Lecoultre Yannic, van de Wall Bryan J M, Beeres Frank J P, Babst Reto
Klinik für Orthopädie und Unfallchirurgie, Luzerner Kantonsspital, Spitalstrasse, 6000, Luzern, Schweiz.
Fakultät für Gesundheitswissenschaften und Medizin, Universität Luzern, Luzern, Schweiz.
Unfallchirurgie (Heidelb). 2024 Nov;127(11):769-775. doi: 10.1007/s00113-024-01470-w. Epub 2024 Aug 27.
Clavicle fractures are among the most frequent injuries of the shoulder girdle. Nondisplaced fractures are generally treated conservatively, whereas dislocated fractures require surgical reduction and stabilization. A variety of implants and surgical techniques with reliable results are available. While all techniques provide similar healing rates, they share a common disadvantage with the high incidence of implant irritation and correspondingly high rates of second interventions for material removal.
The various surgical techniques for clavicle shaft fractures with their specific areas of application as well as advantages and disadvantages are presented. This review also provides an aid for deciding which surgical technique is most appropriate based on the fracture morphology. Furthermore, an overview of current research activities is presented, with a specific focus on new implants which could help to reduce implant irritation.
Open superior and anteroinferior plate osteosyntheses each show similar reliable results. The minimally invasive plate osteosynthesis (MIPO) technique offers an alternative for multifragmented fractures as it has a lower complication rate compared to the open procedure. Double plate osteosynthesis using minifragment plates shows promising results with respect to the incidence of implant-related irritation. Larger prospective studies are still pending. Intramedullary nailing offers a good alternative, especially if material removal is planned anyway, e.g., in the pediatric setting.
锁骨骨折是肩胛带最常见的损伤之一。无移位骨折一般采用保守治疗，而移位骨折则需要手术复位和固定。有多种植入物和手术技术，效果可靠。虽然所有技术的愈合率相似，但它们都有一个共同的缺点，即植入物刺激的发生率高，相应地二次取出材料的干预率也高。
介绍锁骨骨干骨折的各种手术技术及其具体应用领域、优缺点。本综述还为根据骨折形态决定哪种手术技术最合适提供帮助。此外，还概述了当前的研究活动，特别关注有助于减少植入物刺激的新型植入物。
开放上钢板和前下钢板接骨术均显示出相似的可靠效果。微创钢板接骨术（MIPO）技术为多段骨折提供了一种替代方法，因为与开放手术相比，其并发症发生率较低。使用微型钢板的双钢板接骨术在植入物相关刺激发生率方面显示出有前景的结果。仍有待开展更大规模的前瞻性研究。髓内钉固定是一种很好的替代方法，特别是如果无论如何都计划取出材料，例如在儿科情况下。
