Quick Dash Evaluation on the Midshaft Clavicle Fracture Treatment Based on Ngarmukos Procedure

SAGIRAN, Prf.dr. Armis, SpB.,SpOT.,FICS

2006 | Tesis | PPDS I Ilmu Bedah

BACKGROUND: The clavicle maintains the width of the shoulders against gravity and muscle pull, increasing the range of motion of the limb. Midshaft clavicle fracture common occurs, with or without displacement and comminution. Most clavicle fracture can be treated conservatively with excellent result. Recently, poor results of conservative treatment increasingly occur. Application of plate and screw is also reported as a risk factor of non-union and infection, because of excessive periosteal stripping. Ngarmukos introduced double K-wire technique with no larger incision and soft tissue dissection. This research is aimed to evaluate clinical outcome of Ngarmukos procedure in the clavicle fracture treatment using the Quick DASH score. MATERIAL AND METHOD: This research is a case series as a preliminary study of long term outcome evaluation. It was conducted at Sardjito Hospital, Faculty of Medicine GMU Yogyakarta. All the patients underwent Ngarmukos procedure since January 2002 until December 2005 was included in this study. All data were generated descriptive statistics. The Chi-square test is used to determine the significances between characteristics and outcomes. RESULT: There are 19 patient included in this series. Average age is 44.68 year, ranged from 16 – 81. Male : Female ratio = 2.8 : 1. Shortening average is 7.01 mm, ranged from 0.8 – 17.9 mm. The Q-DASH score average is 2.75, ranged between 0 – 6.82. The fracture type is significantly related to the shortening (p < 0.05). The keloid formation also significantly influenced the sense of satisfaction (p < 0.05). Other characteristics are not considered statistical significance to influence the outcomes. The Alpha Cronbach is 0.7792. The Kappa coefficient is 0.783. DISCUSSION: Our results showed that traffic accident is the most frequent mechanism of injury (73.7%). The most frequent education level of the subject is senior high school (42.1%), while the most frequent employment is in private sector (57.9%). This finding is important to government as an input in public policy making. The fracture was mostly in right sided productive age male. It need for good management for excellent result. Most characteristics were not significantly related to the outcomes. Shortening occurs less than 15 mm regarded as normal. The marked shortening is because of the comminution of the fracture fragment. This is because fixation of K-wire is less rigid than plate and screw. The keloid formation also significantly influenced the sense of satisfaction. However, it is not worsening the clinical function. CONCLUSSION: Ngarmukos procedure can restore the anatomical length of the midshaft clavicle fracture. The Quick-DASH score ranges from 0 – 6.82 (normal – good result). Fracture type significantly related to the shortening . Keloid formation influenced the sense of satisfaction.

Kata Kunci : fraktur Clavicula 1/3 Tengah,Operasi Teknik Ngarmukos, Quick DASH; Clavicle fracture; ORIF; Ngarmukos Procedure