Department of Orthopedics and Traumatology, Diakovere Friederikenstift, Humboldtstraße 5, 30169, Hannover, Germany.
Department of Orthopedic Surgery, Medical School Hanover, Diakovere Annastift, Hannover, Germany.
Arch Orthop Trauma Surg. 2022 Jun;142(6):1083-1090. doi: 10.1007/s00402-021-03893-1. Epub 2021 May 4.
There is no uniform approach to the management of lateral clavicle fractures. Recent studies have investigated additive coracoclavicular (CC) augmentation as a treatment option; however, it is unclear whether it is superior to conventional locking plate osteosynthesis.
We carried out a retrospective analysis of 40 patients with lateral clavicle fracture (Neer type IIb) who were treated between 2014 and 2017 with either a hybrid locking plate osteosynthesis/additive arthroscopy-assisted CC augmentation (HP) procedure or a locking plate osteosynthesis only (PO) approach to determine which strategy was more effective. At follow-up, subjective shoulder value, age- and sex-adjusted Constant-Murley score, Taft (TF) score, American Shoulder and Elbow score, Nottingham clavicle score, and Visual Analogue Scale score were compared between patient groups. A radiologic evaluation was also conducted.
A total of 14/17 patients (83%; 9 male/5 female, mean age: 43 ± 15 years) were followed up in the PO group. The mean follow-up time was 29 ± 12.4 months. In the HP group, 17/23 patients (74%; 9 male/8 female, mean age: 43 ± 17 years) were followed up, with a mean follow-up time of 18 ± 7.1 months. There were no significant differences in clinical parameters between the HP and PO groups; notably, the shoulder girdle-specific TF score was comparable in the 2 groups (HP: 11.3 ± 1.1 points and PO: 10.9 ± 0.9 points). In the HP group, additional pathologies were identified and arthroscopically treated in 35% of cases. Radiologic examination revealed a significant difference between pre- and postoperative CC distance in the HP group (P = 0.001).
Additive CC augmentation in combination with locking plate osteosynthesis seems to improve the vertical stability and reduces the revision rate in patients with a lateral clavicle fracture. Furthermore, an arthroscopy-assisted procedure allows for an intraoperative detection and single-step treatment of accompanying intraarticular pathologies.
锁骨外侧端骨折的治疗方法尚无统一标准。近期研究调查了附加喙锁（CC）固定作为一种治疗选择的效果，但是否优于传统锁定钢板内固定术尚不明确。
我们对 2014 年至 2017 年间接受混合锁定钢板内固定/附加关节镜辅助 CC 固定（HP）或单独锁定钢板内固定（PO）治疗的 40 例锁骨外侧端骨折（Neer Ⅱb 型）患者进行回顾性分析，以确定哪种治疗策略更有效。在随访时，对两组患者的主观肩关节评分、年龄和性别校正后的 Constant-Murley 评分、Taft（TF）评分、美国肩肘外科协会评分、诺丁汉锁骨评分和视觉模拟评分进行比较。同时还进行了影像学评估。
PO 组共 14/17 例（83%；9 例男性/5 例女性，平均年龄：43±15 岁）患者得到随访，平均随访时间为 29±12.4 个月。HP 组 23/23 例（74%；9 例男性/8 例女性，平均年龄：43±17 岁）患者得到随访，平均随访时间为 18±7.1 个月。两组患者的临床参数无显著差异；值得注意的是，两组间肩部特异性 TF 评分相当（HP 组：11.3±1.1 分，PO 组：10.9±0.9 分）。HP 组中有 35%的患者发现并经关节镜处理了附加的关节内病变。影像学检查显示 HP 组患者 CC 距离的术前和术后有显著差异（P=0.001）。
附加 CC 固定联合锁定钢板内固定似乎可以提高锁骨外侧端骨折患者的垂直稳定性，降低翻修率。此外，关节镜辅助治疗可以术中发现并一次性处理伴发的关节内病变。
