Duralde Xavier A, Pennington Scott D, Murray Douglas H
Peachtree Orthopaedic Clinic, Atlanta, GA.
J Orthop Trauma. 2014 Nov;28(11):653-8. doi: 10.1097/BOT.0000000000000122.
Stable fixation of displaced type II distal clavicle fractures presents a challenge to the surgeon because of distal fragment comminution and the large deforming forces created by the weight of the arm. We hypothesized that suture fixation around the coracoid and interfragmentary suture fixation would adequately counteract these forces and lead to a high rate of union and restoration of function.
This is a retrospective study of 20 sequential patients treated between 1997 and 2009.
In-patient operating room followed by the clinic.
PATIENTS/PARTICIPANTS: All patients presenting with acute displaced distal clavicle fractures to 2 surgeons were included. All patients completed the study without loss to follow-up.
Open repair was performed by placing two #5 Fiberwire sutures around the coracoid and through drill holes in the clavicular shaft. Interfragmentary fixation was performed with figure-of-eight #2 Fiberwire sutures.
Patients evaluation included the American Shoulder and Elbow Surgeons scale, range of motion, radiographic evaluation, and patient satisfaction.
All fractures healed without loss of reduction at an average of 2.6 months, and all patients were satisfied. American Shoulder and Elbow Surgeons score was 98.5 out of 100. Average follow-up was 7.1 years (range, 3.1-14.3 years). One postoperative wound hematoma and one superficial wound infection were treated nonoperatively.
Interfragmentary and coracoclavicular suture fixation for displaced acute distal clavicle fractures is a safe and effective treatment with an excellent union rate, low complication rate, and high patient satisfaction.
Therapeutic level IV. See instructions for authors for a complete description of levels of evidence.
由于锁骨远端骨折块粉碎以及手臂重量产生的巨大变形力，移位的Ⅱ型锁骨远端骨折的稳定固定给外科医生带来了挑战。我们推测，喙突周围缝线固定和骨折块间缝线固定能够充分抵消这些力，并导致高愈合率和功能恢复。
这是一项对1997年至2009年间连续治疗的20例患者的回顾性研究。
住院手术室及随后的门诊。
患者/参与者：纳入了向2位外科医生就诊的所有急性移位性锁骨远端骨折患者。所有患者均完成研究，无失访。
通过在喙突周围放置两根5号Fiberwire缝线并穿过锁骨骨干的钻孔进行开放修复。采用8字形2号Fiberwire缝线进行骨折块间固定。
患者评估包括美国肩肘外科医生评分、活动范围、影像学评估和患者满意度。
所有骨折平均在2.6个月时愈合，无复位丢失，所有患者均满意。美国肩肘外科医生评分为98.5分（满分100分）。平均随访7.1年（范围3.1 - 14.3年）。1例术后伤口血肿和1例表浅伤口感染经非手术治疗。
对于移位的急性锁骨远端骨折，骨折块间和喙锁缝线固定是一种安全有效的治疗方法，具有优良的愈合率、低并发症发生率和高患者满意度。
治疗性IV级。有关证据级别的完整描述，请参阅作者指南。
