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Die Klavikulaschaftfraktur – Klassifikation und Therapie

Ergebnisse einer Umfrage an unfallchirurgischen/orthopädischen Kliniken in Deutschland

Midshaft clavicle fractures – classification and therapy

Results of a survey at German trauma departments

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Zusammenfassung

Einleitung

Die Therapie der Klavikulaschaftfraktur, insbesondere der dislozierten Fraktur, wird zunehmend kontrovers diskutiert. Das Ziel der vorliegenden Erhebung war es daher, die reale Praxis der Versorgung von Klavikulaschaftfrakturen zu analysieren.

Methodik

In einer anonymen, schriftlichen Umfrage wurden 240 unfallchirurgische/orthopädische Abteilungen in Deutschland nach ihrem diagnostischen und therapeutischen Vorgehen bei der Klavikulaschaftfraktur befragt. Entsprechend einer Rücklaufquote von 59% konnten 142 beantworteter Fragebögen ausgewertet werden.

Ergebnisse

Über 80% der Kliniken verzichten auf eine standardisierte Klassifikation der Fraktur. Einfache Brüche werden durchweg konservativ behandelt, zumeist mit dem Rucksackverband (88%). Durchschnittlich werden 26% aller Klavikulafrakturen operativ stabilisiert, wobei sich hierbei kein signifikanter Unterschied zwischen den unfallchirurgischen Zentren und den übrigen Kliniken ergibt (p=0,45). Die Operationsindikationen umfassen relevante Zusatzverletzungen im Schulterbereich (81–95%), junge und aktive Erwachsene (52–64%) und dislozierte Klavikulaschaftfrakturen (56–75%). Als Implantat steht durchweg die Platte zur Verfügung, wobei die Rekonstruktionsplatte (56%) am häufigsten verwendet wird. Von den befragten Kliniken führen 43% bei geeignetem Frakturtyp eine intramedulläre Osteosynthese durch, wobei diese Technik signifikant häufiger von unfallchirurgischen Zentren (55%) als von den übrigen Kliniken (31%) verwendet wird (p=0,01).

Schlussfolgerungen

Durch diese Erhebung konnte dargestellt werden, dass in Deutschland ein relativ hoher Anteil der Klavikulafrakturen operativ stabilisiert wird. Dieses Ergebnis steht im Einklang mit neueren Publikationen, die überlegene Ergebnisse für die operative Therapie der dislozierten Klavikulaschaftfraktur im Vergleich zur konservativen Behandlung zeigen konnten.

Abstract

Introduction

The therapy of the midshaft clavicle fracture, in particular dislocated midshaft fractures, remains controversial. Therefore the objective of this study was to obtain data about the current treatment for midshaft clavicle fractures.

Methods

In a countrywide anonymous survey 240 German orthopaedic trauma departments were asked about their diagnostic and therapeutic procedures for midshaft clavicle fractures. A total of 142 questionnaires (59%) were returned and evaluated.

Results

More than 80% of the hospitals dispense with a standardised fracture classification for midshaft fractures. Simple fractures are generally conservatively treated, in the majority using a figure-of-eight bandage (88%). On average 26% of all clavicle fractures are operatively stabilized, independent of whether the treatment was performed at a trauma centre or any other hospital (p=0.45). Indications for operative treatment of midshaft fractures include severe additional injuries in the shoulder region (81–95%), young and active adults (52–64%) and dislocated midshaft fractures (56–75%). All departments use plate fixation for midshaft fractures; in particular the reconstruction plate (56%) is most frequently applied. Alternatively, if the fracture pattern is considered suitable for intramedullary fixation, this procedure is performed by 43% of the clinics, although this operative technique is used significantly more often in trauma centres (55%) than in other hospitals (31%) (p=0.01).

Conclusion

This survey demonstrates a high rate (26%) of German trauma hospitals operating clavicular midshaft fractures. This result is consistent with recently published studies showing better results for operative treatment of dislocated midshaft clavicular fractures compared to conservative therapy.

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  1. Klinikum der Universität München, Chirurgische Klinik und Poliklinik – Großhadern, Marchioninistr. 15, 81377, München, Deutschland

    O. Pieske, M. Dang, J. Zaspel, B. Beyer, T. Löffler & S. Piltz

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  1. O. Pieske
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  2. M. Dang
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Correspondence to O. Pieske.

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Pieske, O., Dang, M., Zaspel, J. et al. Die Klavikulaschaftfraktur – Klassifikation und Therapie. Unfallchirurg 111, 387–394 (2008). https://doi.org/10.1007/s00113-008-1430-z

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