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Osteosynthesis of the clavicle with a plate: progress of the operation and possible complications. Displaced clavicle fracture: plate surgery and recovery period Causes and mechanism of fracture

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The clavicle is a tubular S-shaped bone that forms a rigid connection between the upper limb and the torso. The age of patients with its fracture varies from 14 to 40-45 years.

Among older people, injury is less common. Treatment is carried out on an outpatient basis. Hospitalization of the victim in a hospital is required only if surgery is necessary.

Causes and mechanism of fracture

A displaced clavicle fracture is usually the result of a strong mechanical force. Such injuries are considered normal, physiological.

They occur when the impact force exceeds the level of elasticity of the bone tissue. The damaging factor can be a strong blow (a fight, a fall from a height) or squeezing the upper body between two hard objects (road accident).

Physiological clavicle fractures can be:

Direct (the blow is applied directly to the collarbone), in which the bone is destroyed directly at the site of the blow. Commonly found in war zones or after a fight;
Indirect (the blow falls on the abducted hand). The force of the damaging factor is transmitted to the collarbone indirectly. The bone is damaged at the point of greatest bending.

Pathological fractures occur in the presence of a number of diseases accompanied by a decrease in the elasticity and strength of bone tissue (rheumatic arthritis, cancer, osteoporosis, abnormal skeletal development). In this case, the impact force may be minimal. In some cases, the bone breaks without any external influence at all: a strong muscle contraction is enough.

Removal of the plate after a clavicle fracture is a logical conclusion to the treatment of the affected area, indicating a successful completion of the course.

Some patients, who felt much better after successfully installing a metal insert, are in no hurry to remove it after its expiration date. But such amateur activity provokes serious complications, loss of performance and long-term negative consequences for the functioning of the clavicular area.

Because of this, doctors insist on the need to strictly follow a pre-approved therapeutic program in order to remove the used plate. It is better to do this in the same clinic where the initial installation was performed. Ideally, the seizure should be carried out by the same person, if possible.

There are cases where metal inserts attached to a patient in one country could not be safely and quickly removed in another. The difference was based on the equipment used by frontline medical teams. It follows that it is better to carry out the intervention in the same medical institution on an inpatient basis.

When is removal necessary?

Treatment of clavicular fractures has long advanced, eliminating the need to wear bulky plaster casts or even uncomfortable wooden splints for a long period.

Today, surgeons around the world prefer to use lighter structures for identical purposes, be it wires, full metal plates or single high-strength screws. All of them are designed to speed up the recovery process after serious damage to the collarbone.

Some innovative techniques provide the ability to introduce stable metal structures directly into damaged bone structures. This allows you to reliably fix their position in one position, which has a beneficial effect on the speed of fusion.

But classic plates, which are sometimes installed together with adjacent screws for strength, are usually fixed over the bones. The effect from them is approximately the same. The only difference is the type of initial injury. For convenience, the developers of the method have provided a separate classification for all metal fixatives supplied to the medical market. They differ in size, purpose, and types of fractures of the clavicular region.

Instead of suffering with uncomfortable plaster casts that severely limit normal activities and are difficult to even wash with, patients now enjoy the benefits of high-strength plates. They have a number of advantages over outdated methods of helping victims of fractures:

increasing the mobility of the victim;
reduction of the rehabilitation period;
the opportunity to return to sports activities much earlier.

But for a successful return to normal activity, even after a relatively simple clavicular fracture, you will first need to get rid of the metal assistant. Reverse intervention is especially important if, during the examination, the doctor discovers signs of a purulent process in the victim. This situation indicates the body’s inability to accept a foreign body even for good purposes, or a carelessly performed surgical intervention.

Another important reason for the need to get rid of the plate even before the time recommended by the doctor is often osteosynthesis. This is what professional terminology refers to as unsatisfactory fixation of bones, which indicates strong compression or too little pressure.

Clinical cases stand apart when the victim has an individual intolerance to the implant or an allergic reaction to its components. Here it will not be possible to conduct a full allergy test, since the body’s response may not manifest itself immediately. Because of this, neutralizing a potentially dangerous device is an emergency indication.

If we are talking about an extensive fracture, which often entails additional damage to the ligaments of the acromioclavicular joint, then here too one cannot do without installing a special plate. But usually the operation is accompanied by additional installation of screws necessary to enhance the fusion effect.

Damaged ligaments usually heal, regaining their former functionality, after about three months. It is also worth making allowance for the fact that bone structures with fragmentation versions of damage can take much longer to heal.

