Vander Have Kelly L, Perdue Aaron M, Caird Michelle S, Farley Frances A
Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI 48109, USA.
J Pediatr Orthop. 2010 Jun;30(4):307-12. doi: 10.1097/BPO.0b013e3181db3227.
Midshaft clavicle fractures in adolescents have traditionally been treated nonoperatively. Recent studies in the adult literature have shown a higher prevalence of symptomatic malunion, nonunion, and poor functional outcome after nonoperative treatment of displaced fractures. The purpose of this study was to compare operative versus nonoperative treatment of displaced clavicle fractures in adolescents.
Adolescents who sustained closed midshaft clavicle fractures between 2000 and 2008 were identified in our institutional trauma registry. Medical records were reviewed for patient demographics, injury characteristics, treatment, and outcomes.
Forty-two consecutive patients (mean age 15.4 y) with 43 closed midshaft clavicle fractures were identified. Twenty-five patients were treated nonoperatively with a sling or figure-of-8 brace. Seventeen patients were treated operatively with acute plate fixation for fractures displaced more than 2 centimeters. The average shortening at injury was 12.5 mm in the nonoperative group and 27.5 mm in the operative group (P=0.003). The mean time to radiographic union for displaced fractures was 8.7 weeks in the nonoperative group and 7.4 weeks in the operative group (P=0.02). There were no nonunions in either group. All complications in the operative group were related to local hardware prominence. The mean time to return to activities was 16 weeks in the nonoperative group and 12 weeks in the operative group. Symptomatic malunion, with a mean fracture shortening of 26 mm, developed in 5 patients in the nonoperative group. Four of these patients elected corrective osteotomy with internal fixation and all went on to union with resolution of their symptoms.
Plate fixation of displaced midshaft clavicle fracture reliably restores length and alignment. It resulted in shorter time to union with low complication rates. Symptomatic malunion in adolescents may be more common than earlier thought after significantly displaced fractures. Corrective osteotomy with plate fixation can restore clavicle anatomy and eliminate symptoms associated with malunion.
Therapeutic level III.
青少年锁骨中段骨折传统上采用非手术治疗。近期成人文献研究表明，移位骨折非手术治疗后症状性骨不连、骨畸形愈合及功能预后不良的发生率更高。本研究旨在比较青少年移位锁骨骨折的手术治疗与非手术治疗。
在我们机构的创伤登记系统中识别出2000年至2008年间发生闭合性锁骨中段骨折的青少年。查阅病历以获取患者人口统计学资料、损伤特征、治疗方法及预后情况。
共识别出42例连续患者（平均年龄15.4岁），有43处闭合性锁骨中段骨折。25例患者采用吊带或8字绷带进行非手术治疗。17例骨折移位超过2厘米的患者接受了切开钢板内固定手术治疗。非手术组受伤时的平均缩短量为12.5毫米，手术组为27.5毫米（P = 0.003）。移位骨折影像学愈合的平均时间，非手术组为8.7周，手术组为7.4周（P = 0.02）。两组均无骨不连情况。手术组所有并发症均与局部内固定物突出有关。非手术组恢复活动的平均时间为16周，手术组为12周。非手术组有5例患者出现症状性骨畸形愈合，平均骨折缩短26毫米。其中4例患者选择切开矫形内固定，均实现骨折愈合且症状缓解。
移位锁骨中段骨折的钢板内固定能可靠地恢复长度和对线。骨折愈合时间更短，并发症发生率低。青少年移位骨折后症状性骨畸形愈合可能比之前认为的更常见。切开矫形钢板内固定可恢复锁骨解剖结构并消除骨畸形愈合相关症状。
治疗性III级。
