Department of Pediatric Orthopaedic Surgery, Rady Children’s Hospital–San Diego, San Diego, CA, USA.
J Am Acad Orthop Surg. 2012 Aug;20(8):498-505. doi: 10.5435/JAAOS-20-08-498.
There is an increasing trend toward stabilization and fixation of markedly displaced midshaft clavicle fractures in adolescents. Recent studies in the adult literature have shown a greater prevalence of symptomatic malunion, nonunion, and poor functional outcomes after nonsurgical management of displaced fractures. Fixation of displaced midshaft clavicle fractures can restore length and alignment, resulting in shorter time to union. Symptomatic malunion after significantly displaced fractures in adolescents may be more common than previously thought. Adolescents often have high functional demands, and their remodeling potential is limited. Knowledge of bone biology and the effects of shortening, angulation, and rotation on shoulder girdle mechanics is critical in decision making in order to increase the likelihood of optimal results at skeletal maturity. Selection of fixation is dependent on many factors, including fracture type, patient age, skeletal maturity, and surgeon comfort.
青少年明显移位的锁骨中段骨折有稳定和固定的趋势。最近成人文献中的研究表明，对于移位骨折的非手术治疗，畸形愈合、不愈合和功能结果不佳的发生率更高。固定明显移位的锁骨中段骨折可以恢复长度和对线，从而缩短愈合时间。青少年明显移位骨折后的症状性畸形愈合可能比以前认为的更为常见。青少年通常功能需求较高，其重塑潜力有限。了解骨生物学以及缩短、成角和旋转对肩带力学的影响对于决策至关重要，以增加在骨骼成熟时获得最佳结果的可能性。固定的选择取决于许多因素，包括骨折类型、患者年龄、骨骼成熟度和外科医生的舒适度。
