Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, 95 Yong'an Road, 100050, Xicheng, Beijing, P.R. China.
BMC Surg. 2022 Oct 29;22(1):371. doi: 10.1186/s12893-022-01813-7.
Open reduction and internal fixation have been frequently applied for displaced midshaft clavicular fracture. Plate and screw fixation of clavicular fractures could provide rigid fixation and rotational control. Proper implant positioning in surgical fixation is critical to prevent iatrogenic complications. Fluoroscopy plays an important role in the intraoperative evaluation of implants. This study aimed to introduce a new fluoroscopic projection to evaluate the positioning of plates and screws.
Adult patients with a diagnosis of acute displaced midshaft clavicular fracture were included in this study. The slope angle of the midshaft clavicle was measured on sagittal reconstructions of preoperative computed tomography (CT) scans. The incidence of screw revision based on intraoperative standard posteroanterior (PA) and PA 25° cephalic skyline projections was compared. The interobserver agreement for the two projections was calculated.
Twenty-nine patients with midshaft clavicular fractures were enrolled from January 2020 to June 2021. The PA 25° skyline projection could clearly display the tangential line of the plate and inferior border of the clavicle. The slope angle on the superior surface of the midshaft clavicle was 26.0 ± 5.8° (range: 18.5-38.3°). The incidence of screw revision using the PA projection (72.4%) was significantly different from that using the PA 25° skyline projection (34.5%) (P < 0.05). The concordance of the screw revision rate based on the standard PA and PA 25° skyline projections was strong, with kappa coefficients of 0.680 (95% CI: 0.394-0.968) and 0.776 (95% CI: 0.537-0.998).
The PA 25° skyline projection corresponds to the slope angle of the midshaft clavicle. It can provide more accurate information regarding the proper screw length and be applied as a routine method for intraoperative evaluation.
切开复位内固定术常用于治疗移位的锁骨中段骨折。锁骨骨折的钢板螺钉固定可提供牢固的固定和旋转控制。手术固定中正确的植入物定位对于预防医源性并发症至关重要。透视在植入物的术中评估中发挥着重要作用。本研究旨在介绍一种新的透视投影来评估钢板和螺钉的定位。
本研究纳入了诊断为急性移位锁骨中段骨折的成年患者。在术前 CT 扫描的矢状重建图像上测量锁骨中段的斜率角。比较了基于术中标准前后位（PA）和 PA 25°头侧天际线投影的螺钉修正发生率。计算了两种投影的观察者间一致性。
2020 年 1 月至 2021 年 6 月期间，共纳入 29 例锁骨中段骨折患者。PA 25°天际线投影可清晰显示钢板的切线和锁骨下缘。锁骨中段上表面的斜率角为 26.0±5.8°（范围：18.5-38.3°）。使用 PA 投影的螺钉修正发生率（72.4%）明显不同于使用 PA 25°天际线投影的发生率（34.5%）（P<0.05）。基于标准 PA 和 PA 25°天际线投影的螺钉修正率的一致性较强，kappa 系数分别为 0.680（95%CI：0.394-0.968）和 0.776（95%CI：0.537-0.998）。
PA 25°天际线投影与锁骨中段的斜率角相对应。它可以提供更准确的螺钉长度信息，并可作为术中评估的常规方法。
