Chao Yi-Hsuan, Chou Ying-Chao, Lin Chun-Li
Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Orthopaedic Surgery, Taipei City Hospital, Taipei, Taiwan; Innovation & Translation Center of Medical Device, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Department of Orthopedics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
J Shoulder Elbow Surg. 2023 Jan;32(1):192-200. doi: 10.1016/j.jse.2022.08.001. Epub 2022 Sep 24.
Previous researchers used transverse fractures centered over the midpoint of the clavicle as the diaphyseal clavicular fracture models. However, as a result of shear stress concentration in sigmoid-shaped structures, most diaphyseal clavicular fractures have coronal fracture edges and are located distal to the midpoint. The purpose of this study was to quantify the morphology and utilize these parameters to establish clinically relevant fracture models.
The computed tomographic DICOM data of 100 consecutive patients were included. We investigated the morphologic characteristics of the fracture edges after virtual fracture reduction. The fracture orientation was determined based on the normal vectors of the best-fit plane of the fracture edges. The fracture location was measured by the extreme points of the edges. The fracture configuration was evaluated using fracture maps.
There were 28 simple, 43 wedge, and 29 multifragmentary types. Coronal oriented fracture edges accounted for more than 70% of the simple, wedge, and multifragmentary types. The most proximal point of the proximal edge was located at 46.7% (42.0%-56.5%), 47.6% (42.5%-50.1%), and 46.3% (42.0%-49.3%) of the endpoint line in the simple, wedge, and multifragmentary types, respectively (P = .548). The most distal point of the distal edge was located at 72.2% (68.4%-75.0%), 73.2% (69.5%-76.9%), and 74.0% (69.6%-77.1%) of the endpoint line (P = .353). The longest proximal main fragments occurred in the simple types at 71.9% (66.3%-75.4%) of the endpoint line (P < .001), and the shortest distal main fragments occurred in the multifragmentary types at 55.8% (49.8%-59.3%) of the endpoint line (P = .001). The heatmaps showed a high concentration of anteriorly distributed wedge fragments (88%; n = 38/43) and coronally distributed multifragmentary fragments (62%; n = 18/29).
We showed that typical diaphyseal clavicular fractures have coronal fracture edges and are located within the distal half of the diaphyseal segment. The fractured fragments were initiated anteriorly in the wedge types and then propagated coronally in the multifragmentary types. The features of these fracture edges could be useful in designing osteotomy models and provide different perspectives of anterior and superior plating techniques.
以往的研究人员将以锁骨中点为中心的横行骨折作为锁骨骨干骨折模型。然而，由于乙状结肠形结构中存在剪应力集中，大多数锁骨骨干骨折具有冠状骨折边缘，且位于中点远端。本研究的目的是量化骨折形态，并利用这些参数建立与临床相关的骨折模型。
纳入100例连续患者的计算机断层扫描DICOM数据。我们在虚拟骨折复位后研究了骨折边缘的形态特征。根据骨折边缘最佳拟合平面的法向量确定骨折方向。通过边缘的极值点测量骨折位置。使用骨折图谱评估骨折形态。
有28例简单型、43例楔形和29例粉碎型。冠状方向的骨折边缘在简单型、楔形和粉碎型中占比超过70%。近端边缘的最上端点分别位于简单型、楔形和粉碎型终点线的46.7%（42.0%-56.5%）、47.6%（42.5%-50.1%）和46.3%（42.0%-49.3%）处（P = 0.548）。远端边缘的最下端点分别位于终点线的72.2%（68.4%-75.0%）、73.2%（69.5%-76.9%）和74.0%（69.6%-77.1%）处（P = 0.353）。最长的近端主要骨折块出现在简单型中，位于终点线的71.9%（66.3%-75.4%）处（P < 0.001），最短的远端主要骨折块出现在粉碎型中，位于终点线的55.8%（49.8%-59.3%）处（P = 0.001）。热图显示，楔形骨折块在前部高度集中（88%；n = 38/43），粉碎性骨折块在冠状面高度集中（62%；n = 18/29）。
我们发现典型的锁骨骨干骨折具有冠状骨折边缘，且位于骨干段的远端一半范围内。骨折块在楔形骨折类型中从前部开始，然后在粉碎性骨折类型中向冠状面扩展。这些骨折边缘的特征可能有助于设计截骨模型，并为前路和上钢板技术提供不同的视角。
