Abstract：
BACKGROUND: Surgical treatment of midshaft clavicle fractures is associated with quick recovery and low risk of non-union. However, fixation failure may occur in case of severe comminution fractures. Moreover, clinical outcomes may be affected when clavicle fractures occur in combination with other injuries, particularly those involving the lower extremities, as the use of crutches or walkers may hinder the process of rehabilitation by adding strain on the acromioclavicular (AC) joint, resulting in possible fixation failure. This study aims to identify risk factors for fixation failure of midshaft clavicle fractures and elucidate the role of combined fractures in treatment outcomes.
METHODS: This study included patients diagnosed with midshaft clavicle fractures who underwent initial surgery between January 2012 and November 2021 at a designated regional trauma center hospital. Retrospective evaluation of fixation failure was carried out in 352 patients with midshaft clavicle fractures using standard clinical evaluation protocols and conventional radiographs. The prevalence of fixation failure and the effects of several demographic variables on the risk of fixation failure and non-union were examined. Multivariate logistic regression analysis was carried out to identify independent risk factors for fixation failure.
RESULTS: Fixation failure occurred in 40 patients (11.4%). Multivariate analysis identified comminution [odds ratio (OR) 3.532, p value = 0.003, 95% confidence interval (CI) 1.55-8.05)] and fewer number of screws (OR 0.223, p value = 0.022, 95% CI 0.06-0.80) as risk factors for fixation failure. Surgical techniques using wire cerclage reduced the chances of fixation failure in comminuted fractures (OR 0.63, p value = 0.033, 95% CI 0.05-0.80). Combined fractures that required rehabilitation using walkers or crutches increased the risk of non-union (OR 19.043, p value = 0.032, 95% CI 1.28-282.46).
CONCLUSIONS: Additional fixation of comminuted fractures using cerclage can reduce the risk of treatment failure, while multiple fractures or rehabilitation for ambulation increases the risk of the same.
METHODS: III.
METHODS: This study included patients diagnosed with midshaft clavicle fractures who underwent initial surgery between January 2012 and November 2021 at a designated regional trauma center hospital. Retrospective evaluation of fixation failure was carried out in 352 patients with midshaft clavicle fractures using standard clinical evaluation protocols and conventional radiographs. The prevalence of fixation failure and the effects of several demographic variables on the risk of fixation failure and non-union were examined. Multivariate logistic regression analysis was carried out to identify independent risk factors for fixation failure.
RESULTS: Fixation failure occurred in 40 patients (11.4%). Multivariate analysis identified comminution [odds ratio (OR) 3.532, p value = 0.003, 95% confidence interval (CI) 1.55-8.05)] and fewer number of screws (OR 0.223, p value = 0.022, 95% CI 0.06-0.80) as risk factors for fixation failure. Surgical techniques using wire cerclage reduced the chances of fixation failure in comminuted fractures (OR 0.63, p value = 0.033, 95% CI 0.05-0.80). Combined fractures that required rehabilitation using walkers or crutches increased the risk of non-union (OR 19.043, p value = 0.032, 95% CI 1.28-282.46).
CONCLUSIONS: Additional fixation of comminuted fractures using cerclage can reduce the risk of treatment failure, while multiple fractures or rehabilitation for ambulation increases the risk of the same.
METHODS: III.
摘要：
背景：锁骨中段骨折的手术治疗与快速恢复和不愈合的低风险相关。然而,在严重粉碎性骨折的情况下，可能会发生固定失败。此外，当锁骨骨折合并其他损伤时，临床结果可能会受到影响，特别是那些涉及下肢的，因为拐杖或助行器的使用可能会通过增加肩锁（AC）关节的劳损而阻碍康复过程，导致可能的固定失败。本研究旨在确定锁骨中段骨折内固定失败的危险因素，并阐明合并骨折在治疗结果中的作用。
方法：本研究包括2012年1月至2021年11月在指定的区域创伤中心医院接受初次手术的锁骨中段骨折患者。使用标准的临床评估方案和常规X线片，对352例锁骨中段骨折患者的固定失败进行了回顾性评估。检查了固定失败的患病率以及几个人口统计学变量对固定失败和不愈合风险的影响。采用多因素logistic回归分析确定内固定失败的独立危险因素。
结果：40例（11.4%）患者发生固定失败。多变量分析确定粉碎[比值比（OR）3.532，p值=0.003，95％置信区间（CI）1.55-8.05]和螺钉数量较少（OR0.223，p值=0.022，95％CI0.06-0.80）是固定失败的危险因素。使用钢丝环扎的手术技术减少了粉碎性骨折内固定失败的机会（OR0.63，p值=0.033，95％CI0.05-0.80）。需要使用助行器或拐杖进行康复的合并骨折增加了不愈合的风险（OR19.043，p值=0.032，95％CI1.28-282.46）。
结论：粉碎性骨折采用环扎附加固定可降低治疗失败的风险，而多发性骨折或步行康复会增加相同的风险。
方法：III.
方法：本研究包括2012年1月至2021年11月在指定的区域创伤中心医院接受初次手术的锁骨中段骨折患者。使用标准的临床评估方案和常规X线片，对352例锁骨中段骨折患者的固定失败进行了回顾性评估。检查了固定失败的患病率以及几个人口统计学变量对固定失败和不愈合风险的影响。采用多因素logistic回归分析确定内固定失败的独立危险因素。
结果：40例（11.4%）患者发生固定失败。多变量分析确定粉碎[比值比（OR）3.532，p值=0.003，95％置信区间（CI）1.55-8.05]和螺钉数量较少（OR0.223，p值=0.022，95％CI0.06-0.80）是固定失败的危险因素。使用钢丝环扎的手术技术减少了粉碎性骨折内固定失败的机会（OR0.63，p值=0.033，95％CI0.05-0.80）。需要使用助行器或拐杖进行康复的合并骨折增加了不愈合的风险（OR19.043，p值=0.032，95％CI1.28-282.46）。
结论：粉碎性骨折采用环扎附加固定可降低治疗失败的风险，而多发性骨折或步行康复会增加相同的风险。
方法：III.
