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Erschienen in: International Orthopaedics 4/2012

01.04.2012 | Original Paper

Medium-term results after total clavicle resection in cases of osteitis: a consecutive case series of five patients

verfasst von: Ralf Oheim, Arndt Peter Schulz, Rita Schoop, Cornelius H. Grimme, Justus Gille, Ulf-Joachim Gerlach

Erschienen in: International Orthopaedics | Ausgabe 4/2012

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Abstract

Purpose

Claviculectomy is a rare and poorly described event in the surgical therapy of diseases of the clavicle. We present a case series and functional results of patients who underwent total claviculectomy.

Methods

From 1995 to 2006 a total of 26 patients diagnosed with osteitis of the clavicle underwent surgery in our unit. Of these, five patients (all female) needed a total resection of the clavicle in order to ensure permanent healing from infection. The data collection was prospective. The data gathered preoperatively and at follow-up included clinical examinations, laboratory findings, radiographs and the Constant shoulder scores. The mean follow-up period was 7.5 months.

Results

The surgical concept described was able to eliminate infection in all cases studied within an average hospital stay of 13.4 days (8–18 days). Only one patient showed complications; suffering from chronic pain syndrome requiring surgical revision. After total resection of the clavicle four of five patients showed very good functional results. The average Constant score showed a significant increase from 82 before surgery to 95 at follow-up.

