Cunningham Gregory, Culebras Almeida L Alejandro, Gauthier Morgan
Division of Orthopaedics and Traumatology, University Hospitals of Geneva, Geneva, Switzerland.
Shoulder and Elbow Center, Hirslanden Clinique La Colline, Geneva, Switzerland.
JSES Rev Rep Tech. 2022 Feb 19;2(2):168-173. doi: 10.1016/j.xrrt.2022.01.005. eCollection 2022 May.
Displaced Neer type II and V clavicle fractures are usually treated surgically in active patients. However, distal fragment fixation remains a challenge, and no consensus has been established regarding the optimal surgical treatment. Osteosuture techniques have been popularized over the last decade, and multiple different techniques have been described. The aim of this study was to describe an all-suture technique in patients with displaced type II and V clavicle fractures and report its outcome in a prospective case series.
Between 2017 and 2020, 15 patients with displaced acute distal clavicle fractures were treated with an all-suture open technique performed by one shoulder specialized surgeon, with a minimum follow-up of 1 year. Osteosuture repair consisted in a coracoclavicular cerclage with 4 no6 Ethibonds and a figure-of-0 and figure-of-8 fracture cerclage with 2 no2 SutureTapes. Single assessment numerical evaluation (SANE) and adjusted Constant score were recorded at 6 months and 1 year. The radiologic union was assessed on plain radiographs.
At 12 months, all patients reported excellent clinical results, with a mean SANE of 98.2 [± 5.2, range 80 to 100] and a mean adjusted Constant score of 99.0 [± 1.9, range 94 to 100]. One patient developed shoulder stiffness that resolved before the final follow-up. Fractures consolidated in 93% of the cases, with union happening between 3 and 6 months [range 3 to 12 months]. One patient developed an asymptomatic malunion.
Excellent clinical and radiological outcomes can be achieved with this minimally invasive all-suture fixation technique for displaced distal clavicle fractures, which allows for an anatomic reduction and stable fixation. This pilot study showed low complications and a high level of union after a follow-up of 1 year. Among the numerous advantages are a smaller exposure than for plate fixation, avoidance of hardware-related complications such as screw failure, coracoid fracture from drilling, or rotator cuff damage caused by hook-plates. Furthermore, it avoids a reoperation to remove symptomatic hardware.
移位的Neer II型和V型锁骨骨折通常在活跃患者中采用手术治疗。然而，远端骨折块的固定仍然是一个挑战，关于最佳手术治疗方法尚未达成共识。在过去十年中，骨缝合技术得到了推广，并且已经描述了多种不同的技术。本研究的目的是描述一种用于移位的II型和V型锁骨骨折患者的全缝合技术，并在一个前瞻性病例系列中报告其结果。
在2017年至2020年期间，15例急性移位的锁骨远端骨折患者由一位肩部专科医生采用全缝合开放技术进行治疗，最短随访时间为1年。骨缝合修复包括用4根no6 Ethibond缝线进行喙锁环扎，以及用2根no2 SutureTape缝线进行0字和8字骨折环扎。在6个月和1年时记录单评估数值评估（SANE）和调整后的Constant评分。通过X线平片评估骨折的影像学愈合情况。
在12个月时，所有患者均报告了出色的临床结果，平均SANE评分为98.2[±5.2，范围80至100]，平均调整后的Constant评分为99.0[±1.9，范围94至100]。1例患者出现肩部僵硬，在最终随访前症状缓解。93%的病例骨折愈合，愈合时间在3至6个月之间[范围3至12个月]。1例患者出现无症状的畸形愈合。
这种用于移位锁骨远端骨折的微创全缝合固定技术可以实现出色的临床和影像学结果，能够实现解剖复位和稳定固定。这项初步研究显示，随访1年后并发症发生率低，愈合率高。该技术的众多优点包括比钢板固定的暴露范围更小，避免了与内固定相关的并发症，如螺钉松动、钻孔导致的喙突骨折或钩钢板引起的肩袖损伤。此外，它还避免了因取出有症状的内固定装置而进行的再次手术。
