Department of Orthopaedic Surgery, Østfold Hospital Trust, Grålum, Norway.
J Pediatr Orthop. 2021;41(5):279-283. doi: 10.1097/BPO.0000000000001768.
Traditionally, midshaft clavicular fractures in adolescents are treated nonoperatively. In later years, a trend toward operative treatment can be observed. Documentation of the benefit of surgery in this group is scarce. The purpose of this study is to evaluate the long-term patient reported functional outcomes and complications for patients treated operatively and nonoperatively for displaced midshaft clavicular fractures. Using the same outcomes we also compared the operative methods.
One hundred nine adolescents aged 12 to 18 years sustaining displaced midshaft clavicular fractures in the period 2010 to 2016 were identified in our computerized files. Sixty-one were treated nonoperatively, 48 operatively (22 plate and 26 intramedullary nail). Their radiographs and patient journals were examined for fracture classification, wound infection, sensory affection, surgery duration, hardware removal, and nonunion (n=109). Long-term function, pain, and satisfaction were measured with Quick Disability of Arm, Shoulder, and Hand (QuickDASH), Oxford Shoulder Score and Visual Analogue Scale (n=87).
Operative treatment: We could find no difference in functional score outcomes. The main outcome QuickDASH was excellent in both groups (median 0 nail vs. 2.26 plate). Surgery duration was shorter with intramedullary nail. We found 2 infections and 2 sensory affections in the plate group, and 1 infection and 1 sensory affection in the intramedullary nail group. There were 2 refractures in the nail group. Operative versus nonoperative treatment: there were no differences in functional outcomes between the operative and nonoperative groups. For the main outcome QuickDASH both groups scored excellently (median 1.12 operative vs. 0 nonoperative). The nonoperative group was more satisfied with the cosmetic result. There was 1 nonunion in the nonoperative group that later was operated.
Adolescents aged 12 to 18 years with displaced midshaft clavicular fractures show good long-term functional results after plate fixation, intramedullary nail, and nonoperative treatment. No additional benefit is demonstrated for surgery in our material. Nonoperatively treated patients are more satisfied with the cosmetic results. Little difference is seen between the operative methods in our study. We conclude that surgery should rarely be the choice of treatment for displaced midshaft clavicular fractures in adolescents.
Level III study-retrospective comparative study.
传统上，青少年的锁骨中段骨折采用非手术治疗。在以后的几年中，可以观察到手术治疗的趋势。但是，有关该组手术益处的文献记载很少。本研究的目的是评估手术和非手术治疗移位锁骨中段骨折的患者的长期患者报告的功能结果和并发症。使用相同的结果，我们还比较了手术方法。
在我们的计算机文件中，确定了 2010 年至 2016 年期间 109 名 12 至 18 岁的青少年患有移位的锁骨中段骨折。61 例采用非手术治疗，48 例采用手术治疗（22 例钢板和 26 例髓内钉）。检查他们的放射线照片和病历以确定骨折分类，伤口感染，感觉异常，手术持续时间，硬件去除以及骨不连（n = 109）。使用快速上肢，肩和手残疾问卷（QuickDASH），牛津肩评分和视觉模拟量表（n = 87）长期测量功能，疼痛和满意度。
手术治疗：我们发现功能评分结果没有差异。主要结果QuickDASH 在两组中均为出色（中位数，钉 0 比板 2.26）。髓内钉手术时间较短。我们发现板组中有 2 例感染和 2 例感觉异常，髓内钉组中有 1 例感染和 1 例感觉异常。在钉组中有 2 例再骨折。手术与非手术治疗：手术组和非手术组的功能结果没有差异。对于主要结果 QuickDASH，两组的评分均为出色（中位数，手术 1.12 比非手术 0）。非手术组对美容结果更满意。非手术组中有 1 例骨不连，后来进行了手术。
12 至 18 岁的青少年患有移位的锁骨中段骨折，经钢板固定，髓内钉和非手术治疗后可获得良好的长期功能结果。在我们的材料中，手术没有显示出额外的益处。非手术治疗的患者对美容效果更满意。在我们的研究中，手术方法之间几乎没有差异。我们得出的结论是，对于青少年的锁骨中段移位骨折，手术应很少作为治疗选择。
三级研究-回顾性比较研究。
