| Abstract |
Objective To find that there is a specific wedge-shaped bone block on the front side of the distal end in the middle clavicle comminuted fracture, and to explore the probability and clinical significance of this bone block in the middle clavicle comminuted fracture. Methods From 2018 to March 2020, 50 cases of comminuted fracture of the middle clavicle were treated in our department in recent 27 months, and 49 cases had this wedge-shaped bone mass. Among them, there were 25 cases on the left side, 25 cases on the right side, 43 males and 7 females, with an average age of （35.6±2.97） years. Three-dimensional reconstruction of bilateral shoulders is routinely performed before operation. When patients with this wedge-shaped bone block are operated, the wedge-shaped bone block is firstly reset and fixed at the distal end of the fracture, and the soft tissue attached to the bone block is retained. The 2.7 or 3.5mm system lag screw is routinely used for fixation from front to back, and then the distal and proximal ends of the fracture are reset and fixed, and the steel plate is placed above the clavicle. At one year follow-up, DSAH score of shoulder, arm and hand dysfunction and Constant-Murley score of shoulder joint were used for evaluation. Results The operation time was 45-120 minutes, with an average of (60± 2.54)minutes and bleeding was 20-100 ml, with an average of (40±2.12) mL. All patients were followed up for 12-24 months, with an average of (18±1.83) months. All fractures healed completely, and the healing time was 2-4 months, with an average of (3.4±0.81) months. Two patients had deformed steel plate after operation, but did not break, the fracture malunion, the function of the affected limb was not obviously limited, and no revision operation was performed. One patient complained that the affected shoulder felt drooping. No wound infection, brachial plexus injury and blood vessel injury occurred in all patients. The DSAH score was 0-4.1, with an average of (0.3±0.23), and the Constant-Murley score was 90-100, with an average of (97.4±1.2). Conclusion Among 50 patients with comminuted fracture of the middle clavicle, 49 patients have this wedge-shaped bone mass, and the existing rate is 98%. During the operation, the bone block was firstly treated, and the bone block was reduced and fixed at the distal end of the fracture with lag screws. It is convenient to reduce fracture end, shorten operation time, reduce intraoperative bleeding, reduce infection risk, increase fixation stability and reduce stress of steel plate. It can satisfy the early functional exercise after operation, and is beneficial to the functional recovery of the affected limb after operation with satisfactory results.
|