Eichinger Josef K, Balog Todd P, Grassbaugh Jason A
From the Orthopaedic Surgery Service, Madigan Army Medical Center, Tacoma, WA.
J Am Acad Orthop Surg. 2016 Jul;24(7):455-64. doi: 10.5435/JAAOS-D-14-00336.
Historically, management of displaced midshaft clavicle fractures has consisted of nonsurgical treatment. However, recent literature has supported surgical repair of displaced and shortened clavicle fractures. Several options exist for surgical fixation, including plate and intramedullary (IM) fixation. IM fixation has the potential advantages of a smaller incision and decreased dissection and soft-tissue exposure. For the last two decades, the use of Rockwood and Hagie pins represented the most popular form of IM fixation, but concerns exist regarding stability and complications. The use of alternative IM implants, such as Kirschner wires, titanium elastic nails, and cannulated screws, also has been described in limited case series. However, concerns persist regarding the complications associated with the use of these implants, including implant failure, migration, skin complications, and construct stability. Second-generation IM implants have been developed to reduce the limitations of earlier IM devices. Although anatomic and clinical studies have supported IM fixation of midshaft clavicle fractures, further research is necessary to determine the optimal fixation method.
从历史上看，中段锁骨移位骨折的治疗一直采用非手术方法。然而，最近的文献支持对移位和缩短的锁骨骨折进行手术修复。手术固定有多种选择，包括钢板和髓内（IM）固定。IM固定具有切口较小、解剖和软组织暴露减少的潜在优势。在过去的二十年里，使用Rockwood和Hagie针是最流行的IM固定形式，但存在稳定性和并发症方面的问题。在有限的病例系列中也描述了使用其他IM植入物，如克氏针、钛弹性钉和空心螺钉。然而，对于使用这些植入物相关的并发症，包括植入物失败、移位、皮肤并发症和结构稳定性，人们仍然存在担忧。已开发出第二代IM植入物以减少早期IM装置的局限性。尽管解剖学和临床研究支持中段锁骨骨折的IM固定，但仍需要进一步研究以确定最佳固定方法。
