锁骨骨折的治疗

<正>锁骨骨折是最普通的一种骨折,约占全身骨折的2.6%～5%[1]。粉碎性、移位性、短缩的高能量锁骨骨折发生率也正在增长。传统上锁骨骨折都是使用闭合复位进行治疗。大多数早期的     

Surgery for clavicular and humeral fractures in an osteopetrotic patient: a case report

Osteopetrosis is a rare disease characterised by generalised sclerosis of the bone. Surgical treatment for fractures in osteopetrotic bones is difficult due to their hardness. We report successful surgical treatment of humeral and clavicular fractures in a 30-year-old osteopetrotic patient with severe multiple trauma. Two years after surgery, the patient had a full range of movement at the shoulder and elbow, with good bone union and alignment.     

Treatment of clavicular fractures in children

The authors describe a method of treatment of fractures of the clavicle with the help of closed reposition and fixation with the plaster bandage with a hook-semihoop. In 92 children good results were observed within the period from 6 to 10 years.     

锁骨钩钢板治疗锁骨远端骨折和肩锁关节脱位

目的探讨锁骨钩钢板在锁骨远端骨折和肩锁关节脱位中的治疗效果。方法对56例锁骨远端骨折和肩锁关节脱位患者行切开复位锁骨钩钢板内固定术。结果伤口感染2例,经换药愈合。56例均获随访,时间4～16个月。内固定松动及脱出3例,锁骨中段骨折1例,锁骨钩钢板锁骨钩不在肩峰下1例,均经石膏固定愈合;X线片显示锁骨骨折全部愈合,肩锁关节无再脱位发生。按照Karlsson评价标准：优40例,良11例,差5例,优良率91.1%。结论锁骨钩钢板治疗锁骨远端骨折和肩锁关节脱位创伤小、固定牢固、能早期活动肩关节,是治疗锁骨远端骨折和肩锁关节脱位有效的方法。     

Sequelae from clavicular fractures are common

Background Nonoperative treatment is preferred for clavicular fractures irrespective of fracture and patient characteristics. However, recent studies indicate that long term results are not as favourable as previously considered.

Methods We have identified predictive risk factors associated with demographic and baseline data on clavicular fractures. In particular, the following symptoms were investigated: pain at rest, pain during activity, cosmetic defects, reduction in strength, paresthesia and nonunion until 6 months after injury. We followed 222 patients with a radiographically verified fracture of the clavicle, and who were at least 15 years of age, for 6 months.

Results Nonunion occurred in 15 patients (7%). 93 patients (42%) still had sequelae at 6 months. Displacement of more than one bone width was the strongest radiographic risk factor for symptoms and sequelae. Both radiographic projections used in this study (0° and 45° tilted view) provided important information. A comminute fracture and higher age were associated with an increased risk of symptoms remaining at 6 months. Shortening was not predictive of functional outcome; nor was the site of the fracture in the clavicle.

Interpretation The risk for persistent symptoms following nonoperative treatment of clavicular fractures was far higher than expected. Based on these findings it seems reasonable to explore the possibly use of alternative treatment options including surgery for certain clavicular fracture types.     

Biomechanical evaluation of fixation of clavicular fractures

Reproducible fractures of the midshaft of the clavicle were created in 14 fresh frozen human cadaveric clavicles. Under the three-point bending loading by a materials testing machine, the load to failure of fixation of the clavicular fractures treated with steel reconstruction plates (five specimens) and Herbert cannulated bone screw (nine specimens), was compared with a group control formed by five specimens of clavicles without osteosynthesis material. No statistically significant differences were observed between the three groups. In consequence and in terms of biomechanics, in clavicular acute fractures, both plating and intramedullary Herbert cannulated bone screw may be utilized in the treatment of these lesions.     

锁骨钩钢板治疗锁骨肩峰端骨折及肩锁关节脱位

肩锁关节脱位约占肩部损伤的12％。轻度肩锁关节脱位一般采用保守治疗即可取得满意疗效，但对于重度肩锁关节脱位的患，多数学建议手术治疗，认为保守治疗效果差。1。2003年7月-2005年7月，我们采用锁骨钩钢板（cavicular hook plate，CHP）治疗锁骨肩峰端骨折及肩锁关节脱位23例，疗效满意。[第一段]     

Outcome of intramedullary fixation of clavicular fractures

We conducted a retrospective, single-center (tertiary referral center with associated level I trauma center) review to evaluate the outcome of open reduction and internal fixation (ORIF) with intramedullary (IM) clavicle pin of displaced clavicular fractures. Sixty-eight displaced midshaft clavicle fractures in 68 patients underwent ORIF with IM clavicle pins. Patients were identified through a perioperative database by searching for Current Procedural Terminology (CPT) codes. Union was the primary outcome. Secondary outcomes included time to union, pain, incidence of nonunion and delayed union, postoperative range of motion, and incidence of complications. Sixty-six fractures (97%) went on to union. Complications included painful hardware (44%), deep and superficial wound infections (10%), and hardware failure (4%), including pin breakage and extrusion. Postoperative shoulder pain was present in 10% of patients and limited shoulder range of motion in 12%. IM pin fixation can provide good outcomes, even for fractures with a significant amount of shortening and comminution.