抄録
Although many authors continue to recommend primary operative treatment for an unstable type of distal clavicular fracture because of a high incidence of nonunion and residual shoulder disability associated with non-operative treatment, there are many reports of asymptomatic nonunions resulting from the operative treatment. Our 73 patients with a fresh distal clavicular fracture were reviewed on an average 3 years after their injuries. There were 21 undislocated Craig Type I fractures,39 dislocated Type II fractures,2 intraarticular Type III fractures and 11 dislocated Type V three-part fractures. The patients'age at trauma was 41(16-86)years.20 Type I,13 Type II,2 Type III and 6 Type V fractures were treated non-operatively, and the remainder underwent primary operative treatment. At follow-up,71 shoulders were asymptomatic.2 shoulders of Type II and Type III had moderate pain; no patient had a severe, residual shoulder disability. There were 8 nonunions resulting form 6 Type II (5 had nonoperative treatment)and 2Type V (one had non-operative treatment),7 of these were asymptomatic. The symptomatic nonunion resulting from non-operative treatment was Type II, whose displacement of the proximal clavicle was not superior but just posterior, like Rockwood Type IV acromioclavicular dislocation with a posterior displacement of the clavicular end, and had residual hypermobility of the proximal clavicle. We conclude that an unstable type of this fracture has coracoclavicular ligament injury of various degrees, and the functional healing of this ligament can be acquired even by non-operative treatment to some degree, and is usually followed by a bone union. Even if it is not followed, nonunions with coracoclavicular stability are asymptomatic. The objects of this treatment are a coracoclavicular ligament injury, and the stickiness the bone union gets can be followed by residual disability.
