Service de Chirurgie Orthopédique et Traumatologique, Centre Hospitalo-Universitaire de Nîmes, Nîmes, France.
Service de Chirurgie Orthopédique et Traumatologique, Centre Hospitalo-Universitaire de Nîmes, Nîmes, France.
Orthop Traumatol Surg Res. 2023 Sep;109(5):103590. doi: 10.1016/j.otsr.2023.103590. Epub 2023 Mar 10.
Mediolateral shortening is a risk in treatment of clavicle shaft fracture, and can lead to scapular dyskinesis and shoulder dysfunction. Many studies advocated surgical treatment if shortening exceeds 15mm.
Clavicle shaft shortening of less than 15mm has negative impact on shoulder function at more than 1 year's follow-up.
A retrospective case-control comparative study was performed, with assessment by an independent observer. Clavicle length was measured on frontal radiographs showing both clavicles, and the ratio between the healthy and affected sides was calculated. Functional impact was assessed on Quick-DASH. Scapular dyskinesis was analyzed by global antepulsion on Kibler's classification. In total, 217 files were retrieved for a 6-year period. Clinical assessment was performed for 20 patients managed non-operatively and 20 patients managed by locking plate fixation, at a mean 37.5months' follow-up (range: 12-69months).
Mean Quick-DASH score was significantly higher in the non-operated group: 11.363 [0-50] versus 2.045 [0-11.36] (p=0.0092). Pearson ρ correlation between percentage shortening and Quick-DASH score was -0.3956 [95% CI: -0.6295; -0.0959] (p=0.012). Clavicle length ratio differed significantly between groups: operated group, +2.2% [-5.1%; +17%] for 0.34cm; non-operated group, -8.28% [-17.3%; -0.7%] for 1.38cm (p<0.0001). Shoulder dyskinesis was significantly more frequent non-operated patients: 10 versus 3 (p=0.018). A threshold of 1.3cm shortening was found for functional impact.
Restoring scapuloclavicular triangle length is an important aim in management of clavicular fracture. Surgery by locking plate fixation is therefore to be recommended in case of>8% radiological shortening (1.3cm) to avoid medium- and long-term complications in shoulder function.
III; case-control study.
锁骨骨干骨折治疗中存在外侧缩短的风险，可能导致肩胛骨运动障碍和肩部功能障碍。许多研究主张如果缩短超过 15mm 则进行手术治疗。
锁骨骨干缩短小于 15mm 会对 1 年以上的肩部功能产生负面影响。
这是一项回顾性病例对照比较研究，由独立观察者进行评估。在前位 X 线片上显示双侧锁骨，并计算健侧与患侧的比值。使用快速残疾指数（Quick-DASH）评估功能影响。通过 Kibler 分类的整体前推分析肩胛骨运动障碍。在 6 年期间共检索了 217 份文件。对 20 例非手术治疗和 20 例锁定钢板固定治疗的患者进行临床评估，平均随访 37.5 个月（范围：12-69 个月）。
非手术组的 Quick-DASH 评分明显更高：11.363[0-50] 与 2.045[0-11.36]（p=0.0092）。缩短百分比与 Quick-DASH 评分之间的 Pearson ρ 相关性为 -0.3956[95%CI：-0.6295；-0.0959]（p=0.012）。两组锁骨长度比差异有统计学意义：手术组，+2.2%[-5.1%；+17%]为 0.34cm；非手术组，-8.28%[-17.3%；-0.7%]为 1.38cm（p<0.0001）。非手术组患者肩部运动障碍明显更常见：10 例与 3 例（p=0.018）。发现功能影响的缩短阈值为 1.3cm。
恢复肩锁三角长度是治疗锁骨骨折的重要目标。因此，在影像学缩短>8%（1.3cm）的情况下，通过锁定钢板固定进行手术是必要的，以避免中、长期肩部功能并发症。
III；病例对照研究。
