Lu Cheng-Chang, Liu Ping-Cheng, Huang Shih-Hao, Hsieh Chih-Hsin, Tien Yin-Chun, Chien Song-Hsiung
Orthopedics. 2014 Apr;37(4):e377-83. doi: 10.3928/01477447-20140401-60.
Intramedullary titanium elastic nails have been reported to fix displaced midclavicular fractures with excellent functional outcomes and minor complications. This study reports and analyzes the complications and technical pitfalls associated with titanium elastic nail fixation of displaced midclavicular fractures and describes how to prevent these problems. The authors operated on 27 patients (17 men, 10 women; mean age, 45.8 years; range, 16.5-66.9 years) with marked displaced midclavicular fractures using intramedullary titanium elastic nail fixation. The mean Constant score and Disability of the Arm, Shoulder, and Hand score were 93.58 (range, 66.5-100) and 6.22 (range, 0-35), respectively. The mean length difference compared with the contralateral clavicle was a shortening of 0.3 cm (range, -1.5 to 1 cm). Eight patients (30%) had different levels of difficulty at the medial entry point. Clavicular length shortening of more than 1 cm occurred in 5 patients (19%), and all of these patients experienced medial nail tip prominence/protrusion. One patient had 1-cm lengthening of the injured clavicle caused by distraction of the fracture site during titanium elastic nail insertion. Iatrogenic perforation of the posterolateral cortex occurred in 3 patients. Initial misplaced nail insertion occurred in 1 woman who underwent revision with the mini-open method. In 2 patients it was impossible to remove the full nail under general anesthesia. In conclusion, high patient satisfaction and functional outcomes were achieved after titanium elastic nail fixation of displaced midclavicular fractures. However, some complications and technical pitfalls must be considered before titanium elastic nails are used to fix displaced midclavicular fractures.
据报道，髓内钛弹性钉可用于固定移位的锁骨中段骨折，功能预后良好，并发症较少。本研究报告并分析了与钛弹性钉固定移位锁骨中段骨折相关的并发症及技术缺陷，并描述了如何预防这些问题。作者对27例（17例男性，10例女性；平均年龄45.8岁；范围16.5 - 66.9岁）有明显移位的锁骨中段骨折患者采用髓内钛弹性钉固定进行手术。Constant评分和上肢、肩部和手部功能障碍评分的平均值分别为93.58（范围66.5 - 100）和6.22（范围0 - 35）。与对侧锁骨相比，平均长度差为缩短0.3 cm（范围 - 1.5至1 cm）。8例患者（30%）在内侧进针点有不同程度的困难。5例患者（19%）出现锁骨长度缩短超过1 cm，所有这些患者均出现内侧钉尖突出。1例患者在插入钛弹性钉时因骨折部位牵张导致受伤锁骨延长1 cm。3例患者发生后外侧皮质医源性穿孔。1例女性患者初次插钉位置错误，采用微创方法进行了翻修。2例患者在全身麻醉下无法完全取出钉子。总之，钛弹性钉固定移位锁骨中段骨折后患者满意度高，功能预后良好。然而，在使用钛弹性钉固定移位锁骨中段骨折之前，必须考虑一些并发症和技术缺陷。
