Youssef Yasmin, Melcher Peter, Steinert Matthias, Metelmann Isabella, Hepp Pierre, Theopold Jan
Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum, Bereich für arthroskopische und spezielle Gelenkchirurgie/Sportverletzungen Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland.
Klinik für Viszeral‑, Thorax‑, Transplantations- und Gefäßchirurgie, Bereich Thoraxchirurgie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland.
Unfallchirurgie (Heidelb). 2023 Jul;126(7):581-585. doi: 10.1007/s00113-022-01217-5. Epub 2022 Jul 14.
Lateral clavicle fractures can be treated both conservatively and surgically depending on the fracture classification. Different surgical techniques have been described for the operative treatment. The selection of the appropriate technique is decisive for the functional outcome and healing process without complications.
We report on a patient with a secondary dislocation of two Kirschner wires after Kirschner wire osteosynthesis. The secondary dislocation caused one of the wires to migrate into the mediastinum and pulmonary tissue, directly under the aortic arch. To prevent further migration with potential damage to surrounding structures, a uniportal video-assisted thoracoscopy was performed to retrieve the wire.
The treatment of lateral clavicle fractures should be performed with bent Kirschner wires as they can otherwise lead to severe complications including the occurrence of pseudarthrosis or secondary migration of the material. Safe and stable surgical techniques (plate osteosynthesis, hybrid treatment) should be preferred if they are available.
根据骨折分类，锁骨外侧骨折可采用保守治疗或手术治疗。对于手术治疗，已有不同的手术技术被描述。选择合适的技术对于功能结局和无并发症的愈合过程起着决定性作用。
我们报告了一例克氏针内固定术后两根克氏针继发脱位的患者。继发脱位导致其中一根针迁移至主动脉弓正下方的纵隔和肺组织内。为防止其进一步迁移并对周围结构造成潜在损伤，采用单孔电视辅助胸腔镜取出该针。
锁骨外侧骨折的治疗应使用弯克氏针，否则可能导致严重并发症，包括假关节形成或内固定材料继发迁移。如有安全稳定的手术技术（钢板内固定、混合治疗），应优先选用。
