Richardson Martin, Asadollahi Saeed, Richardson Louise
Department of Orthopaedic, Epworth Healthcare, Richmond VIC 3121, Australia.
Int J Shoulder Surg. 2013 Apr;7(2):52-8. doi: 10.4103/0973-6042.114227.
A new and simple operative technique has been developed to provide internal fixation for midshaft clavicle fractures. This involves the use of a large fragment Herbert Screw that is entirely embedded within the bone. Screw fixation is combined with bone grafting from intramedullary reamings of the fracture fragments. The purpose of this report is to assess the outcomes following treatment of midshaft clavicular fracture using this method.
One hundred and fourteen patients with acute displaced midshaft fracture were identified between 2002 and 2007. All patients were followed until fracture union. Patients' medical records were reviewed. Disability of the Arm, Shoulder, and Hand questionnaire (DASH), and American Shoulder and Elbow Surgeons Elbow form (ASES) were posted to all patients. Outcome measures included union rate, time to union, implant removal rate, DASH, and ASES scores.
Patients' median age was 29.5 years (interquartile range, 19-44 years). The most common injury mechanism was sports injury (28%). The median time from injury to surgery was 5 days (interquartile range, 2-9 days). Union occurred in an average of 8.8 weeks. Non-union occurred in three cases (2.6%). The re-operation rate for symptomatic hardware prominence screw was 1.7%. The median DASH score was 0.83 and the median ASES was 100 (n = 35).
Intramedullary fixation using cannulated Herbert screw can be used as an effective approach for operative management of midshaft clavicular fractures. Using this method, an appropriate outcome could be achieved and a second intervention for implant removal could be avoided in great majority of cases.
Level III.
已研发出一种新型简单的手术技术，用于锁骨中段骨折的内固定。该技术采用完全植入骨内的大骨折块Herbert螺钉。螺钉固定与取自骨折碎片髓腔内锉屑的骨移植相结合。本报告旨在评估采用此方法治疗锁骨中段骨折后的疗效。
2002年至2007年间确定了114例急性移位性锁骨中段骨折患者。所有患者均随访至骨折愈合。查阅患者病历。向所有患者发放上肢、肩部和手部功能障碍问卷（DASH）以及美国肩肘外科医生肘关节表格（ASES）。疗效指标包括愈合率、愈合时间、内固定取出率、DASH评分和ASES评分。
患者的中位年龄为29.5岁（四分位间距为19 - 44岁）。最常见的损伤机制是运动损伤（28%）。受伤至手术的中位时间为5天（四分位间距为2 - 9天）。平均8.8周实现骨折愈合。3例（2.6%）出现骨不连。因内固定螺钉突出有症状而行再次手术的比例为1.7%。DASH评分的中位数为0.83，ASES评分的中位数为100（n = 35）。
使用空心Herbert螺钉进行髓内固定可作为锁骨中段骨折手术治疗的有效方法。采用此方法可取得满意疗效，且在大多数情况下可避免进行二次内固定取出干预。
三级。
