目的:探讨锁骨中段骨折最适内固定方式。方法:总结1990年1月～2007年6月426例锁骨中段骨折采用钢丝、克氏针、钢板内固定治疗，术后随访6个月～12个月，对不同内固定疗效进行评估。结果:钢丝固定53例，固定失败18例，优良率66.04%；克氏针固定97例，固定失败12例，优良率87.63%；钢板固定276例，固定失败19例，优良率93.12%。结论:钢丝固定锁骨中段骨折不确切，克氏针固定适应症窄，钢板内固定可靠，对抗上肢旋转剪力、内外张力，有利于骨折愈合和锁骨功能的早期建立。在应用的四种类型钢板中:解剖钢板、重建钢板术后并发症少，是治疗锁骨中段骨折较为理想的内固定方式。
ObjectiveTo systematically review the safety and efficacy of operative versus non-operative treatment for displaced midshaft clavicle fractures.MethodsDatabases including PubMed, The Cochrane Library, EMbase, MEDLINE(Ovid), CBM, CNKI and WanFang Data were searched to collect randomized controlled trials (RCTs) and cohort studies about operation versus non-operation for displaced midshaft clavicle fractures from inception to June 3rd, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed by RevMan 5.2 software.ResultsA total of 14 RCTs and 5 prospective cohort studies involving 1 543 patients were included. The results of meta-analysis showed that operation was superior to non-operation in the Constant score (SMD=0.76, 95%CI 0.40 to 1.13, P<0.000 1), DASH score (SMD=–0.49, 95%CI –0.91 to 0.06,P=0.02), nonunion rate (RR=0.17, 95%CI 0.10 to 0.30, P<0.000 01), malunion (RR=0.20, 95%CI 0.12 to 0.33,P<0.000 01) and patients’ satisfaction rate (RR=1.39, 95%CI 1.13to 1.71,P=0.002), respectively.ConclusionCurrent evidence shows that operation could improve the function of the upper limbs, reduce nonunion and malunion, and improve the satisfaction of the patients with midshaft clavicle fractures. Due to the limited quality of the included studies, more large-scale, high-quality studies are required to verify the above conclusion.
ObjectiveTo compare the effectiveness of thoracoscopic assisted reduction and traditional manual reduction with percutaneous intramedullary nail internal fixation in the treatment of mid-clavicular fractures.MethodsA prospective randomized controlled trial was conducted. Twenty-two patients with mid-clavicular fractures who met the selection criteria between March 2012 and March 2017 were recruited and randomly divided into trial group (7 cases, thoracoscopic assisted reduction and percutaneous intramedullary nail fixation) and control group (15 cases, traditional manual reduction and percutaneous intramedullary nail fixation). There was no significant difference in gender, age, side, cause of injury, fracture classification, interval between injury and operation between the two groups (P>0.05). The operation time and fracture healing time were recorded and compared between the two groups. The effectiveness was evaluated by Constant-Murley scale at 6 months after operation, which included subjective evaluation indexes (functional activity and pain) and objective evaluation indexes (range of motion of shoulder joint and muscle strength).ResultsThe operation time of the trial group was significantly longer than that of the control group (t=5.881, P=0.000). Patients in both groups were followed up 7-20 months, with an average of 11 months. Satisfactory anatomical reduction achieved in all patients, and all incisions healed by first intension. In the control group, 1 patient had difficulty in removing the intramedullary nail, and 1 patient had fracture nonunion. No fracture nonunion or intramedullary nail rupture in the other patients of two groups. There was no significant difference in fracture healing time between the two groups (t=0.764, P=0.453). At 6 months after operation, there was no significant difference in Constant-Murley scale between the two groups (P>0.05).ConclusionThe treatment of the mid-clavicular fracture by using thoracoscopic assisted reduction with intramedullary nail internal fixation requires longer operation time, but does not require fluoroscopy. The effectiveness is comparable to that of traditional surgery.
