Robinson Luke, Gargoum Riyad, Auer Ron, Nyland John, Chan Gilbert
School of Medicine, University of Louisville, Louisville, KY, USA.
School of Medicine, University of Louisville, Louisville, KY, USA.
Injury. 2015 Jul;46(7):1372-6. doi: 10.1016/j.injury.2015.04.019. Epub 2015 Apr 23.
There is a relative paucity of high-level evidence that guides the treatment of displaced midshaft clavicle fractures in adolescents. Some use overhead sports or significant shortening as relative indications for surgical treatment, while others rarely consider operative intervention for these patients. The purpose of this study is to determine the effect of overhead sports participation and fracture shortening on subjective and objective outcomes after nonoperative treatment of displaced midshaft clavicle fractures in those aged 10-17 years.
Using a radiographic database, adolescents with displaced clavicle fractures were identified and contacted over the phone. These subjects were invited to take part in the study in return for compensation. Radiographic measurements of dedicated clavicle films around the time of injury were performed, and a custom survey aimed at elucidating participation in overhead or contact sports was given. The Nottingham Clavicle Score (NCS) and the Constant Shoulder Score were obtained for each patient to provide both subjective and objective outcome data. Statistical Package for Social Science (SPSS) software (version 22, IBM) was used to compare radiographic and sports data to the outcome measures.
Gender, age at the time of fracture, time since fracture, relative and absolute radiographic shortening, and hand dominance were all not significantly correlated with subjective or objective outcomes. Five patients (23%) reported not feeling happy with the appearance of their shoulder at the beach or at the pool. This group had statistically lower NCS results. Eleven of 22 participated in ≥6 months per year of overhead or contact sports; they did not have worse subjective or objective outcomes.
Fracture shortening and sports participation do not have a significant impact in adolescents on outcomes after displaced midshaft clavicle fracture.
目前缺乏高水平证据来指导青少年中段锁骨移位骨折的治疗。一些人将从事过头运动或明显短缩作为手术治疗的相对指征，而另一些人则很少考虑对这些患者进行手术干预。本研究的目的是确定在10 - 17岁的青少年中，从事过头运动和骨折短缩对中段锁骨移位骨折非手术治疗后主观和客观结果的影响。
利用影像学数据库识别出锁骨骨折移位的青少年，并通过电话联系他们。这些受试者被邀请参与研究以获取报酬。对受伤时的锁骨专用X线片进行测量，并进行一项旨在阐明参与过头或接触性运动情况的定制调查。为每位患者获取诺丁汉锁骨评分（NCS）和康斯坦特肩关节评分，以提供主观和客观的结果数据。使用社会科学统计软件包（SPSS）软件（版本22，IBM）将影像学和运动数据与结果指标进行比较。
性别、骨折时年龄、骨折后时间、相对和绝对影像学短缩以及利手均与主观或客观结果无显著相关性。5名患者（23%）表示对自己在海滩或泳池时肩部的外观不满意。这组患者的NCS结果在统计学上较低。22名患者中有11名每年参与≥6个月的过头或接触性运动；他们的主观或客观结果并不更差。
在青少年中段锁骨移位骨折后，骨折短缩和运动参与对结果没有显著影响。
