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ISSN 2992-8036 (Electronic)
ISSN 2306-4102 (Print)
Órgano Oficial del Colegio Mexicano de Ortopedia y Traumatología

2014, Number 2

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Acta Ortop Mex 2014; 28 (2)

Relative clavicle shortening in pediatric fractures: Its importance when selecting conservative treatment

Leal-Oliva A, Mora-Ríos FG, Mejía-Rohenes C, López-Marmolejo A, Acevedo-Cabrera MJ

Language: Spanish
References: 20
Page: 82-87
PDF size: 306.53 Kb.


ABSTRACT

Background: Clavicle fractures represent 2-15% of pediatric fractures. The literature suggests operating on patients over 9 years of age with major shortening or severe comminution in the fracture line. However, no one establishes shortening or angulation parameters for conservative treatment in children. In pediatric patients it is important to take into account relative shortening, that is, the one caused by a fracture when compared with the length of the healthy clavicle. Objective: To know the effect of relative clavicle shortening on movement in pediatric fractures treated conservatively. Material and methods: Retrospective, longitudinal, observational study. We radiographically measured the relative shortening of the fractured clavicle comparing it with the healthy side at the time of the fracture and after fracture healing. Shortening was expressed in percentages. The following views were used: comparative anteroposterior view of the shoulders and panoramic view of both shoulders. Patients were divided into 2 groups: under 9 years and 9-15 years of age. Results: We analyzed 94 fractures; 31 in females and 63 in males. No pseudoarthrosis or symptomatic malunion occurred. The prognosis was good regardless of the initial shortening percentage. Age and shortening are proportionally related with the rehabilitation period and the restoration of painless ranges of motion. The value ranges recorded for shortening were 9.5 to 28%. Conclusions: The surgical indications for shortening resulting from pediatric clavicle fractures should be revised. We have observed good results despite major shortening and total displacement.


REFERENCES

  1. McKee MD, Pedersen EM, Jones C, et al: Deficits following non-operative treatment of displaced, mid-shaft clavicle fractures. J Bone Joint Surg Am. 2006; 88: 35-40.

  2. Vander Have KL, Perdue AM, Caird MS, Farley FA: Operative versus nonoperative treatment of midshaft clavicle fractures in adolescents. J Pediatr Orthop. 2010; 30(4): 307-12.

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

  4. Kubiak R, Slongo T: Operative treatment of clavicle fractures in children: A review of 21 years. J Pediatr Orthop. 2002; 22(6): 736-9.

  5. Prinz KS, Rapp M, Kraus R, Wessel LM, Kaiser MM: Dislocated midclavicular fractures in children and adolescents: Who benefits from operative treatment? Z Orthop Unfall. 2010; 148(1): 60-5

  6. Mehlman CT, Yihua G, Bochang C, Zhigang W: Operative treatment of completely displaced clavicle shaft fractures in children. J Pediatr Orthop. 2009; 29(8): 851-5.

  7. Namdari S, Ganley TJ, Baldwin K, et al: Fixation of displaced midshaft clavicle fractures in skeletally immature patients. J Pediatr Orthop. 2011; 31(5): 507-11.

  8. Mora Ríos FG y cols: Fracturas más frecuentes en niños en el Hospital Regional General Ignacio Zaragoza del ISSSTE. Rev Esp Med Quir ISSSTE. 2012; 17(3): 175-8.

  9. McGraw MA, Mehlman CT: Postnatal growth of the clavicle: birth to 18 years of age. J Pediatr Orthop.. 2009; 29(8): 937-43.

  10. Bishop JY, Flatow EL: Pediatric shoulder trauma. Clin Orthop Relat Res. 2005; 432: 41-8.

  11. Beaty J, Rockwood C: Rockwood and Wilkins: Fractures in Children. The Upper Extremity, Clavicle Fractures. 6a ed. Ed. Lippincot Williams & Wilkins; 2006.

  12. Gardner E: The embryology of the clavicle. Clin Orthop Relat Res. 1968; 58: 9-16.

  13. Jit I, Kulkarni M: Times of appearance and fusion of epiphysis at the medial end of the clavicle. Indian J Med Res. 1976; 64(5): 773-82.

  14. Smekal V, Deml C, Irenberger A, et al: Length determination in midshaft clavicle fractures: Validation of measurement. J Orthop Trauma. 2008; 22(7): 458-62.

  15. Kapandji AI: Fisiología articular, esquemas comentados de mecánica humana. Vol. 1. 6a ed. Editorial Panamericana; 2009: 46-56.

  16. Ludewig PM, Behrens SA, Meyer SM, et al: Three-dimensional clavicular motion during arm elevation: reliability and descriptive data. J Orthop Sports Phys Ther. 2004; 34: 140.

  17. Lenza M, Belloti JC, et al: Conservative interventions for treating middle third clavicle fractures in adolescents and adults. Cochrane Database Syst Rev. 2009 15; 2: CD007121.

  18. Nowak J, Mallmin H, Larsson S: The aetiology and epidemiology of clavicular fractures: a prospective study during a two-year period in Uppsala, Sweden. Injury. 2000; 31: 353-8.

  19. Canadian Orthopaedic Trauma Society: Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures: a multi-center, randomized clinical trial. J Bone Joint Surg Am. 2007; 89: 1-10.

  20. Robinson CM, Court-Brown CM, McQueen MM, et al: Estimating the risk of nonunion following nonoperative treatment of a clavicular fracture. J Bone Joint Surg Am. 2004; 86(7): 1359-65.




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