Conclusions

The surgical technique described for total claviculectomy, along with the insertion of local antibiotic beads, was able to eliminate infection in every case. Good functional results and a low complication rates were observed. For good functional results and the permanent elimination of infection, adjacent joints have to be addressed, the periosteal tube should be preserved and early functional treatment is essential.
Literatur
1.
Zurück zum Zitat Gurd FB (1941) The treatment of complete dislocation of the outer end of the clavicle: an hitherto undescribed operation. Ann Surg 113:1094–1098PubMedCrossRef Gurd FB (1941) The treatment of complete dislocation of the outer end of the clavicle: an hitherto undescribed operation. Ann Surg 113:1094–1098PubMedCrossRef
2.
Zurück zum Zitat Balakrishnan C, Vashi C, Jackson O, Hess J (2008) Post-traumatic osteomyelitis of the clavicle: a case report and review of literature. Can J Plast Surg 16:89–91PubMed Balakrishnan C, Vashi C, Jackson O, Hess J (2008) Post-traumatic osteomyelitis of the clavicle: a case report and review of literature. Can J Plast Surg 16:89–91PubMed
3.
Zurück zum Zitat Kapoor S, Tiwari A, Kapoor S (2008) Primary tumours and tumorous lesions of clavicle. Int Orthop 32:829–834PubMedCrossRef Kapoor S, Tiwari A, Kapoor S (2008) Primary tumours and tumorous lesions of clavicle. Int Orthop 32:829–834PubMedCrossRef
4.
Zurück zum Zitat Li J, Wang Z, Fu J, Shi L, Pei G, Guo Z (2011) Surgical treatment of clavicular malignancies. J Shoulder Elbow Surg 20:295–300PubMedCrossRef Li J, Wang Z, Fu J, Shi L, Pei G, Guo Z (2011) Surgical treatment of clavicular malignancies. J Shoulder Elbow Surg 20:295–300PubMedCrossRef
5.
Zurück zum Zitat Lord JW Jr, Wright IS (1993) Total claviculectomy for neurovascular compression in the thoracic outlet. Surg Gynecol Obstet 176:609–612PubMed Lord JW Jr, Wright IS (1993) Total claviculectomy for neurovascular compression in the thoracic outlet. Surg Gynecol Obstet 176:609–612PubMed
6.
Zurück zum Zitat Walz M, Möllenhoff G, Dollriess C, Muhr G (1998) Nonbacterial osteomyelitis of the clavicle (in German). Chirurg 69:1244–1251PubMedCrossRef Walz M, Möllenhoff G, Dollriess C, Muhr G (1998) Nonbacterial osteomyelitis of the clavicle (in German). Chirurg 69:1244–1251PubMedCrossRef
7.
Zurück zum Zitat Gikas PD, Islam L, Aston W, Tirabosco R, Saifuddin A, Briggs TW, Cannon SR, O’Donnell P, Jacobs B, Flanagan AM (2009) Nonbacterial osteitis: a clinical, histopathological, and imaging study with a proposal for protocol-based management of patients with this diagnosis. J Orthop Sci 14:505–516PubMedCrossRef Gikas PD, Islam L, Aston W, Tirabosco R, Saifuddin A, Briggs TW, Cannon SR, O’Donnell P, Jacobs B, Flanagan AM (2009) Nonbacterial osteitis: a clinical, histopathological, and imaging study with a proposal for protocol-based management of patients with this diagnosis. J Orthop Sci 14:505–516PubMedCrossRef
8.
Zurück zum Zitat Oheim R, Gille J, Grimme CH, Hadler D, Wallstabe S, Gerlach UJ (2011) Medium-term results of surgical treatment for osteitis of the clavicle (in German). Unfallchirurg 114:597–603PubMedCrossRef Oheim R, Gille J, Grimme CH, Hadler D, Wallstabe S, Gerlach UJ (2011) Medium-term results of surgical treatment for osteitis of the clavicle (in German). Unfallchirurg 114:597–603PubMedCrossRef
9.
Zurück zum Zitat Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164PubMed Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164PubMed
10.
Zurück zum Zitat Luther C, Unger K, Heppert V, Simon R, Hitzigrath C, Germann G, Sauerbier M (2010) Chronic osteitis of the lower extremities. An interdisciplinary treatment concept (in German). Unfallchirurg 113:386–393PubMedCrossRef Luther C, Unger K, Heppert V, Simon R, Hitzigrath C, Germann G, Sauerbier M (2010) Chronic osteitis of the lower extremities. An interdisciplinary treatment concept (in German). Unfallchirurg 113:386–393PubMedCrossRef
11.
Zurück zum Zitat Tiemann AH, Schmidt HG, Braunschweig R, Hofmann GO (2009) Strategies for the analysis of osteitic bone defects at the diaphysis of long bones. Strategies Trauma Limb Reconstr 4:13–18PubMedCrossRef Tiemann AH, Schmidt HG, Braunschweig R, Hofmann GO (2009) Strategies for the analysis of osteitic bone defects at the diaphysis of long bones. Strategies Trauma Limb Reconstr 4:13–18PubMedCrossRef
12.
Zurück zum Zitat Ince A, Rupp J, Frommelt L, Katzer A, Gille J, Löhr JF (2004) Is “aseptic” loosening of the prosthetic cup after total hip replacement due to nonculturable bacterial pathogens in patients with low-grade infection? Clin Infect Dis 39:1599–1603PubMedCrossRef Ince A, Rupp J, Frommelt L, Katzer A, Gille J, Löhr JF (2004) Is “aseptic” loosening of the prosthetic cup after total hip replacement due to nonculturable bacterial pathogens in patients with low-grade infection? Clin Infect Dis 39:1599–1603PubMedCrossRef
13.
