Development and clinical application of a new type of anatomical locking plate for sternoclavicular joint fracture and dislocation_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SUN Yuanlin ,  YANG Yunkang , GE Jianhua , YANG Kun , XIANG Feifan , ZHOU Ju , LIANG Jie

Department of Bone and Joint Surgery, the Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China;

Corresponding?author：

YANG Yunkang, Email: droyyk@163.com

Keywords：

Sternoclavicular joint fracture and dislocation; new type of anatomical locking plate; internal fixation

DOI：

10.7507/1002-1892.201707081

Video：

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ObjectiveTo report a new type of anatomical locking plate for sternocalvicular joint, and investigate its effectiveness in treatment of sternoclavicular joint fracture and dislocation.MethodsA new type of anatomical locking plate for sternoclavicular joint was developed, which accorded with the anatomical features and biomechanical characteristics of Chinese sternoclavicular joint. By adopting the method of clinical randomized controlled study, 32 patients with the sternoclavicular joint fracture and dislocation who met the selection criteria between June 2008 and May 2015 were randomly divided into groups A and B (n=16), and the patients were treated with new anatomic locking plate and distal radial T locking plate internal fixation, respectively. There was no significant difference between 2 groups in gender, age, injured side, body mass index, cause of injury, type of injury, the time from injury to operation, and preoperative Rockwood grading score (P>0.05). The operation time, intraoperative blood loss, incision length, hospitalization time, and postoperative complications in 2 groups were recorded, and the effectiveness was evaluated by Rockwood grading score.ResultsThe operations of 2 groups completed successfully. The operation time, intraoperative blood loss, and hospitalization time in group A were significantly less than those in group B (P<0.05), but there was no significant difference in the incision length between 2 groups (t=0.672, P=0.507). All the patients were followed up 18-30 months (mean, 24 months). In group A, there were 1 case of sternoclavicular joint pain and 2 cases of wound infection; in group B, there were 1 case of sternoclavicular joint pain, 1 case of internal fixation loosening, and 1 case of sternoclavicular joint re-dislocation; there was no significant difference in complication incidence between 2 groups (P=1.000). The Rockwood grading scores at each time point after operation in 2 groups were significantly higher than those before operation. At 1 month after operation, the Rockwood grading score in group A was significantly higher than that in group B (t=2.270, P=0.031); but there was no significant difference in the Rockwood grading scores between the 2 groups at 6 months and at last follow-up (P>0.05). At last follow-up, according to the Rockwood scoring standard, the results of group A were excellent in 13 cases, good in 2 cases, poor in 1 case, the excellent and good rate was 93.75%; the results of group B were excellent in 11 cases, good in 4 cases, poor in 1 case, and the excellent and good rate was 93.75%; there was no significant difference between 2 groups (Z=–0.748, P=0.455).ConclusionThe new type of anatomic locking plate accords with the Chinese anatomical characteristics. It has the advantages of easy operative procedure, less surgical trauma, shorter operation time, less intraoperative blood loss, shorter hospitalization time, and it can achieve better results in the treatment of sternoclavicular joint fracture and dislocation.

Citation： SUN Yuanlin, YANG Yunkang, GE Jianhua, YANG Kun, XIANG Feifan, ZHOU Ju, LIANG Jie. Development and clinical application of a new type of anatomical locking plate for sternoclavicular joint fracture and dislocation. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(3): 316-321. doi: 10.7507/1002-1892.201707081 Copy

1.	Albarrag MK. Bilateral asymmetrical traumatic sternoclavicular joint dislocations. Sultan Qaboos Univ Med J, 2012, 12(4): 512-516.
2.	Liu PC, Chien SH, Chen JC, et al. Minimally invasive fixation of displaced midclavicular fractures with titanium elastic nails. J Orthop Trauma, 2010, 24(4): 217-223.
3.	Kirby JC, Edwards E, Kamali Moaveni A. Management and functional outcomes following sternoclavicular joint dislocation. Injury, 2015, 46(10): 1906-1913.
4.	Adamcik S, Ahler M, Gioutsos K, et al. Repair of sternoclavicular joint dislocations with FiberWire^?. Arch Orthop Trauma Surg, 2017, 137(3): 341-345.
5.	張傳毅, 林列, 梁軍波, 等. 新型胸鎖鉤鋼板治療胸鎖關節周圍不穩定性骨折脫位的療效觀察. 中國骨傷, 2016, 29(11): 1040-1044.
6.	Rockwood CA Jr, Groh GI, Wirth MA, et al. Resection arthroplasty of the sternoclavicular joint. J Bone Joint Surg (Am), 1997, 79(3): 387-393.
7.	Zhang C, Lin L, Liang J, et al. Efficacy analysis of a novel sternoclavicular hook plate for treatment of unstable sternoclavicular joint dislocation or fracture. J Orthop Surg (Hong Kong), 2017, 25(1): 2309499016684488.
8.	Lee JT, Campbell KJ, Michalski MP, et al. Surgical anatomy of the sternoclavicular joint: a qualitative and quantitative anatomical study. J Bone Joint Surg (Am), 2014, 96(19): e166.
9.	董加純, 支中正, 顏冰珊, 等. 鋼纜內固定鎖骨近段和胸骨髓腔修復胸鎖關節脫位: 解剖與臨床. 中國組織工程研究, 2014, 18(4): 583-588.
10.	Panzica M, Zeichen J, Hankemeier S, et al. Long-term outcome after joint reconstruction or medial resection arthroplasty for anterior SCJ instability. Arch Orthop Trauma Surg, 2010, 130(5): 657-665.
11.	Ai J, Kan SL, Li HL, et al. Anterior inferior plating versus superior plating for clavicle fracture: a meta-analysis. BMC Musculoskelet Disord, 2017, 18(1): 159.
12.	張布和, 張永東, 田耕. 國人胸骨的形態測量. 解剖學研究, 2002, 24(2): 94-95.
13.	Bak K, Fogh K. Reconstruction of the chronic anterior unstable sternoclavicular joint using a tendon autograft: medium-term to long-term follow-up results. J Shoulder Elbow Surg, 2014, 23(2): 245-250.
14.	樊軍, 羅意, 萬革, 等. 克氏針張力帶與鎖骨鉤鋼板固定治療胸鎖關節前脫位 63 例的臨床分析. 重慶醫學, 2015, 44(22): 3129-3131.
15.	楊琨, 陽運康. 胸鎖關節脫位治療的研究進展. 中國修復重建外科雜志, 2016, 30(1): 115-118.
16.	陳方虎, 趙小平, 鄭文標, 等. 胸鎖鉤鋼板治療胸鎖關節脫位的臨床觀察. 中國骨傷, 2013, 26(5): 380-382.
17.	Schemitsch LA, Sehemitseh EH, McKee MD. Bipolar clavicle injury: posterior dislocation of the acromioclavicular joint with anterior dislocation of the sternoclavicular joint:a report of two cases. J Shoulder Elbow Surg, 2011, 20(1): e18-e22.
18.	Gille J, Schulz A, Wallstabe S, et al. Hook plate for medial clavicle fracture. Indian J Orthop, 2010, 44(2): 221-223.
19.	趙繼, 蔡賢華, 胡昊, 等. T 型鋼板與韌帶重建治療陳舊性胸鎖關節脫位對比研究. 臨床外科雜志, 2014, 22(2): 122-124.