Once the restoration of all structures has been successfully completed, it will be necessary to get rid of the previously installed metal structure. If you ignore such a doctor’s order, the patient is likely to experience plate failure in the near future.

The outcome is explained by the fact that certain devices are designed for a strictly specified operational period. Although they can continue to perform their assigned duties longer, this will not lead to any good.

The essence of extraction

Dismantling the plates is necessary even if it is not a classic fracture, but a dislocation of the clavicle. In this case, it is most productive to use the strategy of applying a hook-shaped plate to the acromioclavicular joint.

If it is not removed in time, then the victim faces a not-so-great scenario:

development of arthrosis in the articular area;
formation of bone growths called osteophytes;
damage to muscle fibers by bone growths.

All of the above provokes a pronounced pain syndrome. Treating it with analgesics without leveling the original source of the problem is an ineffective solution. The pain will return and intensify over time.

Surgeons pay special attention to patients whose professional activities are closely related to sports achievements. Such people are representatives of a group at increased risk of getting a relapse in the same place. To reduce the percentage chance of recurrence of an identical injury, doctors insist on the need to remove the metal structure immediately after confirming successful fusion. If you leave everything as it is, then if there is a second fracture, the presence of a metal fixator on or inside the bone will significantly complicate the subsequent provision of assistance. Not to mention the slowdown in new healing after surgery.

Often, metal retainers that are not removed after the scheduled period become the reason for denying a person permission to perform military service. The same implants may be a contraindication to a number of other professional activities. To solve this problem, you will have to remove previously installed parts, even if they are small in size.

For several decades, the indication for reoperation was the discovery of a fragment of a needle or drill, which was localized in the lesion.

This happened due to inaccurately carried out intervention, as well as the use of homemade devices. They were often not adapted for these purposes, being made from completely weak alloys, which were not adapted for high loads by default. When they were deformed, small particles fell between the bones, which were supposed to grow together, and injured the surrounding soft tissue, muscle fibers and even blood vessels. Damage to the latter threatens extensive internal bleeding, which is quite difficult to diagnose with the naked eye.

Those patients who seemed to have had a successful operation to install clavicular plates, but after a while it turned out that the foreign body causes significant pain, should not endure pain. Discomfort is often caused by the head of the screw or staple interacting closely with the tendons.

As soon as the tendons begin to move, even with a small action, the muscle begins to rub against the protruding part of the supporting mechanism. Most often, people with a thin physique have to deal with such inconveniences.

Also, all ladies who are planning a pregnancy and have already successfully undergone fusion thanks to the plates should have them removed before conception. This will avoid latent negative effects on the fetus.

Planned and emergency removal

The decision on the date of the dismantling operation should be made only after studying the survey results. X-rays and the patient’s current state of health are taken into account. If visualization methods of the lesion demonstrate complete and correct fusion, then the only matter left is to remove the plates with screws.

If metal structures are located in the area of important nerve endings or large vessels, it is necessary to take into account the increased risk of re-fracture in the same place after removal of the mechanism.

Medical practice has also recorded cases where victims were denied removal due to a number of serious chronic diseases. If the benefits of neutralizing the metal fixator do not outweigh the risks in chronic diseases, then surgeons will not undertake such a dangerous task. Traditionally, such manipulations are carried out as planned after a person has completed all preoperative stages with preliminary examinations. But there are a number of exceptions that require early extraction without a preparatory stage.

This concerns the migration of the retainer due to unreliable fastening. When it moves towards vital organs or large vessels, the likelihood of damage increases. Not to mention the accompanying perforation of the skin. To protect the patient from the worst-case scenario, one has to take extreme measures, carrying out radical intervention urgently.

The same can happen if the victim is found to have:

deep suppuration;
rejection of alloy material;
formation of a false joint;
absence of callus, despite all the deadlines that have passed for this.

Despite the apparent simplicity, removing the rods is a labor-intensive process that requires special skill of medical personnel.

During manipulation, the doctor must always be prepared for unforeseen situations, because the story when, when unscrewing the mechanism, the head is deformed and the splines are damaged is not such a rarity.

Due to the poor quality of medical “assistants,” a quite simple task often turns into an almost impossible one. In addition to the surgeon’s skills, special tools specifically for non-standard situations can help resolve the issue.

Rehabilitation period

If the metal structure is located dangerously close to the nerve endings, this greatly increases the chances of complications. Because of this, some traumatologists insist on leaving the implant until better times.

