Chen Xiaobin, Shannon Steven F, Torchia Michael, Schoch Bradley
Institute of Orthopaedics, Chinese PLA, Beijing Army General Hospital, Beijing, China.
Department of Orthopedic Surgery, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA.
Arch Orthop Trauma Surg. 2017 Jun;137(6):749-754. doi: 10.1007/s00402-017-2676-0. Epub 2017 Apr 3.
The clavicle exhibits considerable movement in three planes making rigid fixation challenging. The addition of a second plate may be considered to improve fixation rigidity, but risks compromising the blood supply to the fracture site. The purpose of this study is to assess if extraperiosteal dual plate fixation increases the rate of non-union, reoperation, and complications at 1 year for surgically treated acute mid-shaft clavicle fractures.
Between June 1998 and June 2013, surgically treated mid-shaft clavicle fractures undergoing open reduction internal fixation within 4 weeks of injury were retrospectively reviewed. Patients undergoing single plate fixation were compared to dual plate fixation. Patients were followed for a minimum of 1 year. Charts were reviewed to assess union rates, reoperation, and complications.
One hundred and sixty-three clavicles (125 single plates, 34 dual plates) were evaluated. All patients (100%) in dual plating group and one hundred and fourteen (91%) in single plating group obtained bony union by 1 year (p = 0.13). Six patients (4.8%) experienced a non-union in the single plating cohort compared to the dual plating cohort who had a 100% union rate. Seven patients required reoperation in the single plate cohort due to implant failure (N = 4), infection (N = 2), and non-union (N = 1).
This limited series of patients demonstrates dual plate fixation is a reliable option for acute mid-shaft clavicle fractures, with excellent union rates and low complication rates. Compared to single plate fixation, no significant differences in outcomes were identified. In the case of more complex fracture patterns, application of a second extraperiosteal plate may be utilized without compromising healing or increasing complication rates.
锁骨在三个平面上有相当大的活动度，这使得坚固固定具有挑战性。可考虑增加一块钢板以提高固定的坚固性，但存在损害骨折部位血供的风险。本研究的目的是评估对于手术治疗的急性锁骨中段骨折，骨膜外双钢板固定是否会增加1年时骨不连、再次手术及并发症的发生率。
回顾性分析1998年6月至2013年6月期间，在伤后4周内行切开复位内固定术治疗的锁骨中段骨折患者。将接受单钢板固定的患者与双钢板固定的患者进行比较。对患者进行至少1年的随访。查阅病历以评估骨愈合率、再次手术情况及并发症。
共评估了163例锁骨骨折患者（125例单钢板固定，34例双钢板固定）。双钢板固定组的所有患者（100%）和单钢板固定组的114例患者（91%）在1年时获得了骨愈合（p = 0.13）。单钢板固定组有6例患者（4.8%）发生骨不连，而双钢板固定组的骨愈合率为100%。单钢板固定组有7例患者因植入物失败（4例）、感染（2例）和骨不连（1例）需要再次手术。
这一有限系列的患者表明，双钢板固定是急性锁骨中段骨折的可靠选择，骨愈合率高且并发症发生率低。与单钢板固定相比，未发现结果有显著差异。对于更复杂的骨折类型，应用第二块骨膜外钢板可能不会影响愈合或增加并发症发生率。
