Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland.
Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland.
J Shoulder Elbow Surg. 2021 Sep;30(9):2090-2096. doi: 10.1016/j.jse.2020.11.028. Epub 2021 Jan 22.
The treatment of unstable (Neer type IIB and V) extra-articular distal clavicle fractures remains challenging, especially when encountering a small lateral fragment which does not allow for sufficient screw purchase. It was the purpose of this study to present the clinical and radiologic outcome of a consecutive series of patients treated by a stand-alone coracoclavicular stabilization using a so-called cow-hitch technique with a suture anchor.
Nineteen patients were treated with a specific surgical technique for distal clavicle fractures (11 left, 8 right) with either rupture or bony avulsion of the coracoclavicular ligaments. Fourteen patients were examined in our outpatient clinic for the purpose of this study after a mean follow-up of 5 years (1-12.2 years). The examination included scoring according to Constant Murley score (CMS), the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), the Subjective Shoulder Value (SSV), and follow-up radiographs. Two additional patients were amenable to a telephone interview.
All patients reported very good subjective results, with a mean SSV of 92% and a mean ASES score of 96%. The CMS resulted in average absolute values of 92 points. Fractures consolidated in 95% of cases. One patient developed an asymptomatic pseudarthrosis. The coracoclavicular distance was restored from 21 mm preoperatively to 11 mm at the final follow-up and finally showed an average side-to-side difference of +1.8 mm. Sports activities were fully resumed after an average of 4.7 months.
The coracoclavicular stand-alone cow-hitch suture repair for unstable distal clavicle fractures is a minimally invasive fixation technique without prominent hardware that allows for an anatomic reduction and stable fixation with a low complication and high bony union rate. Both radiographic and clinical long-term results are very satisfactory.
不稳定（Neer 型 IIB 和 V）关节外锁骨远端骨折的治疗仍然具有挑战性，特别是当遇到无法提供足够螺钉固定的小外侧骨折块时。本研究旨在介绍使用所谓的“牛鼻结”技术和缝线锚钉进行单独的喙锁固定治疗一系列患者的临床和影像学结果。
19 例患者因喙锁韧带撕裂或骨撕脱而接受了特定的锁骨远端骨折手术治疗（左侧 11 例，右侧 8 例）。在平均随访 5 年后（1-12.2 年），14 例患者在我院门诊接受了检查。检查包括根据 Constant-Murley 评分（CMS）、美国肩肘外科医生协会（ASES）标准肩部评估表、主观肩部值（SSV）进行评分，以及随访 X 线片。另外 2 例患者可进行电话访谈。
所有患者均报告主观结果非常好，平均 SSV 为 92%，平均 ASES 评分为 96%。CMS 的平均绝对数值为 92 分。95%的骨折均愈合。1 例患者出现无症状假关节。喙锁间距从术前的 21mm 恢复到末次随访时的 11mm，最终平均侧方差异为+1.8mm。平均 4.7 个月后可完全恢复体育活动。
不稳定锁骨远端骨折的单独喙锁“牛鼻结”缝线修复是一种微创固定技术，无明显的硬件，可实现解剖复位和稳定固定，并发症低，骨愈合率高。影像学和临床长期结果均非常满意。
