Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.
Am J Sports Med. 2021 Oct;49(12):3218-3225. doi: 10.1177/03635465211036713. Epub 2021 Sep 8.
Coracoclavicular (CC) ligament reconstruction is a commonly performed procedure for high-grade acromioclavicular (AC) joint separations. Although distal clavicle and coracoid process fractures represent potential complications, they have been described in only case reports and small case series.
To identify the incidence and characteristics of clavicle and coracoid fractures after CC ligament reconstruction.
Case series; Level of evidence, 4.
The US Military Health System Data Repository was queried for patients with a Current Procedural Terminology code for CC ligament repair or reconstruction between October 2013 and March 2020. The electronic health records, including patient characteristics, radiographs, operative reports, and clinical notes, were evaluated for intraoperative or postoperative clavicle or coracoid fractures. Initial operative technique, fracture management, and subsequent clinical outcomes were reviewed for these patients.
A total of 896 primary CC ligament repairs or reconstructions were performed during the study period. There were 21 postoperative fractures and 1 intraoperative fracture in 20 patients. Of these fractures, 12 involved the coracoid and 10 involved the clavicle. The overall incidence of fracture was 3.81 fractures per 1000 person-years. In 5 patients who sustained a fracture, bone tunnels were not drilled in the fractured bone during the index procedure. A total of 17 fractures were ultimately treated operatively, whereas 5 fractures had nonoperative management. Of the 16 active-duty servicemembers who sustained intraoperative or postoperative fractures, 11 were unable to return to full military duty after their fracture care.
Fracture of the distal clavicle or coracoid process after CC ligament repair or reconstruction is a rare but serious complication that can occur independent of bone tunnels created during the index procedure. Fractures associated with CC ligament procedures occurred at a rate of 2.46 per 100 cases. Most patients were ultimately treated surgically with open reduction and internal fixation or revision CC ligament reconstruction. Although the majority of patients with intraoperative or postoperative fractures regained full range of motion, complications such as anterior shoulder pain, AC joint asymmetry, and activity-related weakness were common sequelae resulting in physical limitations and separation from military service.
喙锁韧带（CC）重建是治疗高级肩锁关节（AC）分离的常用方法。虽然锁骨远端和喙突骨折是潜在的并发症，但它们仅在病例报告和小病例系列中有所描述。
确定 CC 韧带重建后锁骨和喙突骨折的发生率和特征。
病例系列；证据水平，4 级。
通过美国军事医疗系统数据库查询 2013 年 10 月至 2020 年 3 月期间接受 CC 韧带修复或重建的患者的当前程序术语（Current Procedural Terminology，CPT）代码。评估电子健康记录，包括患者特征、X 线片、手术报告和临床记录，以确定术中或术后锁骨或喙突骨折。对这些患者的初始手术技术、骨折处理和随后的临床结果进行了回顾。
在研究期间共进行了 896 例原发性 CC 韧带修复或重建。20 例患者中有 21 例术后骨折和 1 例术中骨折。这些骨折中，12 例累及喙突，10 例累及锁骨。总体骨折发生率为每 1000 人年 3.81 例骨折。在 5 例发生骨折的患者中，在指数手术中未在骨折骨中钻骨隧道。共有 17 例骨折最终接受手术治疗，5 例骨折采用非手术治疗。在 16 名发生术中或术后骨折的现役军人中，有 11 人在骨折治疗后无法恢复到完全军事职责。
CC 韧带修复或重建后锁骨远端或喙突骨折是一种罕见但严重的并发症，可独立于指数手术中创建的骨隧道发生。与 CC 韧带手术相关的骨折发生率为每 100 例 2.46 例。大多数患者最终接受切开复位内固定或 CC 韧带重建翻修手术治疗。尽管大多数术中或术后骨折患者恢复了全关节活动度，但常见的并发症如前肩痛、AC 关节不对称和与活动相关的无力是导致身体受限和与军事服务分离的常见后遗症。
