Department of Orthopedic Surgery, Eulji University Hospital, Daejeon, Korea.
Clin Orthop Surg. 2020 Sep;12(3):396-403. doi: 10.4055/cios20026. Epub 2020 Jun 3.
Controversy exists about the optimal treatment of midshaft clavicle fractures in the presence of significant displacement, comminution, or shortening of the fracture in adolescents. The purpose of this study was to compare the clinical and radiological outcomes of 4 different treatments for midshaft clavicle fractures in adolescents: conservative treatment with a figure-of-8 (FO8) brace, open reduction and internal fixation with a plate (OPL), minimally invasive plate osteosynthesis (MIPO), and intramedullary nail fixation with a threaded Steinmann pin (TSP).
A total of 94 teenagers with midshaft clavicle fractures were divided into the FO8, OPL, MIPO, and TSP groups (n = 24, 33, 16, and 21, respectively). We analyzed clinical and radiological outcomes and complications in each group and compared the results among the groups.
All groups showed satisfactory clinical and radiological outcomes, but each group showed different results for the assessment items. The Constant-Murley scores were higher in the operated groups than in the FO8 group. Recovery of joint motion was faster in the operated groups. The TSP group had the highest cosmetic satisfaction with respect to the satisfaction score and measured scar length. Fracture union was achieved in all patients. At the final follow-up, the bone length was closer to normal in the OPL and TSP groups than in the FO8 and MIPO groups, and angulation was less in the OPL and TSP groups than in the MIPO and FO8 groups. The TSP and MIPO groups obtained faster bone healing than the OPL and FO8 groups. In the operated groups, 9 patients had metal-induced irritating symptoms; 1, supraclavicular nerve injury symptoms; and 4, refractures after plate removal.
The nonoperatively treated group had no iatrogenic complications. The operated groups complained of various disadvantages induced by surgery; however, these groups achieved faster functional recovery and slightly better radiological and functional results than the nonoperative group.
青少年锁骨中段骨折存在明显移位、粉碎或缩短时，其最佳治疗方法存在争议。本研究旨在比较四种不同方法治疗青少年锁骨中段骨折的临床和影像学结果：八字绷带保守治疗（FO8）、钢板切开复位内固定（OPL）、微创钢板接骨术（MIPO）和带螺纹斯氏针髓内钉固定（TSP）。
共纳入 94 例青少年锁骨中段骨折患者，分为 FO8、OPL、MIPO 和 TSP 组（每组 24、33、16 和 21 例）。分析每组的临床和影像学结果及并发症，并比较组间结果。
所有组均获得满意的临床和影像学结果，但各评估项目的结果不同。手术组的 Constant-Murley 评分高于 FO8 组。手术组关节活动恢复更快。TSP 组在满意度评分和测量的瘢痕长度方面对美容效果最满意。所有患者均达到骨折愈合。末次随访时，OPL 和 TSP 组的骨长度更接近正常，FO8 和 MIPO 组的成角更小。TSP 和 MIPO 组的骨愈合速度快于 OPL 和 FO8 组。手术组有 9 例出现金属刺激症状，1 例出现锁骨上神经损伤症状，4 例在取出钢板后发生再骨折。
非手术治疗组无医源性并发症。手术组抱怨手术引起的各种不利情况，但与非手术组相比，这些组的功能恢复更快，影像学和功能结果略好。
