Tsung-Ying Tsai, Shan-Ling Hsu, Chi-Hsiang Hsu, Chin-Yi Liao, Yu-Der Lu
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We collected and analyzed clinical studies on different plate fixation methods for unstable fractures to identify the best surgical modality.</p><h3>Methods</h3><p>This retrospective case-control study included 101 patients with Neer types IIB and V unstable distal clavicle fractures treated using plate techniques. The patients were divided into four groups according to the surgical procedure: hook plate (HP group) (<i>n</i> = 13), lateral locking plate alone (LP group) (<i>n</i> = 41), locking plate with coracoclavicular (CC) ligament suture repair (LPC group) (<i>n</i> = 26), and locking plate with distal wire augmentation (LPA group) without CC repair (<i>n</i> = 21). The clinical outcomes of shoulder function were the mean Constant score and the University of California-Los Angeles (UCLA) shoulder scale. The bony union time, loss of CC distance reduction, and AC joint condition were used to evaluate the radiographic results. One-way ANOVA, Kruskal–Wallis test, and chi-square test were performed to compare differences between groups. Multiple p-value comparison corrections were calculated using the Bonferroni method.</p><h3>Results</h3><p>There were no significant differences in the mean Constant and UCLA scores among the groups after 1 year of follow-up. All fractures healed. The LPA and HP groups achieved earlier bone union (LPA 8.4 weeks, HP 8.9 weeks, LP 12.6 weeks, and LPC 13.4 weeks, <i>P</i> = 0.000); however, the HP group had the highest complication rate and required bone removal (LPA 4.0%, HP 23.1%, LP 0.0%, LPC 0.0%, <i>P</i> = 0.003). A low rate of RLOR was observed in the LPA group (LPA 9.5%, HP 23.1%, LP 22.0%, LPC 30.8%, <i>P</i> = 0.362). The incidence of AC joint subluxation was higher in the Neer type V group and was unrelated to surgical methods.</p><h3>Conclusions</h3><p>Hook plate and locking plate with distal wire augmentation in distal clavicle fractures result in an earlier time to bone union when compared with CC suture repair or non-CC suture repair techniques. However, HP may have the higher complication rate and require subsequent implant removal. The incorporation of distal wire augmentation appears to be beneficial in maintaining fracture reduction. In the future, larger prospective studies are needed to confirm these findings.</p><h3>Level of Evidence</h3><p>Level III, therapeutic study.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.0000,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Distal augmentation in unstable distal clavicle fractures: a retrospective cohort study of 101 cases\",\"authors\":\"Tsung-Ying Tsai, Shan-Ling Hsu, Chi-Hsiang Hsu, Chin-Yi Liao, Yu-Der Lu\",\"doi\":\"10.1007/s00402-024-05731-6\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction</h3><p>The optimal management strategy for unstable distal clavicular fractures remains controversial. Recent studies on plate techniques have reported good-to-excellent outcomes with no serious complications. The questions are that: (1) Does the use of wire augmentation with locking plate in distal part (distal wire augmentation) reduce radiographic loss of reduction (RLOR) and get earlier bony union in distal clavicular fractures? (2) Which fixation methods are associated with a higher incidence of acromioclavicular (AC) joints arthritis or subluxation? We collected and analyzed clinical studies on different plate fixation methods for unstable fractures to identify the best surgical modality.</p><h3>Methods</h3><p>This retrospective case-control study included 101 patients with Neer types IIB and V unstable distal clavicle fractures treated using plate techniques. The patients were divided into four groups according to the surgical procedure: hook plate (HP group) (<i>n</i> = 13), lateral locking plate alone (LP group) (<i>n</i> = 41), locking plate with coracoclavicular (CC) ligament suture repair (LPC group) (<i>n</i> = 26), and locking plate with distal wire augmentation (LPA group) without CC repair (<i>n</i> = 21). The clinical outcomes of shoulder function were the mean Constant score and the University of California-Los Angeles (UCLA) shoulder scale. The bony union time, loss of CC distance reduction, and AC joint condition were used to evaluate the radiographic results. One-way ANOVA, Kruskal–Wallis test, and chi-square test were performed to compare differences between groups. Multiple p-value comparison corrections were calculated using the Bonferroni method.</p><h3>Results</h3><p>There were no significant differences in the mean Constant and UCLA scores among the groups after 1 year of follow-up. All fractures healed. The LPA and HP groups achieved earlier bone union (LPA 8.4 weeks, HP 8.9 weeks, LP 12.6 weeks, and LPC 13.4 weeks, <i>P</i> = 0.000); however, the HP group had the highest complication rate and required bone removal (LPA 4.0%, HP 23.1%, LP 0.0%, LPC 0.0%, <i>P</i> = 0.003). A low rate of RLOR was observed in the LPA group (LPA 9.5%, HP 23.1%, LP 22.0%, LPC 30.8%, <i>P</i> = 0.362). The incidence of AC joint subluxation was higher in the Neer type V group and was unrelated to surgical methods.</p><h3>Conclusions</h3><p>Hook plate and locking plate with distal wire augmentation in distal clavicle fractures result in an earlier time to bone union when compared with CC suture repair or non-CC suture repair techniques. However, HP may have the higher complication rate and require subsequent implant removal. The incorporation of distal wire augmentation appears to be beneficial in maintaining fracture reduction. 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引用次数: 0
