-chair position. After an incision, the nail is entered from medial, two reduction forceps are mounted percutaneously at the lateral and medial fragment. After reduction the nail is pushed forward into the lateral fragment. Thereby, the fracture hematoma is not disturbed for the most part.

Postoperative management

Early functional rehabilitation with maximal abduction and anteversion of 90° for 6 weeks.

Results

Anatomic reduction can be achieved with mild cosmetic impairment.

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Authors and Affiliations

  1. Abteilung Unfall- und Wiederherstellungschirurgie, Berufsgenossenschaftliche Unfallklink, Schnarrenbergstraße 95, 72076, Tübingen, Deutschland

    M. Müller, U. Stöckle & T. M. Kraus

  2. Universitätsklinik für Orthopädie und Traumatologie Landeskrankenhaus Salzburg, Salzburg, Österreich

    T. Freude

Authors
  1. M. Müller
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  2. T. Freude
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  3. U. Stöckle
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  4. T. M. Kraus
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Corresponding author

Correspondence to M. Müller.

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Interessenkonflikt

M. Müller, T. Freude, U. Stöckle und T.M. Kraus geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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U. Bosch, Hannover

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C. Hengerer-Henkel, Mannheim

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Müller, M., Freude, T., Stöckle, U. et al. Die intramedulläre Nagelung der diaphysären Klavikulafraktur in minimal-invasiver Repositionstechnik. Oper Orthop Traumatol 29, 97–102 (2017). https://doi.org/10.1007/s00064-016-0479-z

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  • DOI: https://doi.org/10.1007/s00064-016-0479-z

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