骨科英文书籍精读（58）｜锁骨骨折（3）
Complications
EARLY
Despite the close proximity of the clavicle to vital structures, a pneumothorax, damage to the subclavian vessels and brachial plexus injuries are all very rare.
LATE
Non-union In displaced fractures of the shaft nonunion occurs in 1–15 percent. Risk factors include increasing age, displacement, comminution and female sex. However accurate prediction of those fractures most likely to go on to non-union remains difficult.
Symptomatic non-unions are generally treated with plate fixation and bone grafting if necessary. This procedure usually produces a high rate of union and satisfaction.
Lateral clavicle fractures have a higher rate of nonunion (11.5–40 per cent). Treatment options for symptomatic non-unions are excision of the lateral part of the clavicle (if the fragment is small and the coracoclavicular ligaments are intact) or open reduction, internal fixation and bone grafting if the fragment is large. Locking plates and hooked plates are used.
Malunion All displaced fractures heal in a nonanatomical position with some shortening and angulation, however most do not produce symptoms. Some may go on to develop periscapular pain and this is more likely with shortening of more than 1.5cm. In these circumstances the difficult operation of corrective osteotomy and plating can be considered.
Stiffness of the shoulder This is common but temporary; it results from fear of moving the fracture. Unless the fingers are exercised, they also may become stiff and take months to regain movement.
---from 《Apley’s System of Orthopaedics and Fractures》P687-688
重点词汇整理：
proximity/prɑːkˈsɪməti/n. 接近，[数]邻近；接近；接近度，距离；亲近
pneumothorax /,njʊmə'θɔræks/n. [内科] 气胸
subclavian vessels锁骨下血管
brachial plexus 臂丛 /'brekɪəl/
adj. 臂的，臂状的
/ˈpleksəs/n. （血管、淋巴管、神经等的）[解剖] 丛
comminution /,kɔmi'nju:ʃən/n. 粉碎；捣碎
accurate prediction准确预测
excision /ɪkˈsɪʒn/n. 删除，切除；切除之物
All displaced fractures heal in a nonanatomical position with some shortening and angulation所有移位骨折均在非解剖位置愈合，并有一些缩短和成角
corrective osteotomy截骨矫正术
osteotomy /,ɑstɪ'ɑtəmi/n. 截骨术，骨切开术
谷歌翻译：
并发症
早期
尽管锁骨非常接近重要结构，但气胸、锁骨下血管损伤和臂丛损伤都是非常罕见的。
晚期
骨不连
在移位的骨干骨折中，骨不连的发生率为1-15%。危险因素包括年龄增加、移位、粉碎和女性。然而，准确预测那些最有可能导致骨不连的骨折仍然很困难。
如有必要，症状性骨不连一般采用钢板固定和植骨治疗。这个过程通常会产生很高的结合率和满足率。
锁骨外侧骨折不愈合率较高(11.5-40%)。症状性骨不连的治疗选择是锁骨外侧部分切除(如果骨折较小，喙锁韧带完好)或切开复位，内固定和植骨(如果骨折较大)。使用锁板和钩板。
畸形愈合
所有移位的骨折都会在非解剖位置愈合，并伴有一些缩短和成角，但大多数不会产生症状。一些人可能会继续发展为肩胛周围疼痛，这种情况更有可能发生在缩短超过1.5厘米的情况下。在这种情况下，可以考虑进行困难的矫形截骨和钢板手术。
肩关节僵硬
这是常见的，但是暂时的；它是由于害怕移动骨折造成的。除非锻炼手指，否则手指也可能会变得僵硬，需要几个月的时间才能恢复活动。