1. Albarrag MK. Bilateral asymmetrical traumatic sternoclavicular joint dislocations. Sultan Qaboos Univ Med J, 2012, 12(4): 512-516.
2. Liu PC, Chien SH, Chen JC, et al. Minimally invasive fixation of displaced midclavicular fractures with titanium elastic nails. J Orthop Trauma, 2010, 24(4): 217-223.
3. Kirby JC, Edwards E, Kamali Moaveni A. Management and functional outcomes following sternoclavicular joint dislocation. Injury, 2015, 46(10): 1906-1913.
4. Adamcik S, Ahler M, Gioutsos K, et al. Repair of sternoclavicular joint dislocations with FiberWire^?. Arch Orthop Trauma Surg, 2017, 137(3): 341-345.
5. 張傳毅, 林列, 梁軍波, 等. 新型胸鎖鉤鋼板治療胸鎖關節周圍不穩定性骨折脫位的療效觀察. 中國骨傷, 2016, 29(11): 1040-1044.
6. Rockwood CA Jr, Groh GI, Wirth MA, et al. Resection arthroplasty of the sternoclavicular joint. J Bone Joint Surg (Am), 1997, 79(3): 387-393.
7. Zhang C, Lin L, Liang J, et al. Efficacy analysis of a novel sternoclavicular hook plate for treatment of unstable sternoclavicular joint dislocation or fracture. J Orthop Surg (Hong Kong), 2017, 25(1): 2309499016684488.
8. Lee JT, Campbell KJ, Michalski MP, et al. Surgical anatomy of the sternoclavicular joint: a qualitative and quantitative anatomical study. J Bone Joint Surg (Am), 2014, 96(19): e166.
9. 董加純, 支中正, 顏冰珊, 等. 鋼纜內固定鎖骨近段和胸骨髓腔修復胸鎖關節脫位: 解剖與臨床. 中國組織工程研究, 2014, 18(4): 583-588.
10. Panzica M, Zeichen J, Hankemeier S, et al. Long-term outcome after joint reconstruction or medial resection arthroplasty for anterior SCJ instability. Arch Orthop Trauma Surg, 2010, 130(5): 657-665.
11. Ai J, Kan SL, Li HL, et al. Anterior inferior plating versus superior plating for clavicle fracture: a meta-analysis. BMC Musculoskelet Disord, 2017, 18(1): 159.
12. 張布和, 張永東, 田耕. 國人胸骨的形態測量. 解剖學研究, 2002, 24(2): 94-95.
13. Bak K, Fogh K. Reconstruction of the chronic anterior unstable sternoclavicular joint using a tendon autograft: medium-term to long-term follow-up results. J Shoulder Elbow Surg, 2014, 23(2): 245-250.
14. 樊軍, 羅意, 萬革, 等. 克氏針張力帶與鎖骨鉤鋼板固定治療胸鎖關節前脫位 63 例的臨床分析. 重慶醫學, 2015, 44(22): 3129-3131.
15. 楊琨, 陽運康. 胸鎖關節脫位治療的研究進展. 中國修復重建外科雜志, 2016, 30(1): 115-118.
16. 陳方虎, 趙小平, 鄭文標, 等. 胸鎖鉤鋼板治療胸鎖關節脫位的臨床觀察. 中國骨傷, 2013, 26(5): 380-382.
17. Schemitsch LA, Sehemitseh EH, McKee MD. Bipolar clavicle injury: posterior dislocation of the acromioclavicular joint with anterior dislocation of the sternoclavicular joint:a report of two cases. J Shoulder Elbow Surg, 2011, 20(1): e18-e22.
18. Gille J, Schulz A, Wallstabe S, et al. Hook plate for medial clavicle fracture. Indian J Orthop, 2010, 44(2): 221-223.
19. 趙繼, 蔡賢華, 胡昊, 等. T 型鋼板與韌帶重建治療陳舊性胸鎖關節脫位對比研究. 臨床外科雜志, 2014, 22(2): 122-124.

Chinese Journal of Reparative and Reconstructive Surgery

Development and clinical application of a new type of anatomical locking plate for sternoclavicular joint fracture and dislocation

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