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首页> 美国卫生研究院文献>Strategies in Trauma and Limb Reconstruction >Midshaft clavicle fractures treatment: threaded Kirschner wire versus conservative approach
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Midshaft clavicle fractures treatment: threaded Kirschner wire versus conservative approach

机译：中轴锁骨骨折治疗：螺纹克氏针与保守治疗

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Clavicle fractures are common, accounting for 2.6 to 10% of all fractures. Treatment of these fractures is usually non-surgical. Recent evidence, however, reveals that the final result of non-surgically midshaft clavicular fractures, particularly those with quite large displacements or shortening, is not like that which was previously thought. This study evaluated retrospectively all patients presented with a clavicle fracture at Emergency Department of our Institution, between January 2006 and December 2011. Fractures were classified according to Allman’s radiographic classification system, modified by Nordqvist and Petersson. Patients were distinguished into two groups: one that underwent conservative treatment with a “figure-of-8” orthosis and one that underwent surgery with reduction in fracture and fixation with intramedullary threaded Kirschner wire. Pin removal was performed after 4 weeks of rest in Gilchrist bandage, after clinical and radiographic evaluation demonstrating the bone healing. The QuickDASH score and the Constant Murley Shoulder Score were used to evaluate the clinical outcomes. The radiographic outcome was evaluated at 1 and 6 months of follow-up. Database review provided a final cohort of 58 patients, with similar demographic features. There was no significant difference in qDASH and CS between the two groups. The results of qDASH and CS evaluated in function of the radiographic outcome show a statistically significant correlation between the worst qDASH and CS results and the grade of malunion in both groups. In particular, we have found unsatisfactory results when final shortening of the clavicle was 20 mm or more. On radiographic evaluation, surgical treatment demonstrated a greater efficacy in reducing initial shortening of the fractured bone; this is in opposition to conservative treatment that results very often in malunion, shortening, anatomic alterations and loss of functionality. The use of intramedullary threaded Kirschner wire for fixation of midshaft clavicle fractures is a safe procedure and is recommended in case of shortening greater than 2 cm in high-function-demand patients.
机译：锁骨骨折是常见的，占所有骨折的2.6％至10％。这些骨折的治疗通常是非手术的。但是，最近的证据表明，非手术中轴锁骨骨折的最终结果，特别是位移或缩短程度相当大的最终结果，与以前的想法不同。这项研究回顾性地评估了2006年1月至2011年12月间在我们机构急诊科就诊的所有锁骨骨折患者。根据由Nordqvist和Petersson修改的Allman放射学分类系统对骨折进行分类。将患者分为两组：一组接受“ 8位数字”矫形器的保守治疗，另一组接受减少髓内螺纹Kirschner钢丝骨折和固定的手术。在临床和放射学评估表明骨愈合后，在吉尔克里斯特绷带中休息了4周后进行了销钉去除。使用QuickDASH评分和恒定Murley肩膀评分来评估临床结局。在随访的1个月和6个月对放射学结果进行评估。数据库审查提供了58名患者的最终队列，这些患者具有相似的人口统计学特征。两组之间的qDASH和CS差异无统计学意义。根据放射学结果评估的qDASH和CS结果显示，两组中最差的qDASH和CS结果与畸形畸变等级之间存在统计学上的显着相关性。特别是，当锁骨的最终缩短为20毫米或以上时，我们发现效果不理想。根据影像学评估，手术治疗在减少骨折的初期缩短方面显示出更大的功效。这与保守治疗相反，保守治疗经常导致畸形畸形，缩短，解剖改变和功能丧失。使用髓内螺纹Kirschner钢丝固定锁骨中轴骨折是安全的方法，建议在高功能患者中将其缩短到2 cm以上时使用。

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