Fractured collarbone: the solution lies in a wire
Written by:the Dr.. Pierorazio Motta, specialist in Orthopaedic Surgery of the Shoulder, explains how it is now possible to operate the fractured clavicle with arthroscopic techniques rather than with surgery in the open air
What are the main complications of a fracture of the lateral portion of the clavicle?
The fracture of the clavicle of the third side is produced by a traumatic event directed to the shoulder (eg. fall off the bicycle). The fracture abutments do not remain in contact due to the weight of the upper limb, which drags the lateral fragment of the clavicle downwards, while the lateral fragment, due to the traction of the trapezius muscle, is displaced superiorly.
The lack of contact between the stumps of the fracture and the frequent interposition of muscle tissue prevents healing in approximately 30% of cases. The nonunion (pseudoarthrosis) is due, in turn, the joint limitations, pain and reduced shoulder strength affected, with the clavicle visible deformities.
What are the main complications of open surgery?
In order to position the bone contact plate, it causes vascular damage to the abutments of fracture. Unfortunately, the solidity of the surgical assembly is lower than that of the healthy clavicle, with a consequent high risk of partial or total failure of the surgical synthesis and recovery of bone deformities.
What is, however, the arthroscopic surgery?
L 'arthroscopy is a common technique for the treatment of articular pathologies (knee, shoulder, hip, etc.), which exploits the opportunity to explore the articular cavity concerned with a view to an external camera connected to the patient, inserted through small incisions skin (arthroscopic portals).
In the case of the broken collarbone, the surgeon explores the joint space of the shoulder and the extra-articular space (adjuvanted by RX controls in the operating room) to restore the normal alignment of the fracture
Can you describe, in simple language, what is the arthroscopic surgery?
Passing through the arthroscopic portals, performing holes in the medial fragments of clavicle and scapula (coracoid apophysis), through which are passed the high-strength wires in solidarity the proximal stump of the clavicle to the scapula, riallineandolo.
After the arthroscopic treatment, just bring a bandage strap for the arm, with immediate mobilization of the elbow and hand.
After approximately 20 days after surgery, there is already a gradual recovery of the shoulder joint function, which may be extended up to 90 °, recovery will be completed after approximately 6 weeks. You should avoid contact sports for at least three months.
What are the advantages of arthroscopy over traditional techniques?
The advantages are of various types:
- Diagnostic advantages: it is possible to diagnose and treat diseases associated of the shoulder joint (such as the rotator cuff injury, the long head of the biceps, the labrum, etc.), that the literature reports in over 20% of patients with lateral clavicle fracture.
- Biological advantages: with arthroscopy is respected vascularization of the fracture fragments, you have rapid consolidation time (about 30 days) and there is a lower incidence of infections.
- Functional advantages: after arthroscopic surgery there is a faster recovery of the shoulder range of motion with minimal aesthetic damage.
What are, however, disadvantages of arthroscopic technique?
The arthroscopic technique can not be used for older lesions (if it has been more than 20 days after injury).
Moreover, it is not a suitable technique to surgeons inexperienced in shoulder arthroscopy: a failure experience could give rise to possible neurological complications in the preparation dell'apofisi coracoid.
Editor Karin Moscow