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.	张传毅, 林列, 梁军波, 等. 新型胸锁钩钢板治疗胸锁关节周围不稳定性骨折脱位的疗效观察. 中国骨伤, 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.	董加纯, 支中正, 颜冰珊, 等. 钢缆内固定锁骨近段和胸骨髓腔修复胸锁关节脱位: 解剖与临床. 中国组织工程研究, 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.	张布和, 张永东, 田耕. 国人胸骨的形态测量. 解剖学研究, 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.	樊军, 罗意, 万革, 等. 克氏针张力带与锁骨钩钢板固定治疗胸锁关节前脱位 63 例的临床分析. 重庆医学, 2015, 44(22): 3129-3131.
15.	杨琨, 阳运康. 胸锁关节脱位治疗的研究进展. 中国修复重建外科杂志, 2016, 30(1): 115-118.
16.	陈方虎, 赵小平, 郑文标, 等. 胸锁钩钢板治疗胸锁关节脱位的临床观察. 中国骨伤, 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.	赵继, 蔡贤华, 胡昊, 等. T 型钢板与韧带重建治疗陈旧性胸锁关节脱位对比研究. 临床外科杂志, 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. 张传毅, 林列, 梁军波, 等. 新型胸锁钩钢板治疗胸锁关节周围不稳定性骨折脱位的疗效观察. 中国骨伤, 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. 董加纯, 支中正, 颜冰珊, 等. 钢缆内固定锁骨近段和胸骨髓腔修复胸锁关节脱位: 解剖与临床. 中国组织工程研究, 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. 张布和, 张永东, 田耕. 国人胸骨的形态测量. 解剖学研究, 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. 樊军, 罗意, 万革, 等. 克氏针张力带与锁骨钩钢板固定治疗胸锁关节前脱位 63 例的临床分析. 重庆医学, 2015, 44(22): 3129-3131.
15. 杨琨, 阳运康. 胸锁关节脱位治疗的研究进展. 中国修复重建外科杂志, 2016, 30(1): 115-118.
16. 陈方虎, 赵小平, 郑文标, 等. 胸锁钩钢板治疗胸锁关节脱位的临床观察. 中国骨伤, 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. 赵继, 蔡贤华, 胡昊, 等. T 型钢板与韧带重建治疗陈旧性胸锁关节脱位对比研究. 临床外科杂志, 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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