But with acute indications for immediate removal, it is impossible to delay intervention even with life-threatening factors. It will be much more effective to hire a specialist in the field of microsurgery who can cope with the neutralization of neurological disorders. The final verdict on a given topic is made purely individually based on the results of a study of the health of the ward.

It is believed that removing the plate is a less traumatic measure than installing it. To promote high-quality recovery from a fracture, doctors recommend strictly following the established protocol.

You should not assume that prolonged immobilization is a good solution to the problem. If physical activity is limited too much, it will only lead to atrophy or poor circulation. Destabilization of the latter function threatens the rapid development of a number of specific complications such as venous stagnation, thrombosis and lymphostasis.

Schematically, the rehabilitation of such patients can be divided into two types of unequal duration: inpatient and outpatient. The first point provides for the mandatory use of prescribed medications in the specified dose under the supervision of medical personnel. Medicines are designed to block pain. For the same purposes, movement therapy and procedures from the exercise therapy system are used.

After discharge from the inpatient department of the hospital, the outpatient stage begins, which usually lasts about a year. Only the attending physician can announce the exact period after studying the general dynamics of recovery.

To speed up the healing process, the victim will have to make every effort, because he will need to work on restoring natural blood circulation. You will also need to monitor the elimination of muscle atrophy and the restoration of motor function to its previous level.

Physical activity within reasonable limits is best suited for implementing such a plan. This will allow one to overcome the initial stiffness of a person, and the positive effect will not be long in coming. Moreover, you should start with minor exercises, and then increase the load proportionally, focusing on your own feelings.

03.08.2009, 15:10

Hello! 3 weeks ago I fell and broke my right collarbone, a plaster cast was applied, but reduction was not achieved, and after 2 weeks they operated on it - they put a plate. after the operation, severe pain appeared at the operation site closer to the neck, there is a constant ache there when I sit down or walk - after 5-15 minutes a sharp painful pain arises, I must lie down, the moment I lie down the pain intensifies, and then goes away. A week has passed, the doctor says - this is the first time in his practice... and it seems he doesn’t believe me, so tomorrow he might call a neurologist. I want to ask a question - could this be due to the fact that the screws damaged the nerves? or is the plate too big? after all, this didn’t happen before the operation.. tell me what this complication is and how to cure it? Thanks a lot!

10.10.2009, 05:58

Hello! Please provide additional advice. I am attaching a picture before the operation - although it is not very good, and after the operation. More than 2 months have passed since the operation and I practically do not move my arm - after movements, a painful spasm of the muscles in the shoulder occurs and does not go away, movements in the shoulder are significantly limited, I cannot raise my arm above the horizontal level. Please answer, can such spasms be associated with the presence of a plate? In what minimum time can it be removed and will I then have to wear a cast? Tell me how to develop a hand in such situations? thank you in advance!

10.10.2009, 06:01

and here is a picture after the operation

10.10.2009, 06:07

Couldn't upload pictures..

10.10.2009, 22:39

I hardly move my arm [...] could such spasms be associated with the presence of the plate?

The plate as such has nothing to do with it. There was an injury, an operation, and as a result I was in pain for the first few days. A week and a half after the operation, you should already be developing movements. Using your other hand, lift in the direction behind your head. It is better to lie on your back so that the shoulder blade is fixed. If you don’t move for two months, then even a healthy person will move poorly.

11.10.2009, 06:20

The plate is unlikely to restrict your movements. I think it makes sense to take a closer look at the shoulder joint. Take a lateral radiograph or tomogram.

11.10.2009, 22:27

I'll tell you straight. I have a prejudice against this hook-shaped plate.
In a vertical position, due to the weight of the upper limb, its lever action occurs. I see a problem with this. In extreme cases, we will see something like in this topic:
[Only registered and activated users can see links] %FB
Therefore, I can only advise the patient to use a serious scarf bandage, that is, figuratively speaking, to assume that the plate does not hold much. Or an 8-shaped bandage :)

11.10.2009, 22:40

prejudice towards this hook-shaped plate.
In a vertical position, due to the weight of the upper limb, there is

If everything is done as usual, then nothing arises there. Everything ends up in place and cannot move if the plate is not broken or deformed.

