Ashman Bradley D, Slobogean Gerard P, Stone Trevor B, Viskontas Darius G, Moola Farhad O, Perey Bertrand H, Boyer Dory S, McCormack Robert G
Department of Orthopaedics, University of British Columbia, Canada.
Division of Orthopaedic Trauma, Department of Orthopaedics, University of British Columbia, Canada.
Injury. 2014 Oct;45(10):1549-53. doi: 10.1016/j.injury.2014.04.032. Epub 2014 Apr 28.
Operative fixation of displaced, mid-shaft clavicle fractures has become an increasingly common practice. With this emerging trend, data describing patient outcomes with longer follow-up are necessary.
We retrospectively reviewed the medical records of subjects treated with plate fixation for displaced mid-shaft clavicle fractures from 2003 to 2009 at a Level I trauma hospital. All subjects were greater than 12 months post-index surgery. Treatment involved ORIF with either a low-contact dynamic compression plate (LCDC) or a contoured plate (pre-contoured or pelvic reconstruction plate). Our primary outcome was reoperation for any indication.
143 subjects were included. The mean age was 36 ± 14 years and the mean time to reoperation or chart review was 33 months. Contoured plates were used in 64% of cases and LCDC plates were used in the remaining subjects. Twenty-nine subjects (20%) underwent reoperation: 23.5% of subjects treated with LCDC plates and 18.5% of subjects treated with contoured plates (p=0.52). Indications for reoperation included implant irritation (n=25), implant failure (n=2), and non-union (n=2). There was near statistically significant association with reoperation and female gender (p=0.05) but no association between reoperation and age (p=0.14), fracture class (p=0.53), plate type (p=0.49), or plate location (p=0.93). The mean QuickDASH score for the population surveyed was 8.8 (5.5-12.1; 95% CI) with near statistically significant and clinically relevant difference between those considering reoperation and those not 22.3 (8.6-36.0; 95% CI) versus 6.7 (3.6-9.8; 95% CI).
This study represents a large series of displaced clavicle fractures treated with open reduction and plate fixation. Reoperation following plate fixation is relatively common, but primarily due to implant irritation. No difference in reoperation rates between plate types or location could be detected in our current sample size. Also, excellent functional outcomes continue to be observed several years after clavicle fracture fixation.
对移位的锁骨中段骨折进行手术固定已变得越来越普遍。随着这一趋势的出现，有必要获取关于更长随访期患者预后的数据。
我们回顾性分析了2003年至2009年在一家一级创伤医院接受钢板固定治疗移位锁骨中段骨折患者的病历。所有患者均在初次手术后超过12个月。治疗采用切开复位内固定术，使用低接触动力加压钢板（LCDC）或塑形钢板（预塑形或骨盆重建钢板）。我们的主要结局指标是因任何原因进行再次手术。
共纳入143例患者。平均年龄为36±14岁，再次手术或病历复查的平均时间为33个月。64%的病例使用了塑形钢板，其余患者使用了LCDC钢板。29例患者（20%）接受了再次手术：使用LCDC钢板治疗的患者中有23.5%，使用塑形钢板治疗的患者中有18.5%（p=0.52）。再次手术的指征包括植入物刺激（n=25）、植入物失败（n=2）和骨不连（n=2）。再次手术与女性性别之间存在接近统计学意义的关联（p=0.05），但再次手术与年龄（p=0.14）、骨折类型（p=0.53）、钢板类型（p=0.49）或钢板位置（p=0.93）之间无关联。所调查人群的平均QuickDASH评分为8.8（5.5 - 12.1；95%可信区间），考虑再次手术的患者与未考虑再次手术的患者之间存在接近统计学意义且具有临床相关性的差异，分别为22.3（8.6 - 36.0；95%可信区间）和6.7（3.6 - 9.8；95%可信区间）。
本研究代表了一大系列采用切开复位钢板固定治疗的移位锁骨骨折病例。钢板固定后再次手术较为常见，但主要原因是植入物刺激。在我们当前的样本量中，未检测到钢板类型或位置在再次手术率方面的差异。此外，在锁骨骨折固定数年之后仍观察到良好的功能结局。