Zurück zum Zitat Jundt G, Jani L (1997) Primary chronic osteomyelitis (in German). Orthopade 26:889–893PubMed Jundt G, Jani L (1997) Primary chronic osteomyelitis (in German). Orthopade 26:889–893PubMed
14.
Zurück zum Zitat Gerlach UJCG, Schoop R (2009) Akute posttraumatische Osteitis. Trauma Berufskr 11:203–206CrossRef Gerlach UJCG, Schoop R (2009) Akute posttraumatische Osteitis. Trauma Berufskr 11:203–206CrossRef
15.
Zurück zum Zitat Schmelz A, Kinzl L, Einsiedel T (2006) Osteitis. Infections of the locomotive system (in German). Chirurg 77:943–961, quiz 962PubMedCrossRef Schmelz A, Kinzl L, Einsiedel T (2006) Osteitis. Infections of the locomotive system (in German). Chirurg 77:943–961, quiz 962PubMedCrossRef
16.
Zurück zum Zitat Bravman JT, Vidal AF (2009) Midshaft clavicle fractures: are surgical indications changing? Orthopedics 32:909–913PubMedCrossRef Bravman JT, Vidal AF (2009) Midshaft clavicle fractures: are surgical indications changing? Orthopedics 32:909–913PubMedCrossRef
17.
Zurück zum Zitat Virolainen P, Lähteenmäki H, Hiltunen A, Sipola E, Meurman O, Nelimarkka O (2002) The reliability of diagnosis of infection during revision arthroplasties. Scand J Surg 91:178–181PubMed Virolainen P, Lähteenmäki H, Hiltunen A, Sipola E, Meurman O, Nelimarkka O (2002) The reliability of diagnosis of infection during revision arthroplasties. Scand J Surg 91:178–181PubMed
18.
Zurück zum Zitat Kao HC, Huang YC, Chiu CH, Chang LY, Lee ZL, Chung PW, Kao FC, Lin TY (2003) Acute hematogenous osteomyelitis and septic arthritis in children. J Microbiol Immunol Infect 36:260–265PubMed Kao HC, Huang YC, Chiu CH, Chang LY, Lee ZL, Chung PW, Kao FC, Lin TY (2003) Acute hematogenous osteomyelitis and septic arthritis in children. J Microbiol Immunol Infect 36:260–265PubMed
19.
Zurück zum Zitat Malcius D, Jonkus M, Kuprionis G, Maleckas A, Monastyreckiene E, Uktveris R, Rinkevicius S, Barauskas V (2009) The accuracy of different imaging techniques in diagnosis of acute hematogenous osteomyelitis. Medicina (Kaunas) 45:624–631 Malcius D, Jonkus M, Kuprionis G, Maleckas A, Monastyreckiene E, Uktveris R, Rinkevicius S, Barauskas V (2009) The accuracy of different imaging techniques in diagnosis of acute hematogenous osteomyelitis. Medicina (Kaunas) 45:624–631
20.
Zurück zum Zitat Wessel RN, Schaap GR (2007) Outcome of total claviculectomy in six cases. J Shoulder Elbow Surg 16:312–315PubMedCrossRef Wessel RN, Schaap GR (2007) Outcome of total claviculectomy in six cases. J Shoulder Elbow Surg 16:312–315PubMedCrossRef
21.
Zurück zum Zitat Kochhar VL, Srivastava KK (1976) Anatomical and functional considerations in total claviclectomy. Clin Orthop Relat Res 118:199–201PubMed Kochhar VL, Srivastava KK (1976) Anatomical and functional considerations in total claviclectomy. Clin Orthop Relat Res 118:199–201PubMed
22.
Zurück zum Zitat Neut D, van de Belt H, van Horn JR, van der Mei HC, Busscher HJ (2003) Residual gentamicin-release from antibiotic-loaded polymethylmethacrylate beads after 5 years of implantation. Biomaterials 24:1829–1831PubMedCrossRef Neut D, van de Belt H, van Horn JR, van der Mei HC, Busscher HJ (2003) Residual gentamicin-release from antibiotic-loaded polymethylmethacrylate beads after 5 years of implantation. Biomaterials 24:1829–1831PubMedCrossRef
23.
Zurück zum Zitat Gille J, Ince A, González O, Katzer A, Loehr JF (2006) Single-stage revision of peri-prosthetic infection following total elbow replacement. J Bone Joint Surg Br 88:1341–1346PubMedCrossRef Gille J, Ince A, González O, Katzer A, Loehr JF (2006) Single-stage revision of peri-prosthetic infection following total elbow replacement. J Bone Joint Surg Br 88:1341–1346PubMedCrossRef
24.
Zurück zum Zitat Trampuz A, Osmon DR, Hanssen AD, Steckelberg JM, Patel R (2003) Molecular and antibiofilm approaches to prosthetic joint infection. Clin Orthop Relat Res 414:69–88PubMedCrossRef Trampuz A, Osmon DR, Hanssen AD, Steckelberg JM, Patel R (2003) Molecular and antibiofilm approaches to prosthetic joint infection. Clin Orthop Relat Res 414:69–88PubMedCrossRef
25.
Zurück zum Zitat White LM, Schweitzer ME, Deely DM, Gannon F (1995) Study of osteomyelitis: utility of combined histologic and microbiologic evaluation of percutaneous biopsy samples. Radiology 197:840–842PubMed White LM, Schweitzer ME, Deely DM, Gannon F (1995) Study of osteomyelitis: utility of combined histologic and microbiologic evaluation of percutaneous biopsy samples. Radiology 197:840–842PubMed
Metadaten
Titel
Medium-term results after total clavicle resection in cases of osteitis: a consecutive case series of five patients
verfasst von
Ralf Oheim
Arndt Peter Schulz
Rita Schoop
Cornelius H. Grimme
Justus Gille
Ulf-Joachim Gerlach
Publikationsdatum
01.04.2012
Verlag
Springer-Verlag
Erschienen in
International Orthopaedics / Ausgabe 4/2012
Print ISSN: 0341-2695
Elektronische ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-011-1342-3

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