Department of Orthopedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Department of Orthopedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
J Shoulder Elbow Surg. 2021 Mar;30(3):679-684. doi: 10.1016/j.jse.2020.06.035. Epub 2020 Jul 12.
Clavicle nonunions often result after nonoperative treatment for the acute fracture. Those that require >1 surgical procedure in order for a nonunion to heal are termed recalcitrant. The aims of the present study were to (1) determine healing rates of clavicle nonunions after plate osteosynthesis using either a conventional or locked plate, (2) compare iliac crest bone graft vs. bone morphogenetic protein on nonunion healing, and (3) identify risk factors for the development of a recalcitrant nonunion.
We performed a retrospective analysis of a prospectively collected database of 78 clavicle nonunions treated with open reduction and plate fixation with or without graft augmentation by a single surgeon over 25 years. Seventy-one patients over the age of 18 with at least 12 months of follow-up comprised the study group. We analyzed healing rates after the index clavicle nonunion surgery comparing plate type and graft technique as well as identifying risk factors for developing a recalcitrant nonunion.
A total of 62 patients (87.3%) healed after their index nonunion surgery at our institution. Three patients (4.2%) required additional surgery but healed, and 6 patients (8.5%) remain un-united; these 9 patients (12.7%) were defined as recalcitrant. There was no statistically significant difference in healing rates between plate type (P = .633) or type of bone graft (P = .157). There were no identifiable risk factors for the development of a recalcitrant nonunion.
Plate fixation of clavicle nonunions remains a successful method of treatment. The type of plate or the method of bone graft did not produce different results. There were no demographic, patient, or injury characteristics associated with the development of a recalcitrant nonunion.
锁骨骨折不愈合常发生于急性骨折的非手术治疗后。那些需要 >1 次手术才能愈合的骨折被称为难治性骨折。本研究的目的是：(1) 确定使用传统或锁定钢板进行锁骨骨折不愈合的钢板内固定后的愈合率；(2) 比较髂嵴骨移植物与骨形态发生蛋白对骨折不愈合的愈合作用；(3) 确定难治性骨折不愈合发生的危险因素。
我们对一位外科医生在 25 年内使用切开复位钢板固定治疗的 78 例锁骨骨折不愈合患者的前瞻性数据库进行了回顾性分析。71 例年龄大于 18 岁、随访至少 12 个月的患者纳入本研究。我们比较了钢板类型和植骨技术对锁骨骨折不愈合的愈合率，并确定了发生难治性骨折不愈合的危险因素。
在我们的机构中，共有 62 例患者（87.3%）在初次锁骨骨折不愈合手术后愈合。3 例患者（4.2%）需要进一步手术，但最终愈合，6 例患者（8.5%）仍未愈合，这 9 例患者（12.7%）被定义为难治性骨折不愈合。钢板类型（P =.633）或植骨类型（P =.157）对愈合率无统计学差异。没有可识别的难治性骨折不愈合的危险因素。
锁骨骨折不愈合的钢板固定仍然是一种有效的治疗方法。钢板类型或植骨方式并没有产生不同的结果。没有与难治性骨折不愈合发生相关的人口统计学、患者或损伤特征。
