Department of Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands.
Department of Surgery, Isala Hospital Zwolle, Zwolle, The Netherlands.
Eur J Trauma Emerg Surg. 2023 Feb;49(1):289-298. doi: 10.1007/s00068-022-02062-2. Epub 2022 Aug 4.
Lateral clavicle fractures account for 17% of all clavicle fractures and large studies comparing nonoperative and operative treatment are lacking. Therefore, patients cannot be properly informed about different treatment options and prognosis. We assessed long-term patient-reported and clinical outcomes in patients with lateral clavicle fractures.
A multicenter cross-sectional study was performed in patients treated for lateral clavicle fractures between 2007 and 2016. Primary outcome included patient-reported outcome measures (PROMs) (DASH, EQ-5D, return to work, sports, cosmetics and satisfaction). Questionnaires were sent to 619 eligible patients, of which 353 (57%) responded after a mean follow-up of 7.4 ± 2.8 years. Secondary outcome included adverse events and secondary interventions. Outcomes after nonoperative vs. operative treatment (stratified by nondisplaced vs. displaced fractures) were compared using Student t tests and linear regression analysis.
Nondisplaced lateral clavicle fractures were treated nonoperatively and resulted in excellent PROMs. Six patients (3%) developed a nonunion. For displaced lateral clavicle fractures, no differences were found between nonoperative and operative treatment with regard to DASH score (7.8 ± 12.5 vs 5.4 ± 8.6), EQ-5D (0.91 ± 0.13 vs 0.91 ± 0.09), pain (0.9 ± 1.7 vs. 0.8 ± 1.6), patient satisfaction (90.1 ± 25.5 vs. 86.3 ± 20.4), return to work (96.4% vs. 100%) and sports (61.4% vs. 62.3%). The absolute risk of nonunion in patients with a displaced fracture was higher after nonoperative than operative treatment (20.2% vs. 2.9%; p = 0.002), with six patients needing treatment to avoid one nonunion.
Nondisplaced lateral clavicle fractures should be treated nonoperatively and result in good functional outcomes and high union rates. For displaced fractures, neither nonoperative nor operative treatment seems superior. Patients opting for nonoperative treatment should be informed that nonunion occurs in 20% of patients, but only half of these need additional operative treatment. Patients who opt for surgery should be told that nonunion occurs in only 3%; however, most patients (56%) will require secondary intervention for elective implant removal. Regardless of the type of treatment, no differences in functional outcome and PROMs should be expected at long-term follow-up.
锁骨外侧骨折占所有锁骨骨折的 17%，缺乏比较非手术治疗和手术治疗的大型研究。因此，不能向患者正确告知不同的治疗选择和预后。我们评估了锁骨外侧骨折患者的长期患者报告和临床结果。
对 2007 年至 2016 年期间接受治疗的锁骨外侧骨折患者进行了一项多中心横断面研究。主要结局包括患者报告的结局测量（PROM）（DASH、EQ-5D、重返工作、运动、美容和满意度）。向 619 名符合条件的患者发送了问卷，其中 353 名（57%）在平均 7.4±2.8 年的随访后作出了回应。次要结局包括不良事件和二次干预。使用学生 t 检验和线性回归分析比较非手术治疗与手术治疗（按未移位与移位骨折分层）的结果。
未移位的锁骨外侧骨折采用非手术治疗，取得了极好的 PROM。6 名患者（3%）发生骨不连。对于移位的锁骨外侧骨折，非手术治疗与手术治疗在 DASH 评分（7.8±12.5 与 5.4±8.6）、EQ-5D（0.91±0.13 与 0.91±0.09）、疼痛（0.9±1.7 与 0.8±1.6）、患者满意度（90.1±25.5 与 86.3±20.4）、重返工作（96.4%与 100%）和运动（61.4%与 62.3%）方面没有差异。未移位骨折患者非手术治疗的非愈合绝对风险高于手术治疗（20.2%比 2.9%；p=0.002），其中 6 名患者需要治疗以避免 1 例非愈合。
未移位的锁骨外侧骨折应采用非手术治疗，可获得良好的功能结果和高愈合率。对于移位骨折，非手术治疗和手术治疗似乎都没有优势。选择非手术治疗的患者应被告知，20%的患者会发生骨不连，但只有一半的患者需要额外的手术治疗。选择手术治疗的患者应被告知，非愈合仅发生在 3%的患者中；然而，大多数患者（56%）需要进行二次干预以取出择期植入物。无论治疗类型如何，在长期随访中都不应期望功能结果和 PROM 有差异。
