Feng Dongxu, Yang Yang, Kang Xiaomin, Heng Lisong, Zhang Jun, Zhu Yangjun
Department of Orthopaedic Trauma, Hong Hui Hospital, Xi'an Jiaotong University School of Medicine, Xi'an, Shaanxi, China.
Vaccination and immunization department, Xi'an center for disease control and prevention, Xi'an, Shaanxi, China.
Injury. 2023 Mar 18. doi: 10.1016/j.injury.2023.03.023.
Fracture of the medial end of the clavicle is very rare. There is no consensus on the standard surgical strategy for medial clavicle fracture, and treatment is challenging. This study aimed to retrospectively evaluate the efficacy of internal plate fixation for displaced medial clavicle fracture.
Patients who underwent internal plating of a displaced medial clavicle fracture were included in this retrospective study. Each patient underwent open reduction and fixation with an internal extra-articular locking plate or trans-articular hook plate based on their fracture type. Postoperative follow-up included radiographs for assessment of bone union, Constant-Murley score for shoulder function, Disability of the Arm, Shoulder, and Hand (DASH) questionnaire for upper limb function, and visual analog scale (VAS) for pain. Any complications were also recorded.
Between May 2014 and July 2021, 34 patients (9 females, 25 males; mean age, 50.0 ± 14.8 years) were treated with internal plate fixation and included in this study. The fracture line was located in the medial fifth of the clavicle in 32 patients, and 20 patients had intra-articular fracture. Eighteen patients had the fracture fixed with a locking plate, namely an inverted distal clavicle plate (n = 7), straight locking plate (n = 3), distal fibular plate (n = 3), and T-plate (n = 5); the other 16 patients were treated with a clavicle hook plate. During a mean follow-up of 30.7 ± 26.5 months, 33 patients achieved bone healing, the average Constant-Murley score was 90.9 ± 11.0 points, the mean DASH score was 6.0 ± 6.6 points, and the mean VAS was 0.4 ± 1.1 points. Complications occurred in five patients.
Both locking plates and hook plates are effective in treating displaced medial clavicle fracture. A locking plate is recommended when there is enough bone stock in the medial fragment for stable fixation. A clavicle hook plate is recommended for cases in which the medial clavicle fracture is too small, comminuted, or has signs of sternoclavicular joint instability.
锁骨内侧端骨折非常罕见。对于锁骨内侧端骨折的标准手术策略尚无共识，治疗具有挑战性。本研究旨在回顾性评估切开复位钢板内固定治疗移位性锁骨内侧端骨折的疗效。
本回顾性研究纳入了接受移位性锁骨内侧端骨折切开复位钢板内固定治疗的患者。根据骨折类型，每位患者均接受切开复位并用关节外锁定钢板或经关节钩钢板进行内固定。术后随访包括用于评估骨愈合情况的X线片、用于评估肩部功能的Constant-Murley评分、用于评估上肢功能的上肢功能障碍问卷（DASH）以及用于评估疼痛的视觉模拟评分（VAS）。还记录了所有并发症。
2014年5月至2021年7月期间，34例患者（9例女性，25例男性；平均年龄50.0±14.8岁）接受了钢板内固定治疗并纳入本研究。32例患者的骨折线位于锁骨内侧五分之一处，20例患者为关节内骨折。18例患者采用锁定钢板固定，即倒置锁骨远端钢板（n = 7）、直形锁定钢板（n = 3）、腓骨远端钢板（n = 3）和T形钢板（n = 5）；另外16例患者采用锁骨钩钢板治疗。在平均30.7±26.5个月的随访期间，33例患者实现了骨愈合，平均Constant-Murley评分为90.9±11.0分，平均DASH评分为6.0±6.6分，平均VAS评分为0.4±1.1分。5例患者出现并发症。
锁定钢板和钩钢板治疗移位性锁骨内侧端骨折均有效。当内侧骨折块有足够骨量以进行稳定固定时，推荐使用锁定钢板。对于内侧锁骨骨折块过小、粉碎或存在胸锁关节不稳定迹象的病例，则推荐使用锁骨钩钢板。
