Pathak Subodh Kumar, Gautam Rakesh K, Godara Anil, Singh Manjeet, Kumar Naveen, Sharma Aryan, Vyas Avin, Khan Sameer, Kumar Bijender, Mateen Mohammed Obair
Orthopedics, Maharishi Markandeshwar (Deemed to be University), Ambala, IND.
Cureus. 2021 Apr 7;13(4):e14339. doi: 10.7759/cureus.14339.
Introduction Fracture of the clavicle bone is a very common injury owing to its subcutaneous location. Controversy exists about the optimal treatment of midshaft clavicle fractures in the presence of significant displacement and comminution of the fracture. Traditionally, non-surgical management was considered the first treatment option for most clavicle fractures. However, recent evidence shows that the non-surgical option causes more complications than previously reported. The purpose of this study was to compare the clinical and radiological outcomes of conservative treatment and surgical treatment for midshaft clavicle fractures. Materials and methods A total of 45 patients meeting the inclusion criteria were included in this randomized study. The patients were allocated to two groups: conservative and operative on an alternate basis. Patients in the conservative group were managed with figure-of-eight bandage, whereas patients in the operative group were treated surgically by plate fixation. Primary outcome was recorded at six weeks, three months, six months, and 12 months follow-up using the Disabilities of the Arm, Shoulder, and Hand (DASH) and American Shoulder and Elbow Surgeons (ASES) scores. We also assessed patient's satisfaction after the treatment, fracture union, and complication rates among the study cohort. Results The ASES scores were significantly better in the operative group at three months and six months follow-up; however, at 12 months follow-up, there was no significant difference in the score between the groups. Although not statistically significant, the DASH score was better in the operative group than in the conservative group at all the follow-ups. This study showed that the time to union was lesser, rate of non-union was lower, and return to work was faster on the operative group. The mean satisfaction score in the operative and conservative groups was 4.16±0.76 and 4.05±1.24, respectively (p = 0.76). Conclusion This study suggests that open reduction and internal fixation with plate reduced the incidence of mal-union and non-union; however, surgical treatment showed no significant difference in the functional outcome as compared to conservative treatment.
引言 锁骨骨折因其位于皮下,是一种非常常见的损伤。对于存在明显移位和粉碎的中段锁骨骨折的最佳治疗方法存在争议。传统上,非手术治疗被认为是大多数锁骨骨折的首选治疗方法。然而,最近的证据表明,非手术治疗导致的并发症比以前报道的更多。本研究的目的是比较中段锁骨骨折保守治疗和手术治疗的临床和影像学结果。
材料与方法 本随机研究共纳入45例符合纳入标准的患者。患者被交替分配到两组:保守组和手术组。保守组患者采用“8”字绷带治疗,而手术组患者采用钢板固定手术治疗。在6周、3个月、6个月和12个月随访时,使用手臂、肩部和手部功能障碍(DASH)评分和美国肩肘外科医师(ASES)评分记录主要结局。我们还评估了研究队列中患者的治疗后满意度、骨折愈合情况和并发症发生率。
结果 在3个月和6个月随访时,手术组的ASES评分明显更好;然而,在12个月随访时,两组之间的评分没有显著差异。虽然无统计学意义,但在所有随访中,手术组的DASH评分均优于保守组。本研究表明,手术组的骨折愈合时间更短、不愈合率更低且恢复工作更快。手术组和保守组的平均满意度评分分别为4.16±0.76和4.05±1.24(p = 0.76)。
结论 本研究表明,钢板切开复位内固定降低了畸形愈合和不愈合的发生率;然而,与保守治疗相比,手术治疗在功能结局方面没有显著差异。