Nordqvist A, Petersson C J, Redlund-Johnell I
Department of Orthopaedics, Lund University, Malmö University Hospital, Sweden.
J Orthop Trauma. 1998 Nov-Dec;12(8):572-6. doi: 10.1097/00005131-199811000-00008.
The aim of the present study was to analyze the long-term outcome of mid-clavicle fractures in adults and to evaluate the clinical importance of displacement and fracture comminution.
Two hundred twenty-five mid-clavicular fractures that had been nonsurgically treated at Malmö University Hospital were retrospectively evaluated, both clinically and radiographically, an average of seventeen years after injury. There were seventy-one undisplaced fractures, sixty-nine displaced two-fragment fractures, and eighty-five displaced and comminuted fractures. The average patient age at the time of trauma was thirty-three years (range 15 to 70 years). Patients were interviewed, and careful clinical and radiological examination of their shoulders was performed. Two patients had experienced transient neuritis, and another two underwent operative treatment because of progressive neuropathy.
All 225 consecutive patients were treated primarily at the Malmö University Hospital, which serves the Malmö city population (250,000).
PATIENTS/PARTICIPANTS: Since the beginning of this century, all radiographs taken at the Malmö University Hospital have been classified and filed for easy retrieval. In this retrospective study, all patients treated between 1970 and 1979 were identified, and those still living were called for follow-up examination.
Of the 225 fractures reviewed, 197 fractures were originally treated with a figure-of-eight splint for an average period of three weeks without any attempt to reduce the displaced fractures; twenty-four patients were allowed immediate free shoulder mobilization.
Clinical rating and healing were the main outcome measurements.
At follow-up, 185 shoulders were asymptomatic. Thirty-nine shoulders had moderate pain and were rated as fair, and one patient was rated as poor. One hundred twenty-five of the fractures had healed normally, fifty-three were malunited with persistent fracture displacement, and seven were nonunions; nonunion was significantly more prevalent in cases with displaced fractures. Forty malunited fractures and three nonunions were rated as good.
This review demonstrates that few patients with fractures of the mid-part of the clavicle require operative treatment.
本研究旨在分析成人锁骨中段骨折的长期预后，并评估骨折移位和粉碎的临床重要性。
对马尔默大学医院接受非手术治疗的225例锁骨中段骨折患者进行回顾性评估，平均在受伤17年后进行临床和影像学检查。其中71例为无移位骨折，69例为移位的两部分骨折，85例为移位粉碎性骨折。创伤时患者的平均年龄为33岁（范围15至70岁）。对患者进行了访谈，并对其肩部进行了仔细的临床和放射学检查。2例患者曾经历短暂性神经炎，另外2例因进行性神经病变接受了手术治疗。
所有225例连续患者均主要在为马尔默市（25万人口）服务的马尔默大学医院接受治疗。
患者/参与者：自本世纪初以来，马尔默大学医院拍摄的所有X光片均已分类存档以便于检索。在这项回顾性研究中，确定了1970年至1979年间接受治疗的所有患者，并对仍在世的患者进行随访检查。
在回顾的225例骨折中，197例最初采用8字绷带治疗，平均为期三周，未尝试复位移位骨折；24例患者被允许立即进行自由肩部活动。
临床评分和愈合情况是主要观察指标。
随访时，185例肩部无症状。39例肩部有中度疼痛，评定为一般，1例患者评定为差。125例骨折正常愈合，53例畸形愈合且骨折移位持续存在，7例不愈合；不愈合在移位骨折病例中明显更常见。40例畸形愈合骨折和3例不愈合评定为良好。
本综述表明，很少有锁骨中段骨折患者需要手术治疗。