11.10.2009, 22:56

If everything is done as usual, then nothing arises there. Everything ends up in place and cannot move if the plate is not broken or deformed.
The cloudy initial image shows a fracture of the acromial end of the clavicle and a rupture of the coracoclavicular ligament. In the post-op photo everything is in place. An axial projection can be made, in case the clavicle is fixed very posteriorly, but why...
So either something was missed here, something was missing from the damage (what kind?), or it was an immobilization contracture.
How can complaints about pain be explained? And I’m not talking about errors in surgery or diagnosis. The technique is questionable.

14.10.2009, 10:25

Hello again! The essence of the problem is that immediately after the operation there was something like neuropathy, then it was treated. Now, when I make movements with even slight muscle tension, a cramp occurs in the brachial muscle (biceps or triceps or deltoid or completely, I don’t know...) very painful. If you don’t massage it, it will hurt for a long time and you won’t be able to make any movements.
Is this the case for all patients? or is this a complication? can you still take a picture? the doctor says - repeat synchronization only when it is 3 months - to decide the question of whether it is possible to remove the plate... or should it go to neurologists?... or wait until it is removed...

In case of severe injuries, osteosynthesis of the clavicle with a plate is indicated. The essence of the operation is to connect bone fragments using fixing metal elements. Thanks to secure fastening, the patient can return to normal life within a few weeks.

The collarbone is a bone that connects the arm to the rib cage, i.e. forearm bone with sternum. In case of serious injuries due to a fall or impact, when the bone can undergo a complete fracture, osteosynthesis of the clavicle with a plate is indicated. This is a surgical operation that involves connecting parts of the clavicular bone using special metal structures that reliably fix the fragments.

Types of surgery and its benefits

This type of surgery is simply called shoulder osteosynthesis, since the main goal is to restore movement in the shoulder joint due to rigid fixation of bone fragments with metal elements. The intervention is carried out not only for humans: a similar operation is also performed on domestic animals: dogs, cats and others.

To perform osteosynthesis (literally “synthesis”, i.e. connecting bones), various elements made of high-strength plastic and stainless steel are used:

screws;
plates;
bolts;
beams;
knitting needles;
rods;
records;
bone pins.

The choice of material and the features of its design depend on what kind of fracture the patient received, as well as on its other features. Most often, intraosseous fixation is performed using metal staples or rods. They are able to block even the slightest displacement of the bones relative to each other, which allows the collarbone to be securely attached in the area of the fracture.

In some cases, special hook-shaped plates are used. They are connected to the bone using special hooks, which eliminates even the slightest displacement of the fragments and speeds up the recovery process.

Surgical intervention for osteosynthesis of the humerus with a plate is classified not only depending on the selected material, but also according to other criteria. For example, depending on the characteristics of penetration during the procedure, there are:

Closed osteosynthesis– the damaged area is not freed from soft tissue, the surgeon makes minimal incisions in the skin, through which he penetrates deeper and places a fixator. This method is the least traumatic; it is used in cases where the fracture is not too strong, so you can get into the damaged area without large incisions.
Open osteosynthesis involves complete exposure of soft tissues, for which they have to be removed. The surgeon then inserts anchors and sutures.

Depending on the specific method of attaching the plate to the collarbone, the following types of procedure are distinguished:

Certain types of interventions have names associated with the names of the surgeons who first performed the corresponding operations, for example, osteosynthesis according to Weber, osteosynthesis using Bogdanov rods, Kirschner wires.

The decision about which method of intervention to choose is made by the surgeon himself. It depends on the severity of the fracture and the individual characteristics of the patient.

Regardless of the specific type of procedure, correct fixation of clavicle fragments allows you to solve several problems at once:

Thanks to osteosynthesis, the collarbone is able to quickly restore lost movements. After rehabilitation, the patient will be able to move the injured limb, and the stability of the shoulder joint will be restored.
Further bone destruction, inflammatory processes and associated pain are prevented.
During recovery, there is no need to wear a cast, since the clamps securely secure the fragments.
You can move your arm almost immediately after surgery – in the first days after the intervention, so the overall rehabilitation period is short (up to 3 months).
The intervention is carried out under anesthesia, so it eliminates any pain. Subsequently, judging by the reviews, patients also do not experience pain.

Indications for intervention

Osteosynthesis of the clavicle with a knitting needle and other metal elements is carried out in case of severe injuries:

falling on your hand with your full weight;
complete fracture of the collarbone as a result of a blow;
sports injuries;
severe mechanical impact as a result of an accident;
injuries with complications of the humerus (proximal end, condyle and other parts).

