Marsalli Michael, Rojas José T, Barahona Maximiliano
Orthopaedic Department, Clínica Universidad De Los Andes, Santiago, CHL.
Orthopaedic Department, Hospital San José, Santiago, CHL.
Cureus. 2019 Aug 25;11(8):e5480. doi: 10.7759/cureus.5480.
Introduction There is a lack of information about the results of surgical treatment and complications in midshaft clavicle fracture non-unions. Our hypothesis was that there is no difference in functional outcomes between the surgical treatment of an acute displaced middle-third clavicle fracture and the surgical treatment of a chronic symptomatic non-union of a displaced middle-third clavicle fracture. Methods This was a case-control study. Fourteen cases were considered with a displaced midshaft clavicle fracture, initially treated non-surgically, but which developed symptomatic non-union and required surgical treatment. The control group was a cohort of 18 patients with a displaced midshaft clavicle fracture, who had surgical treatment in an acute setting (<3 weeks). Our cases had a median follow-up of 77 months and were retrospectively analyzed. All those in the control group had a 12-month prospective follow-up evaluation. The variables measured were Constant score, time to discharge to work, and bone union rate. Results The median Constant score at final follow-up for surgically treated non-unions was 87.5 (control group 84.5, p > 0.05). The median time to complete return to work was 3.2 months in the control group and 9.7 months in the case group (p=0.001). Hundred percent of those patients who were initially treated with surgery had bone union without other treatment. Two out of 14 cases required a second surgery with a plate and bone graft to achieve bone union. Conclusion Symptoms from displaced midshaft clavicular fracture non-unions are due to related pain and dysfunctional deficits that result from displacement and shortening. According to our study, patients with a displaced midshaft clavicle fracture non-union who needed surgery achieved similar functional results as compared to patients treated in an acute setting for a displaced midshaft clavicle fracture. The median time to discharge and return to work was more than doubled in the non-union surgery group.
关于中段锁骨骨折不愈合的手术治疗结果及并发症的信息匮乏。我们的假设是，急性移位的中1/3锁骨骨折的手术治疗与慢性有症状的移位中1/3锁骨骨折不愈合的手术治疗在功能结局上没有差异。方法：这是一项病例对照研究。纳入14例中段锁骨骨折移位患者，最初采用非手术治疗，但发展为有症状的不愈合并需要手术治疗。对照组为18例中段锁骨骨折移位患者，在急性期（<3周）接受手术治疗。我们的病例中位随访77个月并进行回顾性分析。对照组所有患者进行12个月的前瞻性随访评估。测量的变量包括Constant评分、恢复工作时间和骨愈合率。结果：手术治疗不愈合患者末次随访时的中位Constant评分为87.5（对照组为84.5，p>0.05）。对照组完全恢复工作的中位时间为3.2个月，病例组为9.7个月（p=0.001）。最初接受手术治疗的患者100%无需其他治疗即实现骨愈合。14例中有2例需要二次手术并植骨以实现骨愈合。结论：移位的中段锁骨骨折不愈合的症状是由移位和缩短导致的相关疼痛及功能障碍缺陷引起的。根据我们的研究，需要手术治疗的移位中段锁骨骨折不愈合患者与急性期接受手术治疗的移位中段锁骨骨折患者相比，功能结果相似。不愈合手术组出院和恢复工作的中位时间增加了一倍多。
