Department of Orthopaedic Surgery, Tokai University Oiso HospitalKanagawa-Pref, Japan; and.
Department of Orthopaedic Surgery, Surgical Science, Tokai University School of MedicineKanagawa-Pref, Japan.
J Orthop Trauma. 2022 Jun 1;36(6):e243-e249. doi: 10.1097/BOT.0000000000002301.
To evaluate the influence of posterior hook position on subacromial bone erosion during surgical treatment of distal clavicle fractures with locking compression plate clavicle hook plate (CHP).
Single-center retrospective study.
Level V trauma center (university hospital).
Twenty-one patients (mean age, 45.8 years) treated with CHP were included. One, 3, 15, and 2 patients had Neer type I, IIa, IIb, and V fractures, respectively.
Open reduction and internal fixation were performed with locking compression plate CHP. All implants were removed after a mean of 6.1 months postoperatively.
Japanese Orthopaedic Association shoulder scores were used to assess recovery. Radiographically, the coracoclavicular distance was measured as the distance between the tip of the coracoid process and the undersurface of the clavicle. Three-dimensional computed tomography was performed to identify bone erosion at the hook tips after implant removal. The distance from the acromioclavicular joint center to the bone erosion was divided into 5 areas at 5-mm intervals, and the position and depth of bone erosion were measured in each area.
The mean follow-up period was 17.4 months; mean ± SD Japanese Orthopaedic Association score was 75.9 ± 4.7 at the final follow-up, whereas the mean duration of bony union was 4.4 ± 1.0 (SD) months. Delayed bony union was observed in one patient, whereas a second surgery was required in another due to acromion cut-out. Radiography showed overreduction in 95% of cases. The correlation coefficient showed a difference between coracoclavicular distance and the position of bone erosion measured by CT (Rs = 0.32, P = 0.006). Erosion under the acromion surface was found in all patients. The depth of erosion correlated with the posterior hook position (Rs = 0.29, P = 0.023).
Posterior hook tip placement increased the likelihood of bone erosion and complications due to overreduction. CHP should be set more anteriorly beneath the acromion to prevent complications.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
评估在使用锁定加压钢板锁骨钩钢板（CHP）治疗锁骨远端骨折时，后钩位置对肩峰下骨侵蚀的影响。
单中心回顾性研究。
V 级创伤中心（大学医院）。
21 例患者（平均年龄 45.8 岁）接受 CHP 治疗。1、3、15 和 2 例患者分别为 Neer Ⅰ型、Ⅱa 型、Ⅱb 型和 V 型骨折。
采用锁定加压钢板 CHP 进行切开复位内固定。所有植入物均在术后平均 6.1 个月后取出。
使用日本矫形协会（JOA）肩关节评分评估恢复情况。影像学上，测量喙突尖端与锁骨下表面之间的喙锁距离。在去除植入物后，行三维 CT 以识别钩尖端的骨侵蚀。从肩锁关节中心到骨侵蚀的距离以 5mm 的间隔分为 5 个区域，在每个区域测量骨侵蚀的位置和深度。
平均随访时间为 17.4 个月；末次随访时 JOA 评分平均为 75.9±4.7，骨愈合平均时间为 4.4±1.0（SD）个月。1 例患者出现延迟愈合，另 1 例患者因肩峰切出而需要二次手术。X 线片显示 95%的病例存在过度复位。相关系数显示喙锁距离与 CT 测量的骨侵蚀位置之间存在差异（Rs=0.32，P=0.006）。所有患者均发现肩峰下表面骨侵蚀。骨侵蚀的深度与后钩位置相关（Rs=0.29，P=0.023）。
后钩尖端位置的增加增加了因过度复位导致骨侵蚀和并发症的可能性。CHP 应置于肩峰下更靠前的位置，以预防并发症。
治疗性 IV 级。欲了解完整的证据水平说明，请参见作者须知。