It is quite easy to identify a clavicle injury symptomatically, both by the patient’s sensations and by visual inspection of the damaged area:

The prognosis for recovery is almost always favorable. However, age can make the situation worse as older people's bones become increasingly fragile. Therefore, in such cases, recovery may take much longer (several months or years).

Pay attention! The patient should consult a doctor as soon as possible. Before help arrives, you can take painkillers and apply a cold compress to the injury site. It is strictly forbidden to set the bone yourself.

It is advisable to fix your hand with or.

Contraindications

In general, the operation is performed quite often for different groups of patients. But in some cases, the surgeon may refuse to intervene for the following reasons:

General serious condition of the patient associated with serious diseases of internal organs, consequences of heart attack, stroke.
Tuberculosis of bone.
Old age, high bone fragility.
Abscess, severe inflammation of the soft tissues located near the fracture site.
Arthritis of the joints.
Oncological pathologies of the joint or blood.
Osteomyelitis.
A large number of other injuries (for example, as a result of an accident).

Diagnostics and preparation for the procedure

Preparation for clavicle plate osteosynthesis surgery requires making an accurate diagnosis and making a decision on the use of a specific type of intervention. To do this, the patient undergoes standard types of diagnostics:

The consultation is carried out by a surgeon or traumatologist. The intervention is carried out within the first hours/days after the patient’s admission. The operation does not require any special preparation. However, if the patient usually takes any medications for the manifestations of chronic diseases, it is better for him to inform his doctor additionally about this - he may have to stop taking them for a while, just as when preparing for surgery on the foot for hallux valgus.

Progress of the intervention

In connection with the description of the procedure, patients often wonder how many hours the procedure lasts. Typically it takes 30–60 minutes, but in some cases it can last up to 2–3 hours. The technique of clavicle osteosynthesis is quite simple; it includes the following steps:

First, the surgeon administers local anesthesia by injecting and injecting anesthetic into the affected area.
Then an incision is made 8–10 mm wide and 60–70 mm long.
A canal up to 6 cm long is made in one of the fragments using a drill (a).
In the other, a longitudinal channel is prepared with the same drill (b).
Then both fragments are fixed (c).
And insert a rod or other fastening element (d).
Then the soft tissues are sutured and surgical sutures are placed.

You can see the features of the procedure in this video.

In principle, the osteosynthesis scheme looks approximately the same in different cases, but there may be differences. For example, the surgical technique for osteosynthesis of a humeral shaft fracture with a plate involves the use of special compression plates. They are larger in size because the humerus is larger and denser. The plates are secured with 7–8 screws.

Features of the rehabilitation period

The rehabilitation period depends on the severity of the injury, as well as the age of the patient, for example:

in a child up to 1 month;
in a teenager up to 2 months;
in an adult up to 3 months;
older people can recover up to six months.

At the same time, you can make simple movements with your hand the very next day after the operation, but it is not recommended to exercise during the entire rehabilitation period.

Recovery after shoulder osteosynthesis usually consists of the following stages:

At the first stage, immobilization is carried out with bandages or the patient can make only limited movements of the arm. It is recommended to perform therapeutic exercises under the guidance of a doctor. If necessary, use painkillers and anti-inflammatory drugs.
The second stage involves further use of exercises, their complication, as well as visits to physiotherapeutic procedures and massage.
At the last stage, the exercises become as complicated as possible, using exercise machines and dumbbells.

Pay attention! During the entire rehabilitation period, the patient must closely monitor his well-being. If you experience any extraneous sensations or other unpleasant symptoms, you should immediately notify your doctor.

Possible complications

In most cases, proper surgical intervention does not cause serious complications. However, the following consequences may also occur:

Failure of bone fusion due to improperly selected design, fragility of bone tissue.
Tissue infection.
Inflammatory processes in the damaged area.

In all these cases, the patient immediately consults a doctor and undergoes additional examination (X-ray, magnetic resonance imaging). The decision on further actions is made by the doctor.

Clinics and costs

According to health insurance regulations, this type of operation is free of charge. However, in some cases, the patient may need additional metal structures, so victims often turn to private clinics. The price of the service depends on the degree of complexity of the fracture, the type of fixator chosen and the pricing policy of a particular institution.

Table 1. Overview of clinics and surgery costs

The operation for osteosynthesis of the humerus is used everywhere and in most cases is successful. A large selection of metal structures allows you to choose the best option for each patient. Timely contact with a professional surgeon practically guarantees a favorable prognosis for recovery.