Safran O, Mosheiff R, Mattan Y, Liebergall M
Orthopedic Dept., Hadassah-University Hospital, Jerusalem.
Harefuah. 1997 Jul;133(1-2):16-9, 79.
Clavicular fractures make up 45% of shoulder girdle fractures. The clavicle's susceptibility to injury is due to its subcutaneous position and its role as the bony connection between the thorax and the shoulder. In 95% of cases the mechanism of injury is a direct blow to the shoulder. These fractures are usually treated conservatively without surgery. But there are a few such fractures that require surgical repair in order to unite well. 9 patients were operated on for clavicular fractures during 1991-1995. The indications for surgical repair were lateral-third fracture, floating shoulder, neurovascular deficit or nonunion. The methods used were open reduction and fixation with either plate and screws, Kirchner wires, cerclage or a combination. All fractures united well, with no infections or new neurovascular deficits. Good range of shoulder motion and acceptable cosmetic results were achieved in all. 1 patient had functional limitation due to brachial neuritis caused by brachial damage at the time of injury. Indications for surgical repair and the methods used in these cases are similar to those described in the literature. The high rate of union and absence of complications support surgical repair for the few calvicular fractures that are not likely to unite properly.
锁骨骨折占肩胛带骨折的45%。锁骨易受伤是由于其皮下位置以及它作为胸廓与肩部之间的骨性连接的作用。在95%的病例中，损伤机制是肩部受到直接打击。这些骨折通常采用保守治疗而非手术治疗。但有少数此类骨折需要手术修复才能良好愈合。1991年至1995年间，有9例患者因锁骨骨折接受了手术。手术修复的指征为外侧三分之一骨折、浮动肩、神经血管缺损或骨不连。所采用的方法是切开复位并用钢板螺钉、克氏针、环扎术或联合使用这些方法进行固定。所有骨折均愈合良好，无感染或新的神经血管缺损。所有患者均获得了良好的肩部活动范围和可接受的美容效果。1例患者因受伤时臂丛损伤导致臂丛神经炎而出现功能受限。这些病例中的手术修复指征和所采用的方法与文献中描述的相似。高愈合率和无并发症支持对少数不太可能正常愈合的锁骨骨折进行手术修复。
