Randsborg Per-Henrik, Fuglesang Hendrik F S, Røtterud Jan H, Hammer Ola-Lars, Sivertsen Einar A
*Health Services Research Unit (HØKH) †Department of Orthopaedic Surgery, Akershus University Hospital ‡Institute of Clinical Medicine, University of Oslo, Lørenskog, Norway.
J Pediatr Orthop. 2014 Jun;34(4):393-9. doi: 10.1097/BPO.0000000000000082.
Fractures of the clavicle are common among adolescents and have traditionally been treated nonoperatively. Recent literature has demonstrated less satisfactory results than expected after conservative management of displaced fractures in adults. The purpose of this study was to evaluate the long-term patient-reported outcome after clavicle fractures in older children and adolescents.
Children aged 10 to 18 years who sustained a fracture of the clavicle between 2006 and 2008 were identified in our institution's computerized files. The radiographs were examined and the fracture patterns, degree of dislocation, and shortening were measured. Medical records were reviewed and the patient-reported outcome was assessed using the Oxford Shoulder score and the Quick version of the Disability of Arm, Shoulder, and Hand questionnaire, and specific and general satisfaction scores.
A total of 185 patients (median age, 14.4 y) with 172 midshaft and 13 lateral fractures were included in the study. Sixty-five (37.8%) of the midshaft fractures were displaced, and 9 of these were operated. There was one case of nonunion and one delayed union. One hundred twenty-two (70.9%) of the patients with a midshaft fracture responded to the questionnaires on an average 4.7 years after injury. Overall results were good to excellent for the majority of nonoperatively treated patients; however, shortening of the fracture had a negative effect on the Oxford Shoulder score (P=0.02), the cosmetic satisfaction score (P=0.02), and the overall satisfaction score (P=0.01).
The long-term patient-reported outcome after nonoperatively treated fractures of the clavicle in adolescents is good to excellent for the majority of the patients, and nonunion is rare. However, shortening of the fracture had a small negative effect on the outcome. Conservative management should remain the mainstay of management for fractures of the clavicle in this age group.
Level IV-retrospective case series.
锁骨骨折在青少年中很常见，传统上采用非手术治疗。最近的文献表明，成人移位骨折保守治疗后的结果不如预期。本研究的目的是评估大龄儿童和青少年锁骨骨折后患者报告的长期结局。
在我们机构的计算机文件中识别出2006年至2008年间发生锁骨骨折的10至18岁儿童。检查X线片并测量骨折类型、脱位程度和缩短情况。查阅病历，使用牛津肩部评分、手臂、肩部和手部残疾快速问卷以及特定和总体满意度评分评估患者报告的结局。
本研究共纳入185例患者（中位年龄14.4岁），其中172例为中段骨折，13例为外侧骨折。65例（37.8%）中段骨折发生移位，其中9例接受了手术治疗。发生1例骨不连和1例延迟愈合。122例（70.9%）中段骨折患者在受伤后平均4.7年对问卷进行了回复。大多数非手术治疗患者的总体结果良好至优秀；然而，骨折缩短对牛津肩部评分（P=0.02）、美容满意度评分（P=0.02）和总体满意度评分（P=0.01）有负面影响。
青少年锁骨骨折非手术治疗后的长期患者报告结局对大多数患者来说良好至优秀，骨不连罕见。然而，骨折缩短对结局有轻微负面影响。保守治疗应仍然是该年龄组锁骨骨折治疗的主要方法。
IV级——回顾性病例系列。
