Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea.
Clin Orthop Surg. 2022 Sep;14(3):319-327. doi: 10.4055/cios22080. Epub 2022 Jul 21.
The best option for the treatment of Neer type IIB lateral clavicle fractures remains controversial. The aim of this study was to compare outcomes and complications between pre-contoured locking plate osteosynthesis (PLPO) and coracoclavicular stabilization (CCS) using a TightRope for the treatment of type IIB fractures.
Forty-six consecutive type IIB fractures were treated with PLPO (17 cases) or CCS (29 cases). The mean follow-up period was 33.7 months (range, 12-144 months). Radiographic outcomes were evaluated using serial plain radiographs. Clinical outcomes were evaluated using the University of California, Los Angeles (UCLA) score, the American Shoulder and Elbow Surgeons (ASES) score, and subjective shoulder value (SSV).
Of the 46 cases, complete bony union within 6 months after surgery was achieved in 42 cases (91.3%). The union rate was 100% (17/17) in the PLPO group and 86.2% (25/29) in the CCS group, showing a statistically significant difference ( = 0.043). No significant differences in terms of UCLA score (32.8 vs. 32.1), ASES score (93.2 vs. 90.8), or SSV (89.1% vs. 90.3%) were observed between the PLPO and CCS groups. The complication rates were 17.6% (3/17; 2 cases of screw breakage and 1 case of stiffness) in the PLPO group and 37.9% (11/29; 4 cases of nonunion, 3 cases of stiffness, 2 cases of skin irritation, 1 case of superficial infection, and 1 case of coracoid button migration) in the CCS group, showing no statistically significant difference ( > 0.05). Four cases with nonunion after CCS did not require reoperation because they had good to excellent clinical outcomes without radiographic progression.
Although a higher nonunion rate was observed in the CCS group compared with the PLPO group, satisfactory clinical outcomes were obtained for both groups. Both techniques can be regarded as useful options for the treatment of Neer type IIB lateral clavicle fractures.
对于 Neer ⅡB 型外侧锁骨骨折的治疗，最佳选择仍存在争议。本研究旨在比较预成型锁定钢板接骨术（PLPO）和使用 TightRope 行喙锁固定（CCS）治疗ⅡB 型骨折的疗效和并发症。
连续纳入 46 例 Neer ⅡB 型骨折患者，分别行 PLPO（17 例）或 CCS（29 例）治疗。平均随访 33.7 个月（12-144 个月）。通过连续拍摄 X 线片评估影像学结果。采用加利福尼亚大学洛杉矶分校（UCLA）评分、美国肩肘外科医师协会（ASES）评分和主观肩部值（SSV）评估临床疗效。
46 例患者中，42 例（91.3%）术后 6 个月内达到完全骨性愈合。PLPO 组的愈合率为 100%（17/17），CCS 组为 86.2%（25/29），差异有统计学意义（ = 0.043）。PLPO 组和 CCS 组的 UCLA 评分（32.8 分比 32.1 分）、ASES 评分（93.2 分比 90.8 分）和 SSV（89.1%比 90.3%）差异均无统计学意义。PLPO 组并发症发生率为 17.6%（3/17；2 例螺钉断裂，1 例僵硬），CCS 组为 37.9%（11/29；4 例不愈合，3 例僵硬，2 例皮肤刺激，1 例浅表感染，1 例喙突纽扣迁移），差异无统计学意义（ > 0.05）。CCS 组 4 例不愈合患者无需再次手术，因为他们的临床疗效良好，无影像学进展。
尽管 CCS 组的不愈合率高于 PLPO 组，但两组均获得了满意的临床疗效。两种技术均可作为 Neer ⅡB 型外侧锁骨骨折的有效治疗选择。
