Ranalletta Maximiliano, Rossi Luciano A, Bongiovanni Santiago L, Tanoira Ignacio, Piuzzi Nicolas S, Maignon Gaston
Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi, Italian Hospital of Buenos Aires, Buenos Aires, Argentina.
Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi, Italian Hospital of Buenos Aires, Buenos Aires, Argentina.
J Shoulder Elbow Surg. 2015 Jul;24(7):1036-40. doi: 10.1016/j.jse.2014.12.013. Epub 2015 Feb 7.
Plate fixation of displaced midshaft clavicular fractures has been shown to decrease nonunion, symptomatic malunion, and residual shoulder disability compared with nonoperative treatment. However hardware-related complications are a problem. The new features of the precontoured locking plates may reduce the need for hardware removal, thus maintaining the advantages of plate fixation. This study evaluated the clinical outcomes of patients with displaced midshaft clavicular fractures treated with precontoured locking plates.
From November 2008 to December 2012, we surgically treated 72 patients with displaced midshaft clavicular fractures. We retrospectively evaluated 68 patients who underwent 68 interventions. Postoperative functional outcomes were assessed with the Constant score, the 11-item version of the Disabilities of Arm, Shoulder and Hand (QuickDASH) questionnaire, and radiographs. Pain was subjectively assessed with a visual analog scale. Complications were recorded. Patients were asked if they were able to return to their previous employment level.
The mean follow-up period was 23.6 ± 10.7 months. The average values of the Constant, QuickDASH, and visual analog scale scores were 97.8, 1.8, and 0.4 points, respectively. At the last follow-up, 98.5% were able to return to their regular work. Of 15 complications (22.1%) that occurred, only 3 were considered as major: 1 subclavian vein extrinsic compression, 1 nonunion, and 1 hardware loosening. Hardware removal was required in 9 patients (13.2%).
Satisfactory clinical results with a low rate of complications were achieved with precontoured locking plates for displaced midshaft clavicular fractures and a low rate of hardware removal compared with traditional plates.
与非手术治疗相比，钢板固定移位的锁骨中段骨折已被证明可减少骨不连、有症状的畸形愈合和残留的肩部功能障碍。然而，与硬件相关的并发症是一个问题。预塑形锁定钢板的新特性可能会减少取出内固定物的需求，从而保持钢板固定的优势。本研究评估了采用预塑形锁定钢板治疗移位锁骨中段骨折患者的临床疗效。
2008年11月至2012年12月，我们对72例移位锁骨中段骨折患者进行了手术治疗。我们回顾性评估了68例接受68次干预的患者。术后功能结果采用Constant评分、手臂、肩部和手部功能障碍11项问卷（QuickDASH）以及X线片进行评估。疼痛采用视觉模拟量表进行主观评估。记录并发症情况。询问患者是否能够恢复到以前的工作水平。
平均随访期为23.6±10.7个月。Constant、QuickDASH和视觉模拟量表评分的平均值分别为97.8、1.8和0.4分。在最后一次随访时，98.5%的患者能够恢复正常工作。在发生的15例并发症（22.1%）中，只有3例被认为是严重的：1例锁骨下静脉外在压迫、1例骨不连和1例内固定松动。9例患者（13.2%）需要取出内固定物。
对于移位的锁骨中段骨折，预塑形锁定钢板取得了令人满意的临床结果，并发症发生率低，与传统钢板相比，取出内固定物的比例也低。
