Liu Jinquan, Mi Jingyi, Jin Yesheng, Lin Fang, Wu Yongwei, Ma Yunhong, Liu Jun, Xu Zhonghua, Tang Li, Zhu Aiping, Jing Danfeng, Rui Yongjun, Zhou Ming
Department of Orthopaedics, Wuxi Ninth People's Hospital Affiliated to Soochow University, Wuxi, China.
Department of Orthopaedics, Changzhou Jintan First People's Hospital, Changzhou, China.
Orthop Surg. 2025 Jun;17(6):1656-1668. doi: 10.1111/os.70033. Epub 2025 Mar 24.
Current classifications inadequately address distal clavicle fracture instability due to their coronal plane focus, neglecting multiplanar displacement and underestimation of complexity on routine radiographs. This study aimed to bridge this gap by employing three-dimensional (3D) fracture mapping to characterize injury patterns, offering mechanistic insights to optimize surgical strategies.
A retrospective analysis was conducted on 81 patients diagnosed with acute distal clavicle fractures at Wuxi Ninth People's Hospital between 2019 and 2022. Axial and sagittal CT planes were utilized to demonstrate fracture line alignment. Manual simulated repositioning was performed for all fracture lines, which were subsequently graphically superimposed onto a standard template of the intact distal clavicle. A 3D map was generated and subsequently transformed into a heatmap. The classification of distal clavicle fractures was determined based on the updated and modified Neer classification. Two points were designated at the distal end of the fracture block and at the repositioned counterpart to assess the three-dimensional spatial position, including shortening along the x-axis, horizontal displacement along the y-axis, vertical displacement along the z-axis, as well as the displacement angles in the three planes, thereby quantifying the displacement of each distal clavicle fracture.
This study included 81 cases of distal clavicle fractures (43 cases on the left side and 38 cases on the right side). The distribution included 8 cases (9.88%) of Neer I, 5 cases (6.17%) of Neer IIA, 31 cases (38.27%) of Neer IIB, 11 cases (13.58%) of Neer IIC, 14 cases (17.28%) of Neer III, and 12 cases (14.81%) of Neer V. Fracture mapping revealed that the fracture lines were predominantly located in the distal one-third of the distal clavicle, with the highest concentration at the acromion end. The majority of displaced distal clavicle fractures exhibit multidirectional displacement, mainly posterior, superior, and shortening, along with angulation in the corresponding directions.
Most displaced distal clavicle fractures involve multiple displacements and angulations, necessitating three-dimensional analysis during fracture reduction. A comprehensive 3D assessment of displacement patterns is essential for evaluating stability and guiding treatment. Fracture line analysis further enhances classification accuracy and informs imaging protocols and fixation strategies tailored to specific fracture types.
目前的分类方法由于侧重于冠状面，未能充分解决锁骨远端骨折的不稳定性问题，忽视了多平面移位，且在常规X线片上对复杂性估计不足。本研究旨在通过采用三维（3D）骨折映射来描述损伤模式，提供机制性见解以优化手术策略，从而弥补这一差距。
对2019年至2022年在无锡市第九人民医院诊断为急性锁骨远端骨折的81例患者进行回顾性分析。利用轴向和矢状面CT平面展示骨折线的对齐情况。对所有骨折线进行手动模拟复位，随后将其图形叠加到完整锁骨远端的标准模板上。生成一个3D地图，随后将其转换为热图。根据更新和修改后的Neer分类法确定锁骨远端骨折的分类。在骨折块远端和复位后的对应部位指定两个点，以评估三维空间位置，包括沿x轴的缩短、沿y轴的水平移位、沿z轴的垂直移位以及三个平面内的移位角度，从而量化每个锁骨远端骨折的移位情况。
本研究纳入81例锁骨远端骨折病例（左侧43例，右侧38例）。分布情况为：Neer I型8例（9.88%），Neer IIA型5例（6.17%），Neer IIB型31例（38.27%），Neer IIC型11例（13.58%），Neer III型14例（17.28%），Neer V型12例（14.81%）。骨折映射显示，骨折线主要位于锁骨远端的外三分之一，在肩峰端最为集中。大多数移位的锁骨远端骨折表现为多方向移位，主要是向后、向上和缩短，以及在相应方向上的成角。
大多数移位的锁骨远端骨折涉及多种移位和成角，在骨折复位过程中需要进行三维分析。对移位模式进行全面的三维评估对于评估稳定性和指导治疗至关重要。骨折线分析进一步提高了分类准确性，并为针对特定骨折类型的影像学方案和固定策略提供依据。
