Yue Lei, Huang Changsheng, Zhang Jianming, Wang Ziqi, Wang Shijun, Sun Haolin
Department of Orthopedics, Peking University First Hospital, Beijing, People's Republic of China.
Orthop Res Rev. 2025 May 19;17:221-227. doi: 10.2147/ORR.S507343. eCollection 2025.
Distal clavicle fractures, accounting for a significant portion of clavicle fractures, present a treatment challenge due to their high non-union rate and the controversy surrounding operative versus non-operative management strategies. This review synthesizes recent studies and clinical evidence to compare the effectiveness of operative and non-operative approaches for distal clavicle fractures. It discusses the anatomical and classification aspects of these fractures, the indications for surgery, and the rationale behind different treatment options. Surgical fixation, predominantly through locking plates or hook plates, generally provides high union rates and stable outcomes; however, complications such as hardware irritation, subacromial impingement, and implant removal rates are significant concerns. Recent surgical advancements, including ligament repair, distal augmentation, and arthroscopic techniques, have shown promise in improving outcomes. Conversely, conservative treatment is recommended for certain fracture types, with emerging evidence suggesting it provides comparable functional outcomes to those of surgical methods. Despite a high non-union rate, non-operative treatment can be effective in restoring functions. However, challenges such as symptomatic nonunion and osteoarthritis are noted. The choice between surgical and conservative treatments depends on multiple factors, including fracture type, patient age, activity level, and overall health status. This review highlights the need for a personalized approach in managing distal clavicle fractures, considering the evolving evidence and advancements in treatment strategies.
锁骨远端骨折占锁骨骨折的很大一部分，由于其不愈合率高以及手术与非手术治疗策略存在争议，因此治疗具有挑战性。本综述综合了近期的研究和临床证据，以比较手术和非手术方法治疗锁骨远端骨折的有效性。它讨论了这些骨折的解剖学和分类方面、手术适应症以及不同治疗选择背后的原理。手术固定主要通过锁定钢板或钩钢板进行，通常能提供较高的愈合率和稳定的结果；然而，诸如内固定刺激、肩峰下撞击和植入物取出率等并发症是重大问题。包括韧带修复、远端增强和关节镜技术在内的近期手术进展已显示出改善治疗结果的前景。相反，对于某些骨折类型建议采用保守治疗，新出现的证据表明其功能结果与手术方法相当。尽管不愈合率高，但非手术治疗在恢复功能方面可能有效。然而，也存在诸如症状性不愈合和骨关节炎等问题。手术和保守治疗之间的选择取决于多种因素，包括骨折类型、患者年龄、活动水平和整体健康状况。本综述强调在处理锁骨远端骨折时需要采用个性化方法，同时考虑到不断发展的证据和治疗策略的进展。
