Pennock Andrew T, Bastrom Tracey P, Boutelle Kelly E, Carroll Alyssa N, Edmonds Eric W, Nepple Jeffrey J, Polinsky Samuel G, Spence David D, Perkins Crystal, Willimon Samuel C, Bae Donald S, Busch Michael T, Ellis Henry B, Hergott Katelyn, Kocher Mininder S, Li Ying, Pandya Nirav K, Sabatini Coleen S, Wilson Philip L, Heyworth Benton E
Department of Orthopedic Surgery, Rady Children's Hospital, San Diego, California, USA; University of California San Diego, San Diego, California, USA.
Department of Orthopedic Surgery, Rady Children's Hospital, San Diego, California, USA.
Am J Sports Med. 2023 Mar;51(4):871-876. doi: 10.1177/03635465231152884. Epub 2023 Feb 20.
Bony remodeling of displaced clavicle fractures in adolescents remains poorly understood.
To evaluate and quantify clavicle remodeling in a large population of adolescents with completely displaced fractures, which were treated nonoperatively, to better understand the factors that may influence this process.
Case series; Level of evidence, 4.
Patients were identified from the databases of a multicenter study group investigating the functional outcomes of adolescent clavicle fractures. Patients between the ages of 10 and 19 years with completely displaced middiaphyseal clavicle fractures that were treated nonoperatively and who had further radiographic imaging of the affected clavicle at a minimum of 9 months from initial injury were included. Fracture shortening, superior displacement, and angulation were measured on the injury and final follow-up radiographs using previously validated techniques. Furthermore, fracture remodeling was classified as complete/near complete, moderate, or minimal, using an original classification system found to have good to excellent reliability (interobserver reliability = 0.78, intraobserver reliability = 0.90). Classifications were subsequently analyzed quantitatively and qualitatively to determine the factors associated with deformity correction.
Ninety-eight patients (mean age, 14.4 ± 2.0 years) were analyzed at a mean radiographic follow-up of 3.4 ± 2.3 years. Fracture shortening, superior displacement, and angulation significantly improved during the follow-up period by 61%, 61%, and 31%, respectively ( < .001). Furthermore, while 41% of the population had initial fracture shortening >20 mm at final follow-up, only 3% of the cohort had residual shortening >20 mm. Fracture remodeling was found to be associated with follow-up time; those with longer follow-up time demonstrated more remodeling ( = .001). Eighty-five percent of patients aged <14 years and 54% of patients aged ≥14 years at time of injury with a minimum follow-up of 4 years underwent complete/near-complete remodeling.
Significant bony remodeling occurs in adolescent patients with completely displaced clavicle fractures, including older adolescents, and appears to continue over longer time intervals, even beyond the adolescent years. This finding may help explain the low rate of symptomatic malunions in adolescents, even in severely displaced fractures, and particularly when compared with rates reported in adult studies.
青少年移位锁骨骨折的骨重塑情况仍未得到充分了解。
评估和量化大量非手术治疗的完全移位骨折青少年患者的锁骨重塑情况，以更好地理解可能影响这一过程的因素。
病例系列；证据等级，4级。
从一个多中心研究组的数据库中识别出患者，该研究组调查青少年锁骨骨折的功能结局。纳入年龄在10至19岁之间、非手术治疗的完全移位中1/3锁骨骨折患者，且自初次受伤起至少9个月后对患侧锁骨进行了进一步影像学检查。使用先前验证的技术在受伤时及最终随访X线片上测量骨折缩短、向上移位和角度。此外，采用一种发现具有良好至优秀可靠性的原始分类系统（观察者间可靠性 = 0.78，观察者内可靠性 = 0.90），将骨折重塑分为完全/接近完全、中度或轻度。随后对分类进行定量和定性分析，以确定与畸形矫正相关的因素。
对98例患者（平均年龄14.4 ± 2.0岁）进行了分析，平均影像学随访时间为3.4 ± 2.3年。随访期间骨折缩短、向上移位和角度分别显著改善了61%、61%和31%（P <.001）。此外，虽然41%的患者在最终随访时初始骨折缩短>20 mm，但只有3%的队列患者残留缩短>20 mm。发现骨折重塑与随访时间相关；随访时间较长的患者显示出更多的重塑（P =.00
