Epidemiology of clavicle fractures

An epidemiologic study of 535 isolated clavicle fractures treated in a hospital of a large metropolis during an 11-year period was performed. Data regarding patient's age and sex, side involved, mechanism of injury, and season in which the fracture occurred were obtained from the clinical records. Radiographic classification was performed with the Allman system. Clavicle fractures represented 2.6% of all fractures and 44% of those in the shoulder girdle. Most patients were men (68%), and the left side was involved in 61% of cases. Fractures of the middle third of the clavicle, which were the most common (81%), were displaced in 48% of cases and comminuted in 19%. Fractures of the medial third were the least common (2%). The prevalence of midclavicular fractures was found to decrease progressively with age, starting from the first decade of life when they represented 88.2% of all clavicle fractures and were undisplaced in 55.5% of cases. In adults, the incidence of displaced fractures, independent of location, was higher than that of undisplaced fractures. Traffic accidents were the most common cause of the injury. In the period under study, the incidence of fractures showed no significant change over time and no seasonal variation.     

Management of acute clavicle fractures

It has been believed since the time of Hippocrates that clavicle fractures require little more than benign neglect by clinicians. Although many patients who have clavicle injuries do achieve adequate healing and functional recovery without surgical interventions, good outcomes, especially with displaced fractures, are not universal. Recent literature suggests that a subset of midclavicular injuries may warrant primary surgical treatment to minimize the incidence of nonunion and/or symptomatic malunion. Furthermore, certain types of clavicular injuries result in suboptimal outcomes when managed nonoperatively. This article is based on the currently available clinical evidence on the evolving management of acute clavicle fractures.     

Management of distal clavicle fractures

Most clavicle fractures heal without difficulty. However, radiographic nonunion after distal clavicle fracture has been reported in 10% to 44% of patients. Type II distal clavicle fractures, which involve displacement, are associated with the highest incidence of nonunion. Several studies have questioned the clinical relevance of distal clavicle nonunion, however. Nonsurgical and surgical management provide similar results. The decision whether to operate may be influenced by the amount of fracture displacement and the individual demands of the patient. Surgical options to achieve bony union include transacromial wire fixation, a modified Weaver-Dunn procedure, use of a tension band, screw fixation, plating, and arthroscopy. Each technique has advantages and disadvantages; insufficient evidence exists to demonstrate that any one technique consistently provides the best results.     

锁骨中段骨折的治疗现状

锁骨骨折是最常见的骨折之一,大多数为中段骨折。锁骨中段骨折传统采用保守治疗,但近些年手术治疗越来越多。本文从流行病学、骨折机制、分型、临床评估入手,重点总结了成人锁骨中段骨折的治疗进展并对比了几种手术方式的特点,特别收录了大量近5年的最新研究。     

The treatment of lateral clavicle fractures

This study assesses the results of surgical treatment of 15 displaced Neer type II fractures of the lateral clavicle in 15 patients, which occurred between November 1988 and March 1995 and which were followed up for a mean period of 4.6 years (range 2-9 years). The patients fell into two groups, one 'acute group' and one 'non-union' group.Patients treated initially by a non-operative approach had suffered prolonged morbidity and time off work prior to and after surgery. The ultimate result was good. The fixation used was a Dacron arterial graft as a sling around the clavicle and coracoid process. Delayed (non-union) cases were augmented with bone graft and inter-fragmentary screw fixation. All fractures eventually united.We question the place of prolonged non-operative management in the treatment of displaced Neer type II fractures of the lateral clavicle.     

锁骨近端骨折治疗进展

锁骨近端骨折发病率极低,一般行保守治疗。对于须行手术治疗的患者,因该处解剖结构比较特殊,并缺乏特定内固定材料,稳妥固定难度较大,临床上一直在探索一种比较好的内固定方式。我们对锁骨近端骨折的治疗进展进行综述。     

锁骨远端骨折的治疗

锁骨远端骨折占锁骨骨折的10%～15%,是一种常见的肩胛带骨骨折.由于解剖学和生物力学上的特异性,不稳定锁骨远端骨折的治疗至今仍存在争议,骨不连的发生率最高可达30%[1-3].     

Overtreatment of displaced midshaft clavicle fractures

Background and purpose — The best treatment for displaced clavicle fractures has been debated for decades. Operative treatment has become more common. However, several randomized trials comparing non-operative and operative treatment have not shown any compelling evidence in favor of surgery. We identified the preferred treatment of displaced midshaft clavicle fractures at public hospitals in 3 countries in Scandinavia.

