Improved Robinson classification and clinical treatment of midshaft clavicle fracture based on three-dimensional CT
Objective To investigate the use of preoperative three-dimensional CT for improved Robinson classification and clinical treatment of midshaft clavicle fractures.Methods From March 2016 to December 2020,150 patients with midshaft clavicle fractures were treated.Referring to Robinson classification and combining with the selection of clinical treatment plans,an improved Robinson classification was summarized,which could be divided into three types and five subtypes:4 cases of type 2A,simple fracture of the middle clavicle,displacement＜100％;31 cases of type 2B1,simple fractures,including transverse,oblique,and spiral,with fracture displacement＞100％;64 cases of type 2B2,comminuted fracture,with cortical contact at the distal and proximal ends of the fracture,and a total of ≥ 1 bone block at the fracture end;29 cases of type 2B3,type 2B1 and type 2 fractures,with the fracture line extending to the plane of the conical tuberosity of the clavicle at the distal angle of the clavicle;19 cases of type 2C1,with no cortical contact at the distal and proximal ends of the fracture,and comminuted bone fragments at the fracture ends;3 cases of type 2C2,with segmental fractures and intact intermediate bone fragments.Among 99 patients with type 2A to B2,37 cases were treated with elastic nail internal fixation and 62 cases were treated with plate internal fixation.All types 2B3 to C2 were fixed internally with plates.Based on the classification of fractures and the selection of clinical treatment plans,the analysis was conducted.Results In postoperative follow-up of patients with type 2A to B2,there was no statistically significant difference in the postoperative shoulder Constant score,DASH score,and incidence of complications between the two groups of elastic nail fixation and plate fixation(P＞0.05).The length of the surgical incision in the elastic nail group was significantly shorter than that in the plate group,and the postoperative scar aesthetics were higher.In addition,the surgical incision with internal fixation removed during the secondary surgery was only 1 cm.Conclusion According to the improved Robinson classification,surgical plans can be guided.For patients with type 2A to 2B2,minimally invasive elastic nail internal fixation has a higher degree of scar aesthetics and satisfactory functional recovery,while for patients with type 2B3 to C2,plate internal fixation is still preferred.
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