Koob S, Weber O, Burger C, Müller M C
Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn.
Klinik für Orthopädie, Unfall- und Handchirurgie, St. Martinus Hospital, Olpe.
Z Orthop Unfall. 2014 Apr;152(2):177-81. doi: 10.1055/s-0034-1368188. Epub 2014 Apr 23.
A 32-year-old patient suffered from progredient intermittent claudication of the left arm 6 months after plate fixation of a midshaft clavicular fracture (OTA classification type A). The radiological analysis revealed a subacute stenosis of the left subclavian artery, caused by a granuloma at the tip of a protruding screw, which triggered recurrent emboli and symptoms. Reperfusion was achieved by catheter embolectomy and complete removal of the plate. The case shows that, when performing plate osteosynthesis of clavicular fractures, special consideration has to be given to the length and protrusion of the applied screws. Due to the anatomic proximity not only acute, but also subsequent irritation of the subclavian vessels is possible.
一名32岁患者在锁骨中段骨折钢板固定(OTA分型A型)6个月后出现进行性左上肢间歇性跛行。影像学分析显示左锁骨下动脉亚急性狭窄,由一枚突出螺钉尖端的肉芽肿引起,该肉芽肿引发了反复栓塞和症状。通过导管取栓术和钢板完全取出实现了再灌注。该病例表明,在进行锁骨骨折钢板内固定时,必须特别考虑所用螺钉的长度和突出情况。由于解剖位置接近,不仅可能发生急性,而且随后也可能发生锁骨下血管的刺激。