摘要
不稳定锁骨远端骨折的最佳治疗策略仍存在争议。最近关于钢板技术的研究报道了良好到优异的结果,没有严重的并发症。问题是:(1)在锁骨远端骨折中使用带锁定钢板的金属丝增强术(金属丝增强术)是否能减少复位损失(RLOR)并使骨愈合更早?(2)哪种固定方法与肩锁关节关节炎或半脱位的高发病率相关?我们收集并分析了不稳定骨折不同钢板固定方法的临床研究,以确定最佳的手术方式。方法回顾性病例对照研究纳入101例采用钢板治疗的IIB和V型不稳定锁骨远端骨折患者。根据手术方式将患者分为4组:钩钢板组(HP组)(n = 13)、单独外侧锁定钢板组(LP组)(n = 41)、锁定钢板联合喙锁骨(CC)韧带缝线修复组(LPC组)(n = 26)、锁定钢板加远端金属丝增强(LPA组)不进行CC修复(n = 21)。肩关节功能的临床结果为平均Constant评分和加州大学洛杉矶分校(UCLA)肩关节评分。用骨愈合时间、CC距离复位损失和AC关节状况评估x线片结果。采用单因素方差分析、Kruskal-Wallis检验和卡方检验比较组间差异。使用Bonferroni方法计算多个p值比较校正。结果随访1年后,两组患者的均数Constant和UCLA评分差异无统计学意义。所有骨折愈合。LPA组和HP组骨愈合较早(LPA 8.4周,HP 8.9周,LP 12.6周,LPC 13.4周,P = 0.000);HP组并发症发生率最高,需行除骨术(LPA 4.0%, HP 23.1%, LP 0.0%, LPC 0.0%, P = 0.003)。LPA组RLOR发生率较低(LPA 9.5%, HP 23.1%, LP 22.0%, LPC 30.8%, P = 0.362)。V型组AC关节半脱位的发生率较高,与手术方式无关。结论在锁骨远端骨折中,震荡钢板和锁定钢板加远端金属丝加固较CC缝合或非CC缝合修复均能更早地实现骨愈合。然而,HP可能有较高的并发症发生率,需要随后取出植入物。远端金属丝增强的结合似乎有利于维持骨折复位。在未来,需要更大规模的前瞻性研究来证实这些发现。证据水平:III级,治疗性研究。
Distal augmentation in unstable distal clavicle fractures: a retrospective cohort study of 101 cases
Introduction
The optimal management strategy for unstable distal clavicular fractures remains controversial. Recent studies on plate techniques have reported good-to-excellent outcomes with no serious complications. The questions are that: (1) Does the use of wire augmentation with locking plate in distal part (distal wire augmentation) reduce radiographic loss of reduction (RLOR) and get earlier bony union in distal clavicular fractures? (2) Which fixation methods are associated with a higher incidence of acromioclavicular (AC) joints arthritis or subluxation? We collected and analyzed clinical studies on different plate fixation methods for unstable fractures to identify the best surgical modality.
Methods
This retrospective case-control study included 101 patients with Neer types IIB and V unstable distal clavicle fractures treated using plate techniques. The patients were divided into four groups according to the surgical procedure: hook plate (HP group) (n = 13), lateral locking plate alone (LP group) (n = 41), locking plate with coracoclavicular (CC) ligament suture repair (LPC group) (n = 26), and locking plate with distal wire augmentation (LPA group) without CC repair (n = 21). The clinical outcomes of shoulder function were the mean Constant score and the University of California-Los Angeles (UCLA) shoulder scale. The bony union time, loss of CC distance reduction, and AC joint condition were used to evaluate the radiographic results. One-way ANOVA, Kruskal–Wallis test, and chi-square test were performed to compare differences between groups. Multiple p-value comparison corrections were calculated using the Bonferroni method.
Results
There were no significant differences in the mean Constant and UCLA scores among the groups after 1 year of follow-up. All fractures healed. The LPA and HP groups achieved earlier bone union (LPA 8.4 weeks, HP 8.9 weeks, LP 12.6 weeks, and LPC 13.4 weeks, P = 0.000); however, the HP group had the highest complication rate and required bone removal (LPA 4.0%, HP 23.1%, LP 0.0%, LPC 0.0%, P = 0.003). A low rate of RLOR was observed in the LPA group (LPA 9.5%, HP 23.1%, LP 22.0%, LPC 30.8%, P = 0.362). The incidence of AC joint subluxation was higher in the Neer type V group and was unrelated to surgical methods.
Conclusions
Hook plate and locking plate with distal wire augmentation in distal clavicle fractures result in an earlier time to bone union when compared with CC suture repair or non-CC suture repair techniques. However, HP may have the higher complication rate and require subsequent implant removal. The incorporation of distal wire augmentation appears to be beneficial in maintaining fracture reduction. In the future, larger prospective studies are needed to confirm these findings.
期刊介绍:
"Archives of Orthopaedic and Trauma Surgery" is a rich source of instruction and information for physicians in clinical practice and research in the extensive field of orthopaedics and traumatology. The journal publishes papers that deal with diseases and injuries of the musculoskeletal system from all fields and aspects of medicine. The journal is particularly interested in papers that satisfy the information needs of orthopaedic clinicians and practitioners. The journal places special emphasis on clinical relevance.
"Archives of Orthopaedic and Trauma Surgery" is the official journal of the German Speaking Arthroscopy Association (AGA).