RESUMEN
OBJECTIVE: The aim of this study was to assess the outcome of coracoclavicular screw fixation in displaced distal clavicular fractures. METHODS: Sixteen patients with Neer Type 2 displaced distal clavicle fractures were treated with open reduction and internal fixation. Fixation was performed using a coracoclavicular screw with washer application. After union the screw was removed under local anesthesia. Radiographic evaluation was performed and the clinical outcome was assessed using the Constant score. RESULTS: All patients achieved painless osseous unions. However, one patient showed significant displacement of the fracture due to loosening of the screw one month after surgery. The screw was removed and the fracture was healed with some deformity. All patients returned to their preinjury level in 3 months. The mean Constant score was 98. CONCLUSION: Coracoclavicular screw fixation in the treatment of distal clavicular fractures is a reliable, simple and cost effective technique.
Asunto(s)
Tornillos Óseos , Clavícula/lesiones , Fijación Interna de Fracturas/instrumentación , Fracturas Óseas/cirugía , Luxaciones Articulares/cirugía , Accidentes por Caídas , Articulación Acromioclavicular/diagnóstico por imagen , Articulación Acromioclavicular/lesiones , Articulación Acromioclavicular/cirugía , Adulto , Clavícula/cirugía , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Fijación Interna de Fracturas/métodos , Curación de Fractura/fisiología , Fracturas Óseas/diagnóstico por imagen , Humanos , Luxaciones Articulares/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Radiografía , Rango del Movimiento Articular/fisiología , Recuperación de la Función , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
PURPOSE: This study evaluated the results of arthroscopic subchondral microfracture performed on patients with spontaneous osteonecrosis (ON) (group 1) or secondary ON (group 2) of the knee joint. TYPE OF STUDY: Retrospective clinical study. METHODS: Group 1 included 26 patients (mean age, 48 years) who had spontaneous ON. Group 2 included 15 patients (mean age, 32 years) with ON secondary to inflammatory disease or steroid therapy. Seventy-six percent of the chondral defects were located in the medial femoral condyle. The average defect sizes in group 1 was 162 mm2 and in group 2 was 362 mm2. After debridement of the necrotic tissues, multiple perforations were placed into the subchondral bone to obtain revascularization. RESULTS: There was an increase in the average Lysholm scores from 57 to 90 in group 1 after 27 months of mean follow-up (P < .05); 71% of patients could participate in strenuous sports with no or minimal limitation. The mean activity level in group 1 according to Cincinnati Knee Rating System was 6 preoperatively and 13.54 postoperatively. For group 2, the average scores showed significant improvement and patient satisfaction after surgery (preoperative and postoperative average Lysholm scores were 41 and 75, respectively, with mean follow-up of 37 months). Average activity level in group 2 increased from 2.67 to 11.73. Control magnetic resonance imaging scans of the cases revealed the continuity of normal cartilage with cartilage-like tissue in the treated areas. However, an increase of the size of ON in the subchondral bone was detected in 27% of the knees. CONCLUSIONS: The microfracture technique is safe, simple, and cost-effective, and may be an alternative procedure for treatment of ON of the knee, especially in young patients, before possible subsequent replacement surgery. LEVEL OF EVIDENCE: Level IV.