Objectives: 

To investigate radiological and long-term functional outcomes in modified Neer 2a, 2b, and 5 distal clavicle fractures.

Design: 

Retrospective cohort study.

Setting: 

A single university teaching hospital.

Patients/Participants: 

One hundred fifteen patients sustaining displaced distal clavicle fractures between January 01, 2010 and December 12, 2017.

Intervention: 

Operative versus nonoperative management.

Main Outcome Measurements: 

Radiographs were reviewed for fracture management and union. A customised questionnaire consisting of QuickDASH (Disabilities of the Arm, Shoulder and Hand), work, sports/performing arts, global satisfaction, and complication modules was used to determine functional outcome.

Results: 

One hundred fifteen patients were included [mean age of 49 (18–89) years]. Thirty-three (29%) underwent early fixation (<6 weeks from injury) and were younger (37 vs. 53 years, P < 0.0001). Radiographs were available for 96 patients. Nonunion rate was 55% (53/96), and majority had undergone initial nonoperative management (49 vs. 4, P < 0.00001). Eleven patients with symptomatic nonunion were deemed appropriate for delayed fixation with all cases uniting. Of the operatively managed patients, 27% (12/44) underwent metalwork removal. There were no differences in functional outcome between operative versus nonoperative and union versus nonunion patient groups at a mean follow-up of 79 months (P > 0.05).

Conclusion: 

Functional outcome and patient satisfaction at long-term follow-up were similar regardless of operative fixation or radiological union. Nonunion in displaced distal clavicle fractures seemed to cause minimal functional deficit in most elderly sedentary individuals, or the outcome measures were not sensitive enough to capture these differences. An individualized approach should be adopted, with less active, comorbid, and elderly patients counseled regarding the minimal functional improvement of surgery and risk of reoperation.

Level of Evidence: 

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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移位的锁骨远端骨折的放射学和长期功能结果

目标： 

研究改良 Neer 2a、2b 和 5 远端锁骨骨折的放射学和长期功能结果。

设计： 

回顾性队列研究。

环境： 

单一的大学教学医院。

患者/参与者： 

115 名患者在 2010 年 1 月 1 日至 2017 年 12 月 12 日期间发生移位的远端锁骨​​骨折。

干涉： 

手术与非手术管理。

主要结果测量： 

对射线照片进行了骨折管理和愈合的审查。使用由 QuickDASH（手臂、肩部和手部残疾）、工作、运动/表演艺术、总体满意度和并发症模块组成的定制问卷来确定功能结果。

结果： 

包括 115 名患者 [平均年龄 49 (18–89) 岁]。33 名 (29%) 接受了早期固定（受伤后 <6 周）并且更年轻（37 岁对 53 岁，P < 0.0001）。96 名患者可获得 X 光片。骨不连率为 55% (53/96)，大多数接受了初始非手术治疗（49 对 4，P < 0.00001）。11 名有症状的骨不连患者被认为适合延迟固定，所有病例合并。在接受手术治疗的患者中，27% (12/44) 接受了金属制品移除。在平均随访 79 个月时，手术与非手术以及愈合与不愈合患者组之间的功能结果没有差异( P > 0.05)。

结论： 

无论手术固定还是放射线愈合，长期随访的功能结果和患者满意度相似。移位的远端锁骨​​骨折的骨不连似乎对大多数久坐不动的老年人造成的功能缺陷很小，或者结果测量不够敏感，无法捕捉到这些差异。应采用个体化的方法，对活动较少、合并症和老年患者进行手术的最小功能改善和再次手术的风险进行咨询。

证据等级： 

治疗级别 III。有关证据等级的完整描述，请参阅作者须知。