Patients and methods — A purpose-made multiple-choice questionnaire in English was sent to all public hospitals in Denmark, Sweden, and Finland. This was addressed to the orthopedic surgeon responsible for treatment of clavicle fractures, and completed questionnaires were obtained from 85 of 118 hospitals.

Results — In the 3 countries, 69 of the 85 hospitals that responded would treat displaced clavicle fractures operatively. Clear criteria for treatment allocation were used at 58 of the hospitals, with the remaining 27 using individual assessment in collaboration with the patient. Precontoured locking plates were mostly used, placed either superiorly (64/85) or anteriorly (10/85).

Interpretation — Displaced midshaft clavicle fractures are mainly treated operatively in Sweden, Denmark, and Finland. This treatment is not supported by compelling evidence.     

Natural history of medial clavicle fractures

BackgroundFractures of the medial third of the clavicle comprise less than 3% of all clavicle fractures. The natural history and optimal management of these rare injuries are unknown. The aim of our study is to describe the demographics, management and outcomes of patients with medial clavicle fractures treated at a Level 1 Trauma Centre.MethodsA retrospective review was conducted of patients presenting to our institution between January 2008 and March 2013 with a medial third clavicle fracture. Clinical and radiographic data were recorded including mechanism of injury, fracture pattern and displacement, associated injuries, management and complications. Functional outcomes were assessed using the Glasgow Outcome Scale Extended (GOS-E) scores from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR). Shoulder outcomes were assessed using two patient reported outcomes scores, the American Shoulder and Elbow Society Score (ASES) and the Subjective Shoulder Value (SSV).ResultsSixty eight medial clavicle fractures in 68 patients were evaluated. The majority of patients were male (n = 53), with a median age of 53.5 years (interquartile range (IQR) 37.5–74.5 years). The most common mechanism of injury was motor vehicle accident (n = 28). The in-hospital mortality rate was 4.4%.The fracture pattern was almost equally distributed between extra articular (n = 35) and intra-articular (n = 33). Fifty-five fractures (80.9%) had minimal or no displacement. Associated injuries were predominantly thoracic (n = 31). All fractures were initially managed non-operatively, with a broad arm sling.Delayed operative fixation was performed for painful atrophic delayed union in two patients (2.9%). Both patients were under 65 years of age and had a severely displaced fracture of the medial clavicle. One intra-operative vascular complication was seen, with no adverse long-term outcome.Follow-up was obtained in 85.0% of the surviving cohort at an average of three years post injury (range 1–6 years). The mean ASES score was 80.3 (SD 24.8, range 10–100,), and the mean SSV score was 77.0 (SD 24.6, range 10–100).ConclusionSixty eight patients with medial clavicle fractures were identified over a 5 year period, with excellent functional results seen following conservative management.     

Open clavicle fractures and associated injuries

OBJECTIVES: To describe the associated injuries, demographic distribution, and management of patients sustaining open clavicle fractures. DESIGN: Retrospective case series. SETTING: A single level-1 trauma center. PATIENTS: Twenty patients with open clavicle fractures were identified from a prospectively collected orthopaedic trauma registry. INTERVENTION: All patients were managed with surgical irrigation and debridement with or without internal fixation. RESULTS: Thirteen patients (65%) had a closed head injury. Fifteen patients (75%) had a significant associated pulmonary injury. In that group, there were 10 patients who had a pneumothorax (7 bilateral). Additionally, 12 patients had rib fractures and 11 had documented pulmonary contusions or effusions. Seven patients (35%) had a cervical or thoracic spine fracture or dislocation. Eight patients (40%) had concomitant scapula fractures. Six patients (30%) had additional ipsilateral upper extremity injuries remote from the shoulder girdle. One patient had a scapulothoracic dissociation. Eleven patients (55%) sustained significant facial trauma including fractures (5 patients), lacerations, and hematomas. Fourteen patients (70%) were treated with open reduction internal fixation. Fifteen patients (75%) were followed to healing (mean: 111 wk, median: 56 wk, range: 13 to 333 wk). There were no other complications related to the operative fixations. There were no known infections or nonunions. CONCLUSIONS: Open clavicle fractures are a rare injury. Patients often have associated pulmonary and cranial injuries. Ipsilateral upper extremity and shoulder girdle injuries are common, whereas concomitant neurologic and vascular injuries are infrequent. The majority of patients have rapid and uneventful healing of their fractures after surgical treatment.     

Non-union of fractures of the clavicle

Three cases of non-union of the clavicle were successfully treated by compression fixation using AO semitubular plates.     

重建钢板治疗锁骨骨折

2005年9月～2009年1月,我科采用重建钢板治疗锁骨中外段骨折82例,疗效满意,报道如下。