1. Clavicle fracture operative treatment(MIPO)
Department of Orthopaedic surgery
Inha University Hospital
Kwon Dae Gyu, M.D.

2. Epidemiology 2~5% of all fracture 35~44% of shoulder girdle injury
Incidence: 29~64명/10만
Mid 69~82%, lateral 21~28%, medial 2~3%

3. Various treatment options
Conservative treatment
Intramedullary nailing
Open reduction & internal fixation c plating

4. Conservative Tx Nonunion rate< 1% 수술적 치료시 불유합: 3times 환자의 만족도
Stanley D. The mechanism of clavicular fracture. JBJS Br 1988
Andersen K. Treatment of clavicular fracture. Acta ortho Scan 1987.
Eskola. Outcome of clavicular fracture in 89 patients. Arch ortho Trau sur. 1986
Neer. Nonunion of the clavicle. JAMA.1960

5. Conservative vs Operative
JOT 2005
2144 명을 대상으로 한 metaanalysis
Nonunion rate: op 2.2% vs nonop 5.9%
(displaced fx.: 15.1%)

6. Conservative vs Operative
JBJS 2007
132 patients( non-op 65, op 67)
Radiographic union: 28.4wks vs 16.4wks
Nonunion: 7 vs 2
Symptomatic malunion: 9 vs 0
Functional score: improved in op group at all time point

8. Adolescents often have high functional demands
Remodeling potential is limited

9. Surgical Indication 개방형 골절 신경 혈관의 손상이 동반 다발성 손상 부유 견관절, 피부의 tenting
젊고 활동적인 환자에서 단축이 1.5cm 이상
심한 외관상의 문제
더 좋은 기능적 결과를 빠른 시간내에 얻길 원하는 경우

10. Minimal Invasive Plate Osteosynthesis(MIPO) - clavicle

11. Advantage 수술절개가 작다-미용적으로 우수 골막 및 연부조직의 박리가 적다 -생리학적으로 골유합에 유리
생역학적으로 강력한 고정력

12. Operative technique
position

13. Operative technique
Design

14. Operative technique
2-small incision

15. Operative technique
Reduction technique
Reduction forcep I

16. Operative technique
Reduction technique
Reduction forceps II

17. Operative technique
Reduction technique
Temporary external fixator

18. Operative technique
Reduction technique
Temporary external fixator

19. Operative technique
Reduction technique
IM nail(TEN)

20. Operative technique
Reduction technique
Mixed or miniopen

21. Operative technique Pitfalls
Care should be exercised when using sharp tools such as drill bits, Schanz screws, and K-wires in this region in order to avoid injury to the lung, vessels, and the brachial plexus.
Tunneling should be done with care so that the periosteum is not stripped off from the bone.
Rotational malalignment may occur during fracture reduction and should be corrected before definitive fracture fixation takes place.

22. Postop management ROM start early
Load-bearing activities should be delayed until there are radiological signs of fx healing

23. Case 1
M/19

24. Case 1
M/19 Postop

25. Case 1
M/19 Postop 3M

26. Case 2
M/24

27. Case 2
M/24 Postop

28. Case 2
M/24 Postop 3M

29. Case 3
M/18

30. Case 3
M/18 Postop

31. Case 4
F/23 Initial

32. Case 4
F/23 TD 1wk

33. Case 4
F/23 TD 2wks

34. Case 4
F/23 Postop

35. Case 4
F/23 Postop 2M

36. Other Case
M/25

37. 감사합니다.