Analysis Of Reconstruction Plate And Kirschner Wire Curative Effect On The Comminuted Fracture In The Connecting Piece Of The Collar Bone

ObjectiveTo compare clinical result of reconstruction plate andkirschner wire in treatment of the comminuted fracture in theconnecting piece of the collar bone..To study indication and methodin treatment of the comminuted fracture in the connecting pieceof the collar bone,and announcements and deal method afteroperation. To approach feasibility of control study of twotreatment method in large scale random.Document and methodsClinical document:From January 1996 to may 2002, 15 casesof comminuted fracture in the connecting piece of the collar bonewere chosen by internal fixation of kirschner wire in china-Japanunion hospital of JiLin University. There are 15 patients(9 male)witha mean age of 31(14~68)years, followed range three months to oneyear after operation.During march 2002 and march 2006,27 casewere chosen by internal fixation of reconstruction plate.There are 27patients(19 male)with a mean age of 34(21~70)years,followed rangesix months to two years.Operative methods:(1)Internal fixation of kirschner wire :kirschner wire of decent diameter is selected according to themarrow cavity of the collar bone,that is ectad retrogressed the skinthrough distal end of fracture,and it penetrate the marrow cavity ofproximal end after the reduction of fracture by euthyphoria.Withregard to comminuted fracture of collar bone,method is used thatbone chips is bundle up on bole of bone with steel-wire or silksuture on the ground fracture be fixed with kirschner wire.The tail ofkirschner wire is bended to 90 degree outside the skin.(2) Internalfixation of restitution plate: After pieces of syntripsis reest andbundle up with steel-wire beforehand ,it is large possible to reestsyntripsis to become simple Amphifracture,two parts of bonefracture reduce.The reconstruction plate of suitable length is set atthe front of superior surface of collar bone,and be fixxed by the boltthrough drilling and screw.The steel-wire of fixation beforehand isextracted and the bolt is screwed tight.It is requirement that screw oftensile strength is immersed in fracture and the bigger bone block isfixation with steel plate .Statistical treatment :Compared the reconstruction plate to thekirschner wire , t-test were adopted respectively in the operativeincision, the operative time and the bleeding volume of operativeprocess(Tab.1). χ2-test were adopted in the disesse incidence ofpostoperative complications and the rate of fineness.(Tab.2 andTab.3) The data was analyzed by SPSS13.0 statistics software.ResultThere was no obvious difference in the operative incision, theoperative time and the bleeding volume of operative processbetween groups of reconstruction plate internal and kirschner wireinternal fixation by t-test (P>0.05).The disesse incidence ofpostoperative complications is lower in reconstruction plate than inkirschner wire by χ2-test(P<0.05).The rate of fineness is obviouslyhigher in reconstruction plate than in kirschner wire byχ2-test(P<0.05).Discussion:The objective of internal fixation of fracture of collar bone isreestablishment of anatomy and strong fixation.It can be recoveredthat virgin appearance and function of the clavical.The patient cancarry on functional exercise of the shoulder joint in the early timeand avoid the development of arthrophlogosis of traumatic occlusion,the function of the shoulder joint can be best recoved .Indicated of operating :(1)Compound fracture;(2) The fracturewith injury of vascular nerve;(3)The fracture with obviousshift;(4)The danger of skin perforated at extremitas of fracture;(5)The complete fracture of the extroextremitas of clavicle withshite;(6)Disunion of fracture and pain;(7) Loners with closedreduction;(8)Combined injury in the body;(9)The patient can notconceive malunion or tolerance external fixation.Kirschner wire has its merit:(1)the scar is small with littleincisal opening.(2)the operation is a small wound.(3)the influence ispoor in the aspect of biology and vitodynamics. (4)kirschner wirecan be extract at out-patient clinic after union of fracture.