Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland.
Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland.
Injury. 2024 Apr;55(4):111449. doi: 10.1016/j.injury.2024.111449. Epub 2024 Feb 23.
Clavicle fractures represent up to 10 % of all fractures, affecting mainly a young population. Open reduction and internal plate fixation provide good results, but evidence on the best plate positioning is still unclear. Aim of this retrospective study was to compare superior and antero-inferior plating positioning in the surgical treatment of displaced midshaft clavicle fractures.
104 patients aged > 18 years, treated surgically with plate fixation (51 superior, 53 antero-inferior) for a midshaft clavicle fracture from January 2010 to April 2021 were included. At the time of the visit, mean follow-up time was 6.6 ± 2.6 years. Shoulder function was evaluated with the use of Constant-Murley Score (CMS) and Disabilities of the Arm, Shoulder, and Hand (DASH) score. Return to sport, aesthetic satisfaction, operative time, radiological outcomes, rate of implant removal, and overall patient satisfaction were documented as well.
Mean CMS was 94.1 ± 10.0 points in the superior plating group and 93.4 ± 11.6 points in the antero-inferior plating group. DASH score: 4.6 ± 11.0 superior, 5.1 ± 10.5 antero-inferior. Return to sport: 8.2 ± 2.9 superior, 8.2 ± 3.0 antero-inferior. Aesthetic satisfaction: 8.9 ± 1.6 superior, 8.8 ± 2.1 antero-inferior. Overall satisfaction: 9.1 ± 1.5 superior, 8.9 ± 1.7 antero-inferior. The comparison between groups showed no statistically significant differences (p = n.s.) for all outcome measures. Operative time: 101.6 ± 27.3 min superior, 113.0 ± 31.6 min antero-inferior (p = 0.05). Radiological follow-up documented one non-union and one mal-union in the antero-inferior plating group. Overall, 63 patients underwent plate removal: 58.8 % in the superior plating group and 62.3 % in the antero-inferior plating group (p = n.s.). Main reason for plate removal was pain/discomfort.
Both superior and antero-inferior plating provided excellent clinical, functional, and radiological results for the treatment of displaced midshaft clavicle fractures, without significant differences between groups. The superior plating group showed a statistically shorter operative time. High rate of re-interventions with implant removal was documented in both groups.
III.
锁骨骨折约占所有骨折的 10%，主要影响年轻人群。切开复位内固定钢板提供了良好的效果，但关于最佳钢板定位的证据仍不清楚。本回顾性研究旨在比较锁骨中段骨折切开复位内固定中采用的钢板的上、前下置放位置。
2010 年 1 月至 2021 年 4 月，104 例年龄>18 岁的患者因锁骨中段骨折接受手术治疗（51 例采用上置放，53 例采用前下置放）。就诊时，平均随访时间为 6.6±2.6 年。采用 Constant-Murley 评分（CMS）和上肢残疾问卷（DASH）评估肩部功能。记录重返运动、美容满意度、手术时间、影像学结果、植骨取出率和总体患者满意度。
上置板组 CMS 平均为 94.1±10.0 分，前下置板组为 93.4±11.6 分。DASH 评分：上置板组为 4.6±11.0，前下置板组为 5.1±10.5。重返运动：上置板组为 8.2±2.9，前下置板组为 8.2±3.0。美容满意度：上置板组为 8.9±1.6，前下置板组为 8.8±2.1。总体满意度：上置板组为 9.1±1.5，前下置板组为 8.9±1.7。组间比较在所有结局测量上均无统计学显著差异（p=n.s.）。手术时间：上置板组为 101.6±27.3min，前下置板组为 113.0±31.6min（p=0.05）。影像学随访显示，前下置板组有 1 例骨不连和 1 例畸形愈合。总的来说，63 例患者接受了钢板取出：上置板组 58.8%，前下置板组 62.3%（p=n.s.）。钢板取出的主要原因是疼痛/不适。
上置和前下置钢板治疗锁骨中段骨折均取得了良好的临床、功能和影像学结果，两组间无显著差异。上置板组的手术时间明显较短。两组均有较高的植骨取出率。
III 级。
