Ranalletta Maximiliano, Rossi Luciano A, Barros Hugo, Nally Francisco, Tanoira Ignacio, Bongiovanni Santiago L, Maignon Gastón D
Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi Italian Hospital of Buenos Aires, Buenos Aires, Argentina.
Am J Sports Med. 2017 Feb;45(2):462-467. doi: 10.1177/0363546516666816. Epub 2016 Oct 7.
Early union and a rapid return to prior function are the priorities for young athletes with lateral clavicular fractures. Furthermore, it is essential to avoid nonunion in this subgroup of patients, as this is frequently associated with persistent pain, restriction of movement, and loss of strength and endurance of the shoulder.
To analyze the time to return to sport, functional outcomes, and complications in a group of athletes with displaced lateral clavicular fractures treated using closed reduction and minimally invasive double-button fixation.
Case series; Level of evidence, 4.
A total of 21 athletes with displaced lateral clavicular fractures were treated with closed reduction and minimally invasive double-button fixation between March 2008 and October 2013. Patients completed a questionnaire focused on the time to return to sport and treatment course. Functional outcomes were assessed with the Constant score and the short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire. Pain was evaluated with the visual analog scale (VAS). Radiographs were reviewed to identify radiographic union, malunion, and nonunion.
Of the 21 study patients, 20 returned to sport after treatment; 100% returned to the same level. The mean time to return to play was 78 days (range, 41-120 days). Four patients (20%) returned to sport less than 6 weeks after surgery, 14 (70%) returned between 6 and 12 weeks after surgery, and 2 (10%) returned after 12 weeks. The mean Constant score was 89.1 ± 4.2 (range, 79-100), the mean QuickDASH score was 0.4 ± 2.6 (range, 0-7.1), and the mean VAS pain score was 0.4 ± 1.0 (range, 0-3) at final follow-up (mean, 41 months). The only complication was asymptomatic nonunion. Hardware removal was not necessary in any patient.
Closed reduction and minimally invasive double-button fixation of displaced lateral clavicular fractures in athletes was successful in terms of returning to the previous level of athletic activity regardless of the type of sport, with excellent clinical results and a low rate of complications.
早期愈合以及迅速恢复至伤前功能是年轻锁骨外侧骨折运动员的首要目标。此外，对于这一亚组患者而言，避免骨不连至关重要，因为骨不连常伴有持续疼痛、活动受限以及肩部力量和耐力丧失。
分析一组采用闭合复位和微创双纽扣内固定治疗的移位性锁骨外侧骨折运动员的恢复运动时间、功能结果及并发症情况。
病例系列；证据等级，4级。
2008年3月至2013年10月期间，共有21例移位性锁骨外侧骨折运动员接受了闭合复位和微创双纽扣内固定治疗。患者完成了一份关于恢复运动时间和治疗过程的问卷。采用Constant评分和手臂、肩部和手部功能障碍简表（QuickDASH）问卷评估功能结果。采用视觉模拟量表（VAS）评估疼痛情况。复查X线片以确定影像学愈合、畸形愈合和骨不连情况。
21例研究患者中，20例治疗后恢复运动；100%恢复至之前的运动水平。恢复运动的平均时间为78天（范围41 - 120天）。4例患者（20%）术后不到6周恢复运动，14例（70%）在术后6至12周恢复运动，2例（10%）在12周后恢复运动。末次随访（平均41个月）时，平均Constant评分为89.1±4.2（范围79 - 100），平均QuickDASH评分为0.4±2.6（范围0 - 7.1），平均VAS疼痛评分为0.4±1.0（范围0 - 3）。唯一的并发症是无症状性骨不连。所有患者均无需取出内固定物。
对于运动员移位性锁骨外侧骨折，无论运动项目类型如何，闭合复位和微创双纽扣内固定在恢复至伤前运动水平方面均取得成功，临床效果良好且并发症发生率低。