(5)Theexpense is low, the material is selected conveniently. Shortcoming:the patient cannot carry on functional exercise of the shoulder jointin the early time. The Cleveland needle cinches easily. The fractureabnormally heals. There is also the bursitis in shoulder, the needleeye infection and so on.Reconstruction plate has its merit: (1) the plate to be putabove the collar bone has a role of the tension band function. (2) Theplate can be bent in two directions and pastes with the irregularshape of collar bone attaches closely. The fracture can reach thedissection replacement. (3) The reconstruction plate can contacteffectively .it may reduce the oppression on the bone and theinfluence on the blood circulation. It is advantageous for the union offracture. (4) The dissection replacement and the restored anatomicform of the collar bone and the shoulder joint avoid the occurrenceof traumatic arthritis. (5) It may play the bridge role for thesplintered fracture .Shortcoming: Expense is high. The incisalopening is a little long. The periosteum can be strip more. The platemust be taken out.How to prevent the complication: the complication by using the Kirschner wire: (1) the fracture can displace again by the Kirschner wire and the steel wire loosely slide. The Kirschner wire has enough intensity according to the cavitas medullarisof the collar bone. The Kirschner wire penetrates the near broken ends of fractured bone no shorter than 3cm and penetratesthe near collarbone substantia corticalis. The Kirschner wire need be beaten slowly in order to make the fracture inserted completely when it penetrates the near broken ends of the cavitasmedullaris of the collar bone. The steel wire or the silk thread need bind the broken bone block strongly and be away fromthe fracture line so as to avoid entering the fracture gap by the slide. The patient need carry out correct functional exercise.(2) The bone does not link and slowly heals. Be gentle andnot strip the periosteum too large when the doctor strips underthe periosteum. The broken bone block need be bound strongly with the steel wire or the silk thread on the bole far away from the fracture line. The smashing bone block should be retained the soft tissue relation as far as possible in order to protect blood supply. In the technique the operator should take the flank bone implant underneath the bone fracture and in its reararea when he discovers the bone coloboma. The patient beginsthe shoulder joint activity after the forearm should be fixed routinely by the arm sling for 4~6 weeks. (3) Chronic shoulderpain. The operator should correctly instruct the patient to carryon the functional exercise after the forearm is fixed for 4~6weeks. (4) needle eye infection. It is a routine to use the antibiotic for 5~7 day after the technique in order to prevent the injection. The needle tail in vitro need be cleaned every other day by 0.1% chlorhexidine washes or 75% alcohol.The complication by using the reconstruction plate: (1) theplate breaks, the screw cinches and draws out. These are the mostcommon. According to the comminuted fracture in the connectingpiece of the collar bone, the operator selects the 6~8 hole plategenerally and puts 3 screws in the distal and proximal end of thebone fracture as far as possible. The bone coloboma underneath thebone fracture should be packed by autogenous bone. Reconstructionplate should be put in front of collar bone and above it, namelytensity side. The shoulder joint should avoid abducting excessivelybefore the bone fracture heals. The patient begins functional exerciseby the guarrantee of the external fixation after the forearm is fixedconventionally for 2 ~ 4 weeks. (2) The steel plate breaks again afterit is dislodged. The internal fixation is taken out after the techniquehas passed away for 9 months. The patient avoids carrying a heavyload for a month after the plate is dislodged in order to reduce theoccurrence of the fracture again. (3) The bone fracture does not healor the detention heals. Be gentle and not strip the periosteum toolarge when the doctor strips under the periosteum. The smashingbone block should be retained the soft tissue relation as far aspossible. (4)Blood vessel and nerve injury: the operator protectsblood vessel and nerve by putting the periosteal elevator in thesubclavian. The drill hole directs from after on to front under, thescrew just arrives at the opposite cortical bone.Conclusion1.According to the comminuted fracture in the connecting pieceof the collar bone, the reconstruction plate is stronger for the fixationand occurs less complication than the the Kirschner wire .Thetime for the outside fixed maintenance after technique is shorter. Thepatient can carry out the functional exercise in the early time. Thefunction of the shoulder joint is better. According to the traversefracture or the mild smashing fracture that does not shift, theoperator may select the Kirschner wire .According to thesyntripsis or the bone fracture that is unstable type, the operatorshould select the reconstruction plate.2.The number o the cases are slightly few. The cases arelocalization in the accuracy and integrity of the result. Accordingto the findings and the theoretical superiority of reconstruction plate,it is possible to study the stochastic comparison between thereconstruction plate and the Kirschner wire in the large scale.