Conservative versus surgical treatment of displaced midshaft clavicle fracture in adolescents

Česká verzia

Authors: R. Štichhauer; J. Lešková; A. Šafus; J. Preis
Authors place of work: Lékařská fakulta Hradec Králové, Univerzita Karlova ; Oddělení dětské chirurgie a traumatologie a Centrum dětské traumatologie, Fakultní nemocnice Hradec Králové
Published in the journal: Rozhl. Chir., 2022, roč. 101, č. 2, s. 66-71.
Category: Original articles
doi: https://doi.org/10.33699/PIS.2022.101.2.66–71

Summary

Introduction: Midshaft clavicle fractures are common in childhood and their conservative treatment predominates. The indication for surgical treatment of adolescents with significantly displaced fractures remains controversial. The aim of this study was to compare the results of conservative or surgical treatment (intramedullary nailing) of these fractures.

Methods: Retrospective clinical study of patients aged 11−17 years with significantly displaced clavicle fractures treated at the Department of Pediatric Surgery and Traumatology, University Hospital Hradec Králové in 2011−2020.

Results: In this period, 696 patients with a clavicle fracture (excluding neonatal fractures) were treated. Of these, only 90 (13%) adolescent patients had significantly displaced diaphyseal fractures. Conservative approach was adopted in 52 (58%) of them; the remaining patients underwent a surgical procedure, while an intramedullary inserted and fixed titanium nail (TEN) was used in 20 (22%) cases. Supportive fixation was necessary in 4 of the operated patients. The duration of supportive fixation (basic therapeutic procedure for conservative treatment) was significantly shorter in operated patients (18 vs. 29 days, p=0.0001). No statistically significant difference was found in terms of the time interval of complete healing and return to full activity (74 vs. 85 days, p=0.051). There was one complication in the healing of the surgical wound; all patients healed without sequelae.

Conclusion: According to the study, intramedullary osteosynthesis using a fixed titanium nail reduced the need for supportive fixation and allowed to shorten its time. Overall cosmetic and functional results were comparable to the conservative procedure. Therefore, this method can be recommended, especially for active adolescents.

Keywords:

adolescent – fracture – clavicle – intramedullary nailing

Zdroje

1. Abzug JM, Waters PM. Clavicle and scapula fractures. v Rockwood and Wilkins’ Fractures in children – eight edition. Philadelphia, Lippincot Wolters Kluwer Health 2015:807−843.

2. Havránek P. Zlomeniny diafýzy klíční kosti. In: Havránek P, et al. Dětské zlomeniny. 2nd edition, Praha, Galén 2013:90−93.

3. Pandya NK, Namdari S, Hosalkar HS. Displaced clavicle fractures in adolescents: facts, controversies, and current trends. J Am Acad Orthop Surg. 2012 Aug;20(8):498−505. doi:10.5435/ JAAOS-20-08-498.

4. Caird MS. Clavicle shaft fractures: are children little adults? J Pediatr Orthop. 2012 Jun;32 Suppl1:51−54. doi:10.1097/ BPO.0b013e3182587ad.

5. Meijden OA, Gaskill TR, Millett PJ. Treatment of clavicle fractures: current concepts review. J Shoulder Elbow Surg. 2012 Mar;21(3):423−429. doi:10.1016/jjse. 2011.08.053.

6. Kubiak R, Slongo T. Operative treatment of clavicle fractures in children: a review of 21 years. J Pediatr Orthop. 2002 Nov– Dec;22(6):736−739.

7. Šimek J, Šmejkal K, Frank M, et al. Surgical treatment of clavicle midshaft fractures – prospective randomized trial. [Article in Czech] Acta Chir Orthop Traumatol Cech. 2020;87(2):101−107.

8. Smith NW, Williams N. Post-traumatic nonunion of clavicle fracture in a 9-year old child. J Pediatr Orthop B. 2016 Jan;25(1):74−77. doi:10.1097/ BPB.0000000000000231.

9. Tan L, Sun DH, Yu T, et al. Death due to intra-aortic migration of Kirschner wire from clavicle: a case report and review of the literature. Case Reports Medicine (Baltimore) 2016 May;95(21):e3741. doi:10.1097/MD.00000000000003741.

10. Yang S, Andras L. Clavicle shaft fractures in adolescents. Orthop Clin North Am. 2017 Jan;48(1):47−58. doi: 10.1016/j. ocl.2016.08.007.

11. Li Ying, Helvie P, Farley FA, et al. Complications after plate fixation of displaced pediatric midshaft clavicle fractures. J Pediatr Orthop. 2018 Aug;38(7):350−353. doi:10.1097/BPO.00000000000832.

12. Altamini SA, McKee MD, Canadian Orthopaedic Trauma Society. Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. Surgical technique. J Bone Joint Surg Am. 2008 Mar;90 Suppl 2 Pt 1:1−8. doi:10.2106/JBJS.G.01336.

13. Luo TD, Ashraf A, Larson AN, et al. Complications in the treatment of adolescent clavicle fractures. Orthopedics 2015 Apr;38(4):e287−e291. doi:10.3928ú01477447-20150402-56.

14. Lin HK, Zhou ZP, Lai CS, et al. Minimally invasive retrograde insertion of elastic intramedullary nails for displaced clavicle fractures in children. [Article in Chinese]. Zhongguo Gu Shang. 2018 Sep 25;31(9):808−811. doi:10.3969/j. issn.1003-0034.2018.09.006.

15. Rapp M, Prinz K, Kaiser MM. Elastic stable intramedullary nailing for displaced pediatric clavicle midshaft fractures: a prospective study of the results and patient satisfaction in 24 children and adolescents aged 10 to 15 years. J Pediatr Orthop. 2013 Sep;33(6):608−613. doi:10.1097/BPO.0b013e31829d1a76.

16. Marz J, Klezl Z. Osteosynthesis of clavicle fractures – an overview of complications and causes of failure. [Article in Czech] Acta Chir Orthop Traumatol Cech. 2018;85(4):245−248.

17. Amer K, Smith B, Thomson JE, et al. Operative versus nonoperative outcomes of middle-third clavicle fractures: a systematic review and meta-analysis. J Ortop Trauma 2020 Jan;31(1):e6−e13. doi:10.1097/BOT.0000000000001602.

18. Gao B, Dwivedi S, Patel SA, et al. Operative versus nonoperative management of displaced midshaft clavicle fractures in pediatric and adolescent patients: a systematic review and meta-analysis. J Orthop Trauma 2019 Nov;33(11):e439−e446. doi:10.1097/BOT. 00000000001580.

19. Song MH, Yun YH, Kang K, et al. Nonoperative versus operative treatment for displaced midshaft clavicle fractures in adolescents: a comparative study. J Pediatr Orthop B. 2019 Jan;28(1):45−50. doi:10.1097/BPB.000000000000535.

20. Mukhtar IA, Yaghmour KM, Ahmed AF, et al. Flexible intramedullary nailing versus nonoperative treatment for pediatric displaced midshaft clavicle fractures. J Child Orthop. 2018 Apr 1;12(2):104−110. doi:10.1302/1863-2548.12.170185.

21. Yang S, Werner BC, Gwathmey jr FW. Treatment trends in adolescent clavicle fractures. J Pediatr Orthop. 2015 Apr-May;35(3):229−233. doi:10.1097/ BPO.0000000000000258.

22. Carry PM, Koonce R, Pan Z, et al. A survey of physician opinion: adolescent midshaft clavicle fracture treatment preferences among POSNA members. J Pediatr Orthop. 2011 Jan–Feb;31(1):44−49. doi:10.1097/BPO.0b013e3181ff67ce.