Djahangiri Ali, Farron Alain
Service d'orthopédie et de traumatologie, CHUV et Université de Lausanne, 1011 Lausanne.
Rev Med Suisse. 2009 Aug 5;5(212):1542-5.
Slightly displaced clavicular midshaft fracture is currently treated nonoperatively. There is considerable debate about whether acute displaced fractures should be treated operatively. Nonunion rate after displaced fracture has been underestimated for a long time, and malunion clinical impact often minimized. It is known that operative treatment decreases these rates. However, operating all displaced fractures may lead to overtreatment. Acute operative treatment of midshaft fractures with delayed treatment of established nonunion showed no significant difference in the outcome, but malunion surgical management is technically demanding. Consequently these fractures could be treated surgically, but operative indication should be adapted to patient expectations.
目前,轻度移位的锁骨中段骨折采用非手术治疗。对于急性移位骨折是否应进行手术治疗存在相当大的争议。移位骨折后的骨不连发生率长期以来一直被低估,而畸形愈合的临床影响往往被最小化。众所周知,手术治疗可降低这些发生率。然而,对所有移位骨折进行手术可能会导致过度治疗。对中段骨折进行急性手术治疗并对已形成的骨不连进行延迟治疗,结果显示无显著差异,但畸形愈合的手术处理在技术上要求较高。因此,这些骨折可以进行手术治疗,但手术指征应根据患者的期望进行调整。