Fractures of the clavicle.

Three hundred and forty-two patients with fractures of the clavicle attended the Fractrure Clinic at Bridgend General Hospital between 1957 and 1972. The history of injury was recorded in the notes at the first visit but in only 215 cases was the exact mechanism of the injury clearly stated. Of these, 91 per cent were caused by a fall or a blow on the point of the shoulder. All patients were treated symptomatically. A triangular sling was applied to support the weight of the arm and early use of the limb was encouraged. One hundred unselected patients were followed up, the longest period being 15 years and the shortest, 1 year. None had any loss of function of muscle power at the shoulder. Only 15 per cent were left with any noteworthy deformity at the site of fracture.     

Fractures of the medial end of the clavicle

Much is known regarding the epidemiology of clavicle fractures, particularly those of the middle-third and distal clavicle. Medial clavicle fractures are uncommon, and as a result, there is little information available. The purpose of this study is to review retrospectively a case series of medial clavicle fractures treated at a tertiary trauma center. All clavicle fractures treated at our institution over a 5-year period were reviewed by use of all available radiographic studies and medical records. These data were evaluated with respect to several epidemiologic points, including mechanism of injury, associated injuries, fracture orientation, fracture displacement, treatment, and associated injuries. Follow-up data were gathered in 32 of 44 available patients with chart review and telephone survey. We evaluated 57 medial fractures in 55 patients. Patients were typically men in the fifth decade injured as a result of vehicular trauma. Fractures were occasionally missed on chest radiographs but were always identifiable by computed tomography scan. Injuries were most often closed and without neurovascular injury. However, patients almost always had multisystem trauma. Operative treatment was rarely performed, and patients typically had little or no pain at the time of follow-up. Finally, it was found that 11 patients died within 1 month of their injuries, indicating that 20% (11/55) of patients with medial clavicle fractures died as a result of the trauma associated with their injury. Medial clavicle fractures remain a relatively uncommon injury compared with other clavicular fractures. However, they typically are accompanied by significant multisystem trauma and have a high associated mortality rate.     

Fractures of the distal clavicle: a case for fixation.

We present a series of 43 Neer type 2 fractures of the distal one-third of the clavicle. These displaced fractures are associated with a high incidence of non-union. In those patients treated non-operatively there was a higher incidence of local complications, residual shoulder dysfunction and non-union than in those treated by open reduction and internal fixation. We recommend that type 2 fractures should be treated by open reduction and internal fixation.     

Fractures of the distal third of the clavicle treated by hook plating

We retrospectively assessed the union and shoulder function following hook plate fixation in 18 patients with Neer type 2 fractures of the lateral end of the clavicle. The average age was 40 (range 22-62) years, and the mean follow-up was 25 (range 6-48) months. Fifteen patients had acute fractures and the rest were non-unions. Complications included two non-unions, one following a deep infection. There were no iatrogenic fractures. Acromial osteolysis was seen in five patients who had their plates in situ. The average pain score at rest was 1 (range 0-4), and the average pain score on abduction was 2.2 (range 0-5). The average Constant score was 88.5 (range 63-100). Patients were asked to rate their shoulder function; three rated it as normal, 11 as nearly normal and one as not normal. Hook plate fixation appears to be a valuable method of stabilising Neer type 2 fractures of the clavicle, resulting in high union rates and good shoulder function. These plates need to be removed after union to prevent acromial osteolysis.     

锁骨中段骨折:手术治疗与非手术治疗的选择

锁骨骨折占全身骨折的5％，占肩胛带骨折的44％。锁骨骨折中76％为锁骨中段1／3骨折。Robinson报告锁骨骨折的发生率为29．3／100000，其中69．2％位于中段；而Nordqvist和Petersson报告锁骨骨折的发生率：男性为86／100000，女性为44／100000，其中3／4位于中段。锁骨具有保护臂丛神经与锁骨下血管、连接稳定躯干与上肢、增加并稳定肩关节活动等功能。锁骨还与肩胛骨组成曲柄样结构：上臂前屈180°时，胸锁关节处锁骨向上30°，向后35°，沿纵轴向上旋转50°，合并肩胛骨60°旋转。故Codman曾说：“我们以拥有比动物更发达的大脑而自豪，同时还应为拥有锁骨而自豪，因为它是人类骨骼进化最重要的成果之一，灵长类以外其它动物所不具备的多种上肢重要功能均依赖锁骨。”[第一段]     

Osteoblastoma of the clavicle

A 14-year-old female with a 1-year history of a painful clavicle mass underwent resection and reconstruction with an intercalated autograft and rigid plate fixation. The histopathology was diagnostic for osteoblastoma. Although a clavicle mass is a common entity following clavicle trauma, less common disorders such as bone tumors need to be considered in the differential diagnosis. Osteoblastoma is an uncommon, benign bone tumor representing 1% of all primary bone tumors. An extensive review of the literature reveals only one reported case of clavicular osteoblastoma.     

锁骨弧形钢板治疗锁骨中段骨折

2002～2005年,我们共收治锁骨中段骨折患者29例,采用锁骨弧形钢板内固定,取得良好效果. 1 材料与方法 1.1 病例资料本组29例,男25例,女4例,年龄19～54岁.横断及短斜面骨折22例,粉碎骨折7例.均无血管神经损伤及其它合并症.     

锁骨钢板治疗锁骨中段粉碎性骨折

[目的] 探讨应用解剖型锁骨钢板治疗锁骨中段粉碎性骨折的临床价值。[方法] 应用锁骨钢板治疗锁骨中段粉碎性骨折2l例。[结果] 21例均得到随访，时间6～14个月，所有病例骨折均于术后8～12周临床愈合，无感染、骨不连、内固定松动、再骨折等发生。[结论] 鉴于锁骨中段骨折的特点，应用解剖型的锁骨钢板，有手术时间短、出血少、并发症少、内固定坚强、可早期进行患肩功能锻炼等优点。