Woltz Sarah, Sengab Alysia, Krijnen Pieta, Schipper Inger B
Department of Trauma Surgery, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
Arch Orthop Trauma Surg. 2017 Aug;137(8):1047-1053. doi: 10.1007/s00402-017-2734-7. Epub 2017 Jun 21.
Clavicular shortening due to non-anatomical healing of displaced clavicular fractures is believed to have a negative effect on shoulder function after recovery. The evidence for this, however, is equivocal. This review aimed to systematically evaluate the available literature to determine whether the current beliefs about clavicular shortening can be substantiated.
This systematic review was performed following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. PubMed, EMBASE, Web of Science and the Clinical Trial Registry were searched to identify all studies published in English that evaluated the association between clavicular shortening and shoulder function in patients aged ≥16 years with a nonoperatively treated, displaced midshaft clavicular fracture. Relevant data from the selected studies was extracted and summarized. Risk of bias of the included studies was assessed using the MINORS instrument.
Six studies, of which five were retrospective, were included in this review analyzing a total of 379 patients. Due to heterogeneity in methods and reporting across studies, a pooled analysis of the results was not feasible. No clear associations were found between shortening and shoulder function scores (DASH and Constant score) or arm strength in each of the included studies.
The existing evidence to date does not allow for a valid conclusion regarding the influence of shortening on shoulder function after union of nonoperatively treated midshaft clavicular fractures. Shortening alone is currently not an evidence-based indication to operate for the goal of functional improvement. Well-powered prospective comparative studies are needed to draw firm conclusions.
移位锁骨骨折非解剖愈合导致的锁骨缩短被认为会对恢复后的肩部功能产生负面影响。然而，对此的证据并不明确。本综述旨在系统评估现有文献，以确定目前关于锁骨缩短的观点是否能得到证实。
本系统综述按照系统评价和Meta分析的首选报告项目（PRISMA）声明进行。检索了PubMed、EMBASE、科学网和临床试验注册库，以识别所有用英文发表的研究，这些研究评估了年龄≥16岁、非手术治疗的移位锁骨中段骨折患者的锁骨缩短与肩部功能之间的关联。从所选研究中提取并汇总相关数据。使用MINORS工具评估纳入研究的偏倚风险。
本综述纳入了6项研究，其中5项为回顾性研究，共分析了379例患者。由于各研究在方法和报告方面存在异质性，对结果进行汇总分析不可行。在每项纳入研究中，未发现缩短与肩部功能评分（DASH和Constant评分）或手臂力量之间存在明确关联。
目前的现有证据无法就非手术治疗的锁骨中段骨折愈合后缩短对肩部功能的影响得出有效结论。目前，仅缩短本身并非基于证据的为改善功能而进行手术的指征。需要开展有充分说服力的前瞻性对照研究以得出确切结论。