ObjectiveTo investigate the effectiveness of Nice knot combined with elastic intramedullary nailing fixation in treatment of Robinson type 2B midshaft clavicular fracture in adults.MethodsBetween March 2016 and January 2018, 20 patients with Robinson type 2B midshaft clavicular fractures were treated with reduction and internal fixation by Nice knot and elastic intramedullary nailing. There were 13 cases and 7 cases, with an average age of 43 years (range, 18-56 years). The causes of injury included the traffic accident in 6 cases, falling in 12 cases, and falling from height in 2 cases. The interval between injury and admission ranged from 1 hour to 2 days (mean, 3.2 hours). The fractures were classified as Robinson type 2B1 in 16 cases and type 2B2 in 4 cases. The length of incision, the operation time, the visual analogue scale (VAS) score on the 2nd day after operation, the fracture healing time, the postoperative shoulder function and the Disability of Arm Shoulder and Hand (DASH) score, the complications, and the time of second surgical removal of internal fixator and incision length were recorded.ResultsThe length of incision was 2-6 cm (mean, 4.7cm). The operation time was 45-120 minutes (mean, 77.2 minutes). The VAS score was 1-5 (mean, 3.2) on the 2nd day after operation. All incisions healed by first intention and no infection or nerve injury occurred. All patients were followed up 12-32 months (mean, 18.6 months). All fractures healed with the healing time of 10-15 weeks (mean, 12.1 weeks). The Constant score was 92-98 (mean, 96.3) and DASH score was 0-6.4 (mean, 3.1). The elastic intramedullary nailing bending and hypertrophic nonunion occurred in 1 case and the skin stimulated by elastic nail tail in 1 case after operation. The internal fixators were removed at 12-26 months (mean, 14.6 months) after operation. And the length of incision was 1-2 cm (mean, 1.3 cm) and the operation time was 5-15 minutes (mean, 9.0 minutes). ConclusionFor the midshaft clavicular fracture in adults, the procedure of the Nice knot combined with elastic intramedullary nail has advantages of small incision, light pain, rapid fracture healing, small secondary operation injury, and avoiding the risk of clavicular epithelial nerve injury, and can obtain good effectiveness.
Objective To explore effectiveness of minimally invasive internal fixation with locking plates for mid-shaft clavicle fractures. Methods Between October 2022 and August 2023, 28 patients with mid-shaft clavicle fractures were treated by minimally invasive internal fixation with locking plates. There were 10 males and 18 females with a mean age of 46.2 years (range, 18-74 years). The fractures were caused by traffic accident in 16 patients, sports-related injury in 7 patients, and other injuries in 5 patients. According to Robinson classification, the fractures were classified as type 2A1 in 1 case, type 2A2 in 6 cases, type 2B1 in 15 cases, and type 2B2 in 6 cases. The interval between fracture and operation ranged from 5 hours to 21 days (median, 1.0 days). The pain visual analogue scale (VAS) score was 8.1±1.6. The VAS score at 3 days after operation and the occurrence of complications after operation were recorded. During follow-up, X-ray films were re-examined to observe the healing of the fracture; the shoulder joint function was evaluated according to the Constant-Murley score at 6 months, and the length of the incision scar (total length of the distal and proximal incisions) was measured. ResultsAll operations were successfully completed without any subclavian vascular or nerve damage. All incisions healed by first intention. The VAS score was 1.2±0.7 at 3 days after operation, and there was a significant difference in VAS score between pre- and post-operation (t=8.704, P<0.001). At 1 week after operation, the patient’s shoulder was basically painless, and they resumed normal life. All patients were followed up 12-20 months (mean, 13.3 months). X-ray films showed that the bone callus began to form at 2-4 months after operation (mean, 2.7 months). There was no delayed healing or non healing of the fracture, and no loosening or fracture of the internal fixators during follow-up. At 6 months after operation, the mean total incision length was 1.5 cm (range, 1.1-1.8 cm); no patient complained of numbness or paresthesia on subclavicular region or anterior chest wall. The Constant-Murley score of shoulder joint function was 93-100 (mean, 97.6). Conclusion Minimally invasive internal fixation with locking plates is a good surgical method for treating mid-shaft clavicle fractures, with simple operation, minimal trauma, good postoperative results, and high satisfaction.