锁骨
医学
破折号
固定(群体遗传学)
射线照相术
外科
回顾性队列研究
口腔正畸科
人口
环境卫生
计算机科学
操作系统
作者
Sarah Pradel,Maxime Brunaud,Rémy Coulomb,Pascal Kouyoumdjian,Olivier Marès
标识
DOI:10.1016/j.otsr.2023.103590
摘要
Mediolateral shortening is a risk in treatment of clavicle shaft fracture, and can lead to scapular dyskinesis and shoulder dysfunction. Many studies advocated surgical treatment if shortening exceeds 15 mm. Clavicle shaft shortening of less than 15 mm has negative impact on shoulder function at more than 1 year's follow-up. A retrospective case-control comparative study was performed, with assessment by an independent observer. Clavicle length was measured on frontal radiographs showing both clavicles, and the ratio between the healthy and affected sides was calculated. Functional impact was assessed on Quick-DASH. Scapular dyskinesis was analyzed by global antepulsion on Kibler's classification. In total, 217 files were retrieved for a 6-year period. Clinical assessment was performed for 20 patients managed non-operatively and 20 patients managed by locking plate fixation, at a mean 37.5 months’ follow-up (range: 12–69 months). Mean Quick-DASH score was significantly higher in the non-operated group: 11.363 [0–50] versus 2.045 [0–11.36] (p = 0.0092). Pearson ρ correlation between percentage shortening and Quick-DASH score was −0.3956 [95% CI: −0.6295; −0.0959] (p = 0.012). Clavicle length ratio differed significantly between groups: operated group, +2.2% [−5.1%; +17%] for 0.34 cm; non-operated group, −8.28% [−17.3%; −0.7%] for 1.38 cm (p < 0.0001). Shoulder dyskinesis was significantly more frequent non-operated patients: 10 versus 3 (p = 0.018). A threshold of 1.3 cm shortening was found for functional impact. Restoring scapuloclavicular triangle length is an important aim in management of clavicular fracture. Surgery by locking plate fixation is therefore to be recommended in case of > 8% radiological shortening (1.3 cm) to avoid medium- and long-term complications in shoulder function. III; case-control study.
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