Service de Chirurgie Orthopédique et Traumatologique du Membre Supérieur, Chirurgie de la Main et des Nerfs Périphériques, CHU Lapeyronie, Montpellier, France ; and.
Clinique Saint-Jean Sud de France, Groupe OrthoSud, Saint Jean de Védas, France .
J Orthop Trauma. 2022 Jul 1;36(7):e271-e277. doi: 10.1097/BOT.0000000000002330.
To evaluate the clinical outcome of lateral clavicle malunion treated with all-arthroscopic coracoclavicular (CC) stabilization.
Retrospective, case series.
Department of hand and upper extremity surgery, university hospital center.
Forty-five patients with unstable and displaced lateral clavicle fracture treated between January 2015 and August 2019 were included in the study.
Closed reduction and arthroscopic CC stabilization using cortical buttons.
Shoulder pain and active motion. Patient-reported outcome measures included the Constant score, the Subjective Shoulder Value, the AcromioClavicular Joint Instability score, and the Specific AcromioClavicular Score. Radiographic evaluation assessed bony union and malunion.
Mean duration of follow-up was 25 months (12-60 months). Five patients (11%) had lateral clavicle nonunion and 7 (16%) had lateral clavicle malunion (5 in the coronal plane and 2 in the axial plane). Lateral clavicle malunion did not significantly affect clinical or functional outcomes (P > 0.05). Mean active shoulder motion was forward flexion 163 degrees (SD 28), abduction 162 degrees (SD 26), and external rotation 63 degrees (SD 21). On average, the patients scored 88.3 (SD 17.7) in the Constant score, 90% (SD 12) in the Subjective Shoulder Value, 88.8 (SD 9.4) in the AcromioClavicular Joint Instability score, and 11.4 (SD 8.5) for SACS. The overall complication rate was 38% (including 7 malunions, 5 nonunions, 2 adhesive capsulitis, and 3 button malpositions).
Closed reduction and internal fixation of lateral clavicle fracture with all-arthroscopic CC stabilization using cortical button potentiates bony union but may generate lateral clavicle malunion, which does not affect the clinical or functional outcome. This result can be attributed to CC ligament healing and acromioclavicular joint congruence. All-arthroscopic CC stabilization is a minimally invasive but demanding surgical alternative for managing unstable and displaced lateral clavicle fracture.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
评估全关节镜锁骨-喙突（CC）稳定化治疗锁骨外侧端畸形愈合的临床效果。
回顾性病例系列研究。
大学医院中心手外科。
纳入 2015 年 1 月至 2019 年 8 月间接受治疗的不稳定和移位的锁骨外侧端骨折患者 45 例。
采用皮质纽扣闭合复位和关节镜下 CC 稳定化。
肩部疼痛和主动运动。患者报告的结果测量包括 Constant 评分、主观肩部值、肩锁关节不稳定评分和特定肩锁关节评分。影像学评估评估骨愈合和畸形愈合情况。
平均随访时间为 25 个月（12-60 个月）。5 例（11%）患者发生锁骨外侧端骨不连，7 例（16%）发生锁骨外侧端畸形愈合（5 例在冠状面，2 例在矢状面）。锁骨外侧端畸形愈合并不显著影响临床或功能结果（P＞0.05）。平均主动肩部运动为前屈 163°（标准差 28°）、外展 162°（标准差 26°）和外旋 63°（标准差 21°）。患者的 Constant 评分平均为 88.3（标准差 17.7），主观肩部值为 90%（标准差 12%），肩锁关节不稳定评分为 88.8（标准差 9.4），SACS 评分为 11.4（标准差 8.5）。总体并发症发生率为 38%（包括 7 例畸形愈合、5 例骨不连、2 例粘连性关节囊炎和 3 例纽扣位置不当）。
采用皮质纽扣全关节镜锁骨-喙突稳定化治疗锁骨外侧端骨折可促进骨愈合，但可能导致锁骨外侧端畸形愈合，而不会影响临床或功能结果。这一结果归因于 CC 韧带愈合和肩锁关节吻合。全关节镜锁骨-喙突稳定化是一种微创但具有挑战性的手术选择，适用于治疗不稳定和移位的锁骨外侧端骨折。
治疗性 IV 级。有关证据水平的完整描述，请参阅作者指南。
