Peters Jens, Singh Gurdeep, Hakobyan Hrayr
Department of Trauma Surgery and Orthopaedics, Clinic Sulingen, Sulingen, Lower Saxony, 27232, Germany.
Ther Clin Risk Manag. 2022 May 9;18:551-560. doi: 10.2147/TCRM.S361006. eCollection 2022.
This study describes clinical and radiological outcomes following treatment of displaced primary fractures, refractures, delayed unions and non-unions of the clavicle with open reduction and internal fixation (ORIF) with a plate plus filling of the residual bone defect and/or implant augmentation with a gentamicin-loaded bone graft substitute (CERAMENT G, BONESUPPORT).
Patients who underwent surgical treatment either for displaced clavicle fractures, refractures, delayed unions or non-unions between June 2018 and May 2021 were enrolled in this retrospective study. Bony consolidation, complication rate, and functional outcomes, including overall health, were assessed.
A total of 26 clavicles in 25 patients with a mean age of 50.7 (16-85) years, 16 male and 9 female, were enrolled in the study. The mean follow-up was 14.9 (6-31) months. There were 18 cases of displaced clavicle fractures, four refractures, two delayed unions and two non-unions. The majority of the clavicle lesions were located at the middle third (17/26, 65.4%), seven at the lateral third (26.9%) and two at the medial third (7.7%) of the clavicle. A mean Goldberg score of 7 indicated complete bony union and remodeling of the bone graft substitute in all cases. No complications occurred. The mean University of California at Los Angeles Shoulder Score and the mean Quick Disability of the Arm, Shoulder and Hand Score were 34.6±0.8 (32-35) points and 0.6±1.6 (0-5.4) points, respectively, and revealed excellent functional results. The mean 12-item Short-Form Survey physical component questionnaire was 57.7±1.7 (54.1-58.9) points, and no patient experienced any pain at the last follow-up.
Our initial experience suggests that ORIF using a plate plus bone defect filling and/or implant augmentation with a gentamicin-eluting bone graft substitute may be useful not only for complication management after clavicle fractures but also in the initial treatment of challenging clavicular fractures.
本研究描述了采用钢板切开复位内固定（ORIF）治疗锁骨移位性原发性骨折、再骨折、延迟愈合和不愈合，并填充残余骨缺损和/或使用载庆大霉素骨移植替代物（CERAMENT G，BONESUPPORT）进行植入物增强后的临床和放射学结果。
本回顾性研究纳入了2018年6月至2021年5月期间因锁骨移位性骨折、再骨折、延迟愈合或不愈合而接受手术治疗的患者。评估骨愈合情况、并发症发生率和功能结果，包括总体健康状况。
本研究共纳入25例患者的26根锁骨，平均年龄50.7（16 - 85）岁，男性16例，女性9例。平均随访时间为14.9（6 - 31）个月。其中锁骨移位性骨折18例，再骨折4例，延迟愈合2例，不愈合2例。大多数锁骨病变位于锁骨中1/3（17/26，65.4%），7例位于外侧1/3（26.9%），2例位于内侧1/3（7.7%）。平均戈德堡评分为7分，表明所有病例中骨移植替代物均实现了完全骨愈合和重塑。未发生并发症。加利福尼亚大学洛杉矶分校肩关节平均评分和手臂、肩部和手部快速残疾平均评分分别为34.6±0.8（32 - 35）分和0.6±1.6（0 - 5.4）分，显示出优异的功能结果。12项简短形式调查问卷身体成分问卷平均分为57.
