Shoulder and Elbow Surgery, Schulthess Klinik, Zurich, Switzerland.
Department of Orthopedic Surgery and Traumatology, Cantonal Hospital Frauenfeld, Pfaffenholzstrasse 4, 8501, Frauenfeld, Switzerland.
Arch Orthop Trauma Surg. 2023 Aug;143(8):4925-4931. doi: 10.1007/s00402-023-04769-2. Epub 2023 Jan 12.
Lateral clavicle fractures are unstable and prone to nonunions, which is why they are often treated surgically rather than conservatively. Despite the variety of surgical techniques found in the literature, the best method for treating this rare fracture type has not yet been determined. Our case series aimed to describe a coracoclavicular (CC) reconstruction technique and to assess complications and patient outcomes 1 year postoperatively.
Nineteen patients who underwent surgery for an unstable lateral clavicle fracture (IIB, IIC, IID) with a suture button device (Dog Bone, Arthrex, Inc., Naples, FL, USA) were available for clinical and radiological follow-up. The assessments included the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment (ASES) score, the Constant Score (CS), the Subjective Shoulder Value (SSV), as well as the ipsilateral and contralateral coracoclavicular distance.
The median age was 50 years (IQR 28-59), 13 (68.4%) were male and the delay to surgery was 5 days (IQR 2-9). The median clinical scores were 100 (ASES), 91 (CS), and 95 (SSV). The CC distance improved postoperatively (p = 0.003). However, nonunion occurred in 3 (15.8%) patients, 5 (26.3%) had other complications, and 5 (26.3%) needed revision surgery (4 plate removals and 1 pseudoarthrosis). The overall complication rate was 36.8%.
Restoring the CC ligaments alone could not reliably achieve fracture stability, with more than one-third of cases in this series experiencing major complications. Given the high revision and nonunion rates, we do not recommend this type of surgical technique.
锁骨外侧骨折不稳定，容易发生不愈合，因此通常需要手术治疗而不是保守治疗。尽管文献中有多种手术技术，但尚未确定治疗这种罕见骨折类型的最佳方法。我们的病例系列旨在描述一种喙锁（CC）重建技术，并评估术后 1 年的并发症和患者结果。
19 例不稳定的锁骨外侧骨折（IIB、IIC、IID）患者采用缝线纽扣装置（Arthrex，Inc.，佛罗里达州那不勒斯的 Dog Bone）进行手术，可进行临床和影像学随访。评估包括美国肩肘外科医师协会（ASES）标准肩部评估（ASES）评分、Constant 评分（CS）、主观肩部值（SSV），以及同侧和对侧 CC 距离。
中位年龄为 50 岁（IQR 28-59），13 例（68.4%）为男性，手术延迟 5 天（IQR 2-9）。中位临床评分分别为 100（ASES）、91（CS）和 95（SSV）。CC 距离术后改善（p = 0.003）。然而，3 例（15.8%）发生骨不连，5 例（26.3%）发生其他并发症，5 例（26.3%）需要翻修手术（4 例取出钢板和 1 例假关节）。总体并发症发生率为 36.8%。
单独修复 CC 韧带不能可靠地实现骨折稳定性，本系列中有三分之一以上的病例发生重大并发症。鉴于高翻修和骨不连率，我们不推荐这种手术技术。
