Niikura Takahiro, Lee Sang Yang, Sakai Yoshitada, Nishida Kotaro, Kuroda Ryosuke, Kurosaka Masahiro
Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan.
Case Rep Med. 2012;2012:407349. doi: 10.1155/2012/407349. Epub 2012 Dec 25.
We describe a case of radiation-associated fracture nonunion of the clavicle, which was treated by locking plate fixation and autologous bone grafting. The patient was a 67-year old man who received 70 Gy radiation therapy to treat nasopharyngeal carcinoma. Eight years later, he suffered a pathological fracture of the right clavicle. One year after the fracture, surgical treatment was performed due to persistent pain and weakness. Radiographs demonstrated atrophic nonunion. Bone scan demonstrated hot uptake at both ends of the fractured bone. MRI demonstrated a formation of pseudoarthrosis with fluid collection and suggested bone marrow edema at both ends of the fracture fragments. In surgery, fibrous pseudoarthrosis tissue was excised and both ends of the fracture fragments were refreshed to identify bleeding. Open reduction and internal fixation using a 7-hole locking plate and autologous bone grafting were performed. Successful bony union was obtained 1 year postoperatively, and no adverse events were observed up to 52 months after the operation. Our case suggests that a locking plate provides sufficient fixation and autologous bone grafting is effective in enhancing bone healing in a radiation-associated fracture nonunion of the clavicle in which it is difficult to achieve bony union.
我们描述了一例锁骨放射性骨折不愈合的病例，该病例采用锁定钢板固定和自体骨移植进行治疗。患者为一名67岁男性，曾接受70 Gy放射治疗以治疗鼻咽癌。八年后，他右侧锁骨发生病理性骨折。骨折一年后，由于持续疼痛和无力而进行了手术治疗。X线片显示为萎缩性不愈合。骨扫描显示骨折两端放射性摄取增加。MRI显示形成了伴有液体积聚的假关节，并提示骨折碎片两端存在骨髓水肿。手术中，切除纤维性假关节组织，对骨折碎片两端进行清创以确定有出血情况。采用7孔锁定钢板进行切开复位内固定并进行自体骨移植。术后1年获得了成功的骨愈合，术后52个月未观察到不良事件。我们的病例表明，锁定钢板提供了足够的固定，自体骨移植对于促进锁骨放射性骨折不愈合（难以实现骨愈合）的骨愈合是有效的。
