Steadman Clinic & Steadman Philippon Research Institute, Vail, CO, USA.
J Shoulder Elbow Surg. 2011 Jan;20(1):86-91. doi: 10.1016/j.jse.2010.07.009. Epub 2010 Nov 3.
Recent studies have demonstrated better outcomes with operative fixation of displaced midshaft clavicle fractures. We hypothesize that the risk of major complication with intramedullary fixation for clavicle fractures will be low.
Clavicle fractures in 58 patients were treated with intramedullary fixation. Patients were excluded for concomitant pathologies and prior surgery status. Data collected included age, gender, treatment, fracture location, time of pin removal, type of complication, dates of further surgery, and American Shoulder and Elbow Surgeons (ASES) score. Complications were grouped into major (infection, nonunion, malunion) and minor (skin erosion, painful hardware, hardware breakage without consequence) categories. The mean age at surgery was 38 years (range, 18-67 years). All pins were removed at an average of 67 days (95% confidence interval, 54-85).
Of the 58 patients, 15 (25.8%) complications occurred in 14 patients (24.1%). Five (8.6%) were classified as major (5 nonunions requiring revision surgery). Ten (17.2%) were classified as minor (1 delayed union, 2 superficial wound infections, 2 hardware failures after union, 5 skin erosions with pin exposure but without significant infection). Postoperative ASES scores average 89 at a mean follow-up of 7 years.
Complete union and function were achieved in most patients, with an 8.6% risk of major complication. Intramedullary fixation has the potential for early but temporary hardware prominence, hardware exposure, and a slightly higher incidence of nonunion.
Patients with intramedullary fixation can expect smaller scars, no long-term hardware complications, and small potential for refracture or further hardware-related complications after hardware removal.
最近的研究表明，移位的锁骨中段骨折的手术固定可获得更好的结果。我们假设锁骨骨折髓内固定的主要并发症风险较低。
对 58 例锁骨骨折患者采用髓内固定治疗。排除合并症和既往手术史的患者。收集的数据包括年龄、性别、治疗方法、骨折部位、针去除时间、并发症类型、进一步手术日期以及美国肩肘外科医师协会（ASES）评分。并发症分为主要（感染、不愈合、畸形愈合）和次要（皮肤侵蚀、疼痛性内固定物、内固定物断裂但无后果）两类。手术时的平均年龄为 38 岁（范围，18-67 岁）。所有的针都在平均 67 天（95%置信区间，54-85）去除。
在 58 例患者中，14 例患者（24.1%）发生了 15 例（25.8%）并发症。其中 5 例（8.6%）为主要并发症（5 例不愈合需行翻修手术）。10 例（17.2%）为次要并发症（1 例延迟愈合，2 例浅表伤口感染，2 例愈合后内固定物失效，5 例皮肤侵蚀伴针外露但无明显感染）。术后平均 ASES 评分为 89 分，平均随访 7 年。
大多数患者都实现了完全愈合和功能恢复，主要并发症的风险为 8.6%。髓内固定具有早期但暂时的内固定物突出、内固定物暴露的风险，以及稍高的不愈合发生率。
髓内固定的患者可以期待更小的疤痕，没有长期的内固定物并发症，并且在去除内固定物后，再次骨折或进一步与内固定物相关的并发症的潜在风险较小。
