Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK; The University of Edinburgh, Edinburgh, UK.
The University of Edinburgh, Edinburgh, UK.
J Shoulder Elbow Surg. 2021 Nov;30(11):2570-2576. doi: 10.1016/j.jse.2021.03.151. Epub 2021 Apr 22.
Lateral-end clavicle fractures have a high rate of nonunion that can lead to ongoing pain and loss of shoulder function. The operative techniques used to manage such nonunions vary, and data on postoperative functional outcomes and complications are limited, with no consensus on the optimal surgical treatment. Our goal was to present the outcomes and complications of a new indication for combined locking plate and tunneled suspensory device fixation in the operative management of lateral-end clavicle fracture nonunions.
A consecutive series of 38 patients (mean age, 46 years; age range, 24-76 years) with symptomatic lateral-end clavicle nonunions underwent operative treatment using a new technique of anatomic locking plate combined with open reduction and tunneled suspensory device fixation between March 2011 and September 2019. Patients were assessed at a minimum of 1-year postoperative follow-up for patient-reported outcomes, range of motion, and complications.
All patients (N = 38) achieved bony union after operative treatment. Functional outcomes were available for 34 patients. The mean Oxford Shoulder Score was 44 (standard error of the mean [SEM], 0.7), and the mean EQ-5D-3L index score was 0.784 (SEM, 0.033). Mean forward flexion was 176° (SEM, 3°); mean extension, 53° (SEM, 3°); mean combined abduction, 171° (SEM, 4°); mean internal rotation, 57° (SEM, 2°); and mean external rotation, 83° (SEM, 4°). In 2 patients (5.3%), metalwork (plate) removal was performed owing to plate prominence.
Nonunion of lateral-end clavicle fractures can be effectively managed by combined plate and open reduction-tunneled suspensory device fixation. Excellent union rates and functional outcomes, as well as low complication rates, can be expected. The most significant complication of this technique is subsequent metalwork removal.
锁骨外侧端骨折的不愈合率较高，可能导致持续疼痛和肩部功能丧失。用于治疗此类不愈合的手术技术多种多样，术后功能结果和并发症的数据有限，对于最佳手术治疗方法尚无共识。我们的目的是介绍一种新的锁定钢板和隧道式悬吊装置固定联合治疗锁骨外侧端骨折不愈合的手术方法的结果和并发症。
2011 年 3 月至 2019 年 9 月，连续 38 例（平均年龄 46 岁；年龄范围 24-76 岁）有症状的锁骨外侧端骨折不愈合患者采用新的解剖锁定钢板联合切开复位和隧道式悬吊装置固定的新方法进行手术治疗。所有患者在术后至少 1 年进行随访，评估患者报告的结果、活动范围和并发症。
所有患者（N=38）在手术后均实现了骨愈合。34 例患者可获得功能结果。平均牛津肩评分（Oxford Shoulder Score）为 44（均数标准差 [standard error of the mean, SEM]，0.7），平均 EQ-5D-3L 指数评分为 0.784（SEM，0.033）。平均前屈为 176°（SEM，3°）；平均伸展为 53°（SEM，3°）；平均联合外展为 171°（SEM，4°）；平均内旋为 57°（SEM，2°）；平均外旋为 83°（SEM，4°）。有 2 例患者（5.3%）因钢板突出而行金属（钢板）取出术。
锁骨外侧端骨折的不愈合可以通过钢板联合切开复位-隧道式悬吊装置固定有效地治疗。可获得良好的愈合率和功能结果，并发症发生率低。该技术最显著的并发症是随后的金属取出。
