Department of Orthopaedic Surgery, Indiana University, 1801 N Senate Blvd, Ste 535, Indianapolis, IN, 46202, USA.
Department of Orthopaedics, Prisma Health, Columbia, SC, USA.
Eur J Orthop Surg Traumatol. 2023 Dec;33(8):3373-3377. doi: 10.1007/s00590-023-03563-5. Epub 2023 May 2.
The purpose of this study was to determine whether anterior plating is better tolerated than superior plating for midshaft clavicle fractures.
This was a prospective non-randomized observational cohort study following operative vs. non-operative management of clavicle fractures from 2003 to 2018 at 7 level 1 academic trauma centers in the USA. The subset of patients treated with plate and screws is the basis for this comparative study. Adults aged 18-85 with closed clavicle fractures displaced over 100% or shortened by more than 1.5 cm were eligible for enrollment. Patients were followed for 2 years following enrollment. Allowable fixation methods at the discretion of the surgeon consisted of anterior-inferior or superior plating. A total of 412 patients were enrolled. Of these, 192 patients received either superior or anterior plating for a displaced clavicle fracture with complete documented prospective research forms capturing type of plating technique. The primary outcome measure was hardware removal (HWR). Secondary outcomes were Disability of the Arm Shoulder and Hand (DASH) score and Visual Analog Pain (VAP) score, and satisfaction score (1 = high satisfaction; 5 = low satisfaction).
There was no difference in HWR rates (7.1% superior 9/127; 6.2% anterior 4/65, p = 0.81), VAP score (mean 1.5 SD 1.0 superior; mean 1.7 SD 0.6 anterior, p = 0.21), DASH score (mean 7.5 SD 12.4 superior; mean 5.2 SD 15.2 anterior; p = 0.18) or satisfaction score (mean 1.6 SD 1.0 superior; mean 1.7 SD 0.60 anterior, p = 0.18).
There is no difference in HWR rates or functional outcomes when using a superior vs. anterior plating technique.
本研究旨在确定对于锁骨中段骨折，前路钢板固定是否比前路钢板固定更能耐受。
这是一项前瞻性非随机观察性队列研究，对 2003 年至 2018 年在美国 7 个 1 级学术创伤中心接受手术与非手术治疗的锁骨骨折患者进行了研究。本比较研究的基础是接受钢板和螺钉治疗的患者亚组。年龄在 18-85 岁之间、有闭合性锁骨骨折、移位超过 100%或缩短超过 1.5cm 的患者有资格入组。患者在入组后随访 2 年。允许术者根据需要选择固定方法，包括前下或前上钢板固定。共入组 412 例患者，其中 192 例患者因锁骨骨折移位接受了前上或前下钢板固定，且有完整的前瞻性研究表格记录了钢板固定技术的类型。主要结局指标为内固定物取出（HWR）。次要结局指标为上肢功能障碍（DASH）评分、视觉模拟疼痛（VAP）评分和满意度评分（1=非常满意；5=非常不满意）。
HWR 发生率无差异（前上组 7.1%，127 例中 9 例；前下组 6.2%，65 例中 4 例，p=0.81），VAP 评分（前上组平均 1.5 标准差 1.0；前下组平均 1.7 标准差 0.6，p=0.21）、DASH 评分（前上组平均 7.5 标准差 12.4；前下组平均 5.2 标准差 15.2，p=0.18）或满意度评分（前上组平均 1.6 标准差 1.0；前下组平均 1.7 标准差 0.6，p=0.18）。
在前上和前下钢板固定技术中，HWR 发生率或功能结果